Effects of pre- and post-surgery physical activity interventions on physical activity and sedentary behaviour levels following knee and hip arthroplasty: A systematic review and meta-analysis of randomised controlled trials

Abstract

Objective: To evaluate general exercise and behavioural interventions designed to improve physical activity (PA) or reduce sedentary behaviour in total knee or hip arthroplasty (TKA/THA) patients.

Design: A systematic review and meta-analysis were conducted on randomised controlled trials reporting PA or sedentary behaviour changes in TKA/THA patients, with effects calculated using standardised mean differences (SMD). Subgroup analyses assessed whether effects differed based on intervention characteristics, arthroplasty timing, outcome type, and follow-up duration. Risk of bias and certainty of evidence were assessed using the PEDro scale and GRADE, respectively.

Results: Twenty-three trials were included, with meta-analyses including 1265 and 270 participants for PA and sedentary behaviour outcomes, respectively. PA interventions did not decrease sedentary behaviour (SMD=-0.19; 95% CI: -0.66 to 0.29; very low certainty of evidence), but did improve PA (SMD=0.16; 95% CI: 0.01 to 0.30; high certainty of evidence). This included improvements in step count (SMD=0.22; 95% CI: 0.05 to 0.40), but not moderate-to-vigorous PA (SMD=-0.01, 95% CI: -0.33 to 0.30). Interventions were most effective when they integrated wearable activity trackers (e.g., Fitbits; SMD=0.38; 95% CI: 0.18 to 0.57), behaviour change techniques (SMD=0.20, 95% CI: 0.01 to 0.39), and began less than two weeks after surgery (SMD=0.32, 95% CI: 0.14 to 0.50).

Conclusion: PA interventions, particularly those integrating behavioural strategies and wearable technology, promote PA in arthroplasty patients, but their effects on sedentary behaviour are unclear. These findings suggest that implementing evidence-based PA interventions be considered an essential component of acute arthroplasty care to enhance overall patient health.

Keywords: Activity trackers; Arthroplasty; Behaviour change; Physical activity; Sedentary behavior; Step count.