We conducted a systematic review and meta-analysis on randomised controlled trials investigating exercise interventions before total hip and knee arthroplasty. We also described the intervention components in a standardised format using the Template for Intervention Description and Replication (TIDieR) and Behaviour Change Technique Taxonomy (BCTTv1).  

The direction of effects for quality of life, pain and function favoured exercise interventions pre-surgery and up to 12-weeks post-surgery. Patients who exercised before surgery experienced an average of 9% improvement in quality of life, 7% less pain, and 12% better function before and after surgery. These improvements could enhance patients’ ability to maintain independence and perform activities of daily living, supporting faster recoveries and more favourable post-operative outcomes, benefiting both patients and healthcare providers. This suggests that engaging in pre-operative exercise provides benefits before and after hip and knee arthroplasty.  

Although we described the intervention components and behaviour change techniques of the included interventions, standardised reporting is needed to enable robust evaluation of effectiveness.

What next?

Patients awaiting joint arthroplasty should engage in exercise to enhance their quality of life, reduce pain and improve function. Intervention developers should incorporate strength-based exercises and provide clear instruction on how to perform the exercises for independent practice.  

Future research should also examine the impact on surgical outcomes and the long-term effects on quality of life, pain and function. 

Citation details

Hares NA, Sanders JP, Esliger DW, Thomas JJC, Bourron B, MacKinnon HJ, Madigan CD. Are pre-operative exercise interventions for joint arthroplasty effective at improving peri-operative outcomes: A systematic review and meta-analysis of randomized controlled trials. Journal of Sport and Health Sciences (2025). DOI: 10.1016/j.jshs.2025.101083