( dings show that an appropriately design...)Does Exercise Before Hip Replacement Help?,Health

dings show that an appropriately designed program of water and land-based exercise involving cardiovascular, strength training, and flexibility activities can be a safe, well tolerated, and effective approach to improving function and muscle strength in middle-aged and older adults with severe osteoarthritis of the hip and knee," the authors state. They point out that patients participated in strength training for only 3 weeks (9 sessions), which is well below the recommended duration required to bring about significant strength gains. They suggest that the increase in strength was due to a combination of increased neuromuscular coordination and a reduction of fear about anticipated pain associated with increased muscular effort. They note that knee replacement patients would probably need to participate in strength training for a longer period of time in order to experience increased function prior to surgery.

The fact that the patients responded differently depending upon what joint was being replaced suggests the need for different approaches for people with osteoarthritis of the hip and knee. Also, because several participants who dropped out of the study did so because of the travel required to get to the group exercise location, the authors suggest that future studies should consider the location and convenience of the exercise sessions. They conclude: "Additional attention should be placed on testing postoperative interventions for building on preoperative gains in function and fitness, adapting the intervention more successfully for the TKA [knee replacement] population, and examining the cost effectiveness of exercise for patients undergoing total joint replacement."

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