This overview of 10 systematic reviews (8 meta-analyses) asks whether preoperative exercise programs improve functional recovery after total knee or hip replacement in older adults. It synthesizes the highest level of available evidence on prehabilitation — and the answer is more limited than many assume.
Residents are often taught that prehabilitation is beneficial before joint replacement — this overview challenges that assumption with a more precise answer. Prehabilitation does one thing reliably: it reduces length of hospital stay by 1-2 days. It does not reliably improve postoperative function, strength, pain, or quality of life.
The critical appraisal insight here is about exercise dosing. OA patients awaiting TJR typically cannot perform resistance exercise at the 70-80% 1-RM threshold needed to drive muscle hypertrophy. Programs that use subtherapeutic loads produce no meaningful preoperative strength gain — and without preoperative gain, there is no postoperative benefit to transfer.
For your practice: when a patient asks about prehabilitation, the honest answer is that it will likely reduce time in the hospital but probably will not change how well they function at 3 or 6 months. If you do prescribe it, consider BFR or NMES-based protocols for patients who cannot tolerate standard resistance loads — the evidence for these modalities as prehabilitation tools is preliminary but mechanistically sound.
This overview of 10 systematic reviews (8 meta-analyses) asks whether preoperative exercise programs improve functional recovery after total knee or hip replacement in older adults. It synthesizes the highest level of available evidence on prehabilitation — and the answer is more limited than many assume.
Residents are often taught that prehabilitation is beneficial before joint replacement — this overview challenges that assumption with a more precise answer. Prehabilitation does one thing reliably: it reduces length of hospital stay by 1-2 days. It does not reliably improve postoperative function, strength, pain, or quality of life.
The critical appraisal insight here is about exercise dosing. OA patients awaiting TJR typically cannot perform resistance exercise at the 70-80% 1-RM threshold needed to drive muscle hypertrophy. Programs that use subtherapeutic loads produce no meaningful preoperative strength gain — and without preoperative gain, there is no postoperative benefit to transfer.
For your practice: when a patient asks about prehabilitation, the honest answer is that it will likely reduce time in the hospital but probably will not change how well they function at 3 or 6 months. If you do prescribe it, consider BFR or NMES-based protocols for patients who cannot tolerate standard resistance loads — the evidence for these modalities as prehabilitation tools is preliminary but mechanistically sound.