[Centreville] 81-year-old Lily M. holds a position on the board of a large hospital. She routinely works ten-hour days, five days a week, giving lectures, running board meetings and doing other duties. This busy schedule keeps Lilly on her feet for long periods each day.
In view of Lilly’s age alone, her activity level is impressive, but when you consider the fact that she had total knee replacement (TKR) surgery six months ago, her behavior is extraordinary. Despite the short time since her surgery, Lilly experiences no knee pain or issues with her gait. How is this possible? Lilly attributes her quick recovery to the strength she built up during three months of “prehabilitation,” when she did strength training twice a week with a fitness trainer before surgery.
Lilly’s case is not a fluke. A 2009 study conducted at the University of Louisville revealed that strength training before a TKR led to improvements in strength, ability to stand up from a chair, and walk up and down stairs. In addition, quadriceps strength before surgery is associated with greater dynamic balance a year afterwards.
TKRs are now more popular than ever. More than 381,000 of the procedures take place annually, and researchers expect this number to grow six-fold in the next 20 years. The surgery can help people with severe osteoarthritis in the knees to lessen or eliminate their pain while at the same time improving their functioning.
However, a TKR also leads to a period of inactivity during recovery, and this lack of movement has drawbacks. Within the first month after surgery, people lose about 60% of the strength in their quadriceps. Thus, it’s no surprise that TKR patients walk and climb stairs more slowly than their peers.
University of Louisville researchers conducted a study comparing people who “prehabbed” with those who did not (control group) for five months before surgery. Like Lilly, the participants who strength trained fared extremely well. Before surgery, a good strength training program prevented increases in knee pain and improved functional abilities (getting up from a chair, walking, and stair-climbing).
One month after surgery, the control group experienced losses in quadriceps strength and declines in walking speed, whereas the exercise group did not when compared to baseline tests. Three months later, functional ability and strength in the operated leg were also greater in the group that exercised.
The exercise group trained three times a week before surgery, doing routines such as leg curls and leg extensions. After surgery, both groups received the same physical therapy.
Overall, the study found that quadriceps strength was associated with greater functional ability and less knee pain. Likewise, scientists from the University of Delaware found the same connections when monitoring quadriceps strength in people several days before and one year after a TKR. The researchers also noted that quadriceps strength prior to surgery predicts dynamic balance a year afterwards. Dynamic balance is tested by observing how quickly a person can stand up from a chair, walk and do a sharp turn, then return to the chair.
In light of these results, if a TKR is in your future, you might wonder how long you should train before the procedure. As mentioned, the study with Lily included five months of prehabilitation, although she trained for only three. Obviously, the earlier you start, the more strength you will build up prior to surgery.
As a whole, the above-cited findings and Lilly’s experience make sense: joints are healthier when the surrounding muscles are strong. Strength training before a TKR allows you to build healthier joints and muscles that simply need to be maintained after surgery, instead of having to be built up for the first time. Fitness training in general is great but strength training specifically has proven to give the best results faster.
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