Latest / The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement / Episode 81: Prehab for Low Stamina (Steps, Pacing, and Building Capacity Before Surgery)

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Episode 81: Prehab for Low Stamina (Steps, Pacing, and Building Capacity Before Surgery) · The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement

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  A lot of people preparing for knee replacement
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  drift into a boom and bust pattern. They do very
• 0:05
  little for a few days because pain is high. And
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  then they get a better day and try to catch up
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  all at once. That's when the cleaning errands,
• 0:12
  meal prep, and exercises all land on the same
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  afternoon. And the next day, it tends to go badly.
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  Are you ready to get back to what you love after
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  knee replacement? The Total Knee Success Podcast
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  is your trusted guide with practical tips, evidence
• 0:30
  -based strategies, and no fluff. It's not personal
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  medical advice, just solid education to help
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  you manage pain, regain mobility, and get back
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  to living the life you love. Let's dive in. Welcome
• 0:44
  back to the Total Knee Success Podcast. I'm Michelle.
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  This is the third episode in our four -part prehab
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  series, what to do before you have knee replacement
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  surgery. If you want to go through the full series
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  in order, start with episode 79 first. In episode
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  79, we talked about knee stiffness, range, swelling
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  patterns, and the daily habits that can make
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  your knee easier to work with after surgery.
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  In episode 80, we moved into weaker quads, strength,
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  activation. and why the front of your thigh can
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  feel so unreliable early on. Today we're moving
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  into another problem that comes up all the time
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  before surgery, and that's low stamina. By the
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  end of this episode, you'll better understand
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  stamina before surgery, how steps can help when
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  they're dosed well, and how pacing can build
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  capacity without turning every day into a flare.
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  And just as a reminder, this podcast is for education
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  only. It's not medical advice. Before you start,
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  stop, or change any exercise program, talk with
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  your surgeon, physician, or physical therapist
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  so the plan fits your health history, medications,
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  and current symptoms, especially if you have
• 1:54
  heart, lungs, circulation, or other medical concerns.
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  Prehab is not just about doing random exercises
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  before surgery. It's targeted work before surgery
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  to prepare for what the early phase will require.
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  And when stamina is low, that target is not only
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  strength. It's your ability to tolerate repeated
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  movement across your day. Low stamina usually
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  shows up in just ordinary moments. A short errand
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  wipes you out. Standing in the kitchen is harder
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  than it should be. And you can do one thing,
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  but not several things in the same day. That
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  doesn't always mean you're badly deconditioned.
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  Sometimes it means dealing with pain and swelling
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  is taking so much out of you. that ordinary movement
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  costs more than it used to. Pain, swelling, and
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  years of avoiding knee aggravation gradually
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  reduce how much movement your body can tolerate.
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  And this is important before surgery because
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  the first phase after surgery is repetitive.
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  You're getting up often, walking short distances
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  often, doing exercises often, and managing more
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  upright time than your body may be used to right
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  now. So for this episode, I want to keep the
• 3:01
  goal simple. The goal is not to become fit before
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  surgery. that won't happen overnight. The goal
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  is to build a small, repeatable base. Let's keep
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  using Megan, the same made -up example person
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  from episodes 79 and 80. She's not a real person,
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  but she reflects what many people describe before
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  knee replacement surgery. Megan has a surgery
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  date on the calendar. Her knee is stiff in the
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  morning, more swollen by evening, and her quad,
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  the muscle on the front of the thigh, has been
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  underused for a long time because she's been
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  favoring that side. In episode 80, she started
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  working on strength and activation. Now we notice
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  something else. Even on days when the exercises
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  seem to be going fine, she still gets worn down
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  by just ordinary life activities. She can do
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  a few rounds of sit to stands in the morning,
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  but later in the day, a short walk to the mailbox
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  kind of feels like a lot. She's not saying I
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  feel weak, she's saying I get tired fast. This
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  is also where it helps to pause and separate
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  normal knee -related stamina problems from symptoms
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  that need medical follow -up. If somebody has
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  chest pain, unusual shortness of breath, lightheadedness,
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  fainting, palpitations, or other symptoms that
• 4:13
  don't fit the usual knee osteoarthritis picture,
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  that's not something to sort out with general
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  exercise education. That person should talk to
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  their provider first. But when people notice
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  that they tend to get more painful, more swollen,
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  and less able to do things as the day goes on,
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  that's often the kind of pattern people describe
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  when activity tolerance is low. In that situation,
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  the conversation is usually less about pushing
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  through more and more about whether the amount
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  and timing of activity need to be adjusted. This
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  is where a more structured plan can help. When
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  stamina is low before knee replacement, some
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  people do well with these five steps. They're
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  not a formal program and they're not right for
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  everyone, but they fit what shows up again and
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  again in the research on useful prehab. It tends
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  to be specific, measured, gradual, and combined
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  with other exercise rather than treated like
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  a walking challenge by itself. And the first
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  step is to get a baseline. For some people, a
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  step counter can help because it gives them something
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  concrete to measure. And many people already
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  have one. It may be on a smartwatch or in their
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  wrist or it may be on the smartwatch on their
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  wrist or the phone in their pocket. If they do
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  not, a timed walk can do the same job. The point
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  is to stop guessing and get a real starting point.
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  The research helps here, too. A 2025 study in
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  people with knee osteoarthritis found that adding
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  daily step goals to a telehealth exercise and
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  education program did not by itself increase
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  physical activity. That's useful because it tells
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  us the number alone is not the answer. A 2022
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  study after knee replacement helps fill in the
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  rest of the picture. In that study, people were
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  not just given a number. They used a wearable
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  tracker, followed an exercise program, and had
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  regular coaching. And the authors noted that
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  step goals should be individualized to the person.
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  That's where a step counter tends to be the most
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  useful, not as a standalone fix, but as one part
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  of a more tailored plan. For Megan, that first
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  step is not to push harder. It's to observe.
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  She tracks a few normal days. She sees that a
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  usual day at home lands around 2 ,800 steps.
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  while an errand day pushes much higher and often
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  leaves her worse the next day. That gives her
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  a clearer place to begin. The second step is
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  to choose a starting amount that's repeatable.
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  The better starting point is an amount she can
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  tolerate consistently, not one unusually good
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  day. That's where stamina starts to build. For
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  Megan, that may be a step range close to her
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  baseline rather than a big jump above it. It
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  may be several short walks instead of one longer
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  one. It may be a few minutes after breakfast,
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  a few minutes after lunch, and another short
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  bout later in the day. The key question is whether
• 7:01
  she can tolerate it consistently. She's going
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  to be monitoring her symptoms during that time.
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  The third step is to build slowly. Some people
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  do well with very small weekly increases once
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  they've found a starting point they can tolerate.
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  For listeners who like numbers, an increase of
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  up to about 10 % over a week can be a reasonable
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  ceiling. Not a rule. Knee replacement research
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  does not give us one exact progression formula
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  for this. So symptoms still have to be the director
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  for your program, which means watch your symptoms
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  and pay attention and listen to them. If they're
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  increasing, you need to back off a little bit.
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  Take Megan's baseline of 2 ,800 steps. A 5 %
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  increase is 140 more steps. So her next week
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  might be about 2 ,940 steps per day. Thereabouts,
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  it doesn't have to be perfect. A 10 % increase
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  is 280 more steps, so that would put her at a
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  little over 3 ,000 steps per day. For some people,
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  that's still fine. For others, that would be
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  too much. That's why a 10 % increase works better
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  as a ceiling than as a goal. If your knee is
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  clearly more swollen, more painful, and harder
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  to use later that day or the next morning, then
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  that increase may have been too much. In that
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  situation, many people do better by holding steady.
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  backing down or spreading the same amount of
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  activity out differently over the day, a little
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  less in the afternoon, a little more in the morning,
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  figuring out what works for them. For Megan,
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  that could mean staying at her new baseline for
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  a full week before adding a small amount. It
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  could mean adding two or three minutes across
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  the day rather than tacking on one long walk.
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  The point is to make progression gradual and
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  deliberate. The fourth step is pacing. Pacing
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  is how people keep activity from piling up in
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  a way their body does not tolerate well. A lot
• 8:56
  of people preparing for knee replacement drift
• 8:58
  into a boom and bust pattern. They do very little
• 9:01
  for a few days because pain is high. And then
• 9:03
  they get a better day and try to catch up all
• 9:05
  at once. That's when the cleaning errands, meal
• 9:08
  prep, and exercises all land on the same afternoon.
• 9:12
  And the next day, it tends to go badly. For Megan,
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  pacing changes the shape of the day. She does
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  not stop moving. She spreads movement out. She
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  chooses one errand instead of three. She sits
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  for part of meal prep. She stops stacking her
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  strengthening work on top of an already demanding
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  outing. She pays attention not only to how she
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  feels during activity, but also later that evening
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  and the next morning. This is often where the
• 9:38
  clearest information is found. The fifth step
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  is to make sure walking is supported by the rest
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  of your prehab. This is not the same as gradually
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  adding more steps. Step progression helps you
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  build capacity. Strength and standing tolerance
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  help remove some of the barriers that make walking
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  feel so costly in the first place. If your quad
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  is weak or if standing is already hard to tolerate,
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  step counts alone may not move things very far.
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  Prehab studies often use more than one type of
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  exercise, so building stamina is usually not
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  treated as a walking -only project. One 2023
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  study found better endurance after surgery when
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  patients did a short preoperative program that
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  included both strengthening and endurance work.
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  So this fifth step is really about support. Walking
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  is one part of stamina, but it usually works
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  better when it's backed up by strength. That's
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  why Megan keeps her quad work in the plan. She
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  keeps working on sit to stands and the strengthening
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  she started in episode 80. She also practices
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  shorter periods of standing in the kitchen and
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  uses brief walks to build capacity across the
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  day. Walking helps, but it works better when
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  her body is better prepared to support her. If
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  I pull all of that together, the logic is fairly
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  straightforward. Measure first, start where your
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  body actually is, progress slowly, pace throughout
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  the day, and keep stamina work tied to strength
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  and standing tolerance. That's a much cleaner
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  approach than waiting for one good day and trying
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  to prove something during that day. Before we
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  wrap up, if you want some information about the
• 11:17
  two weeks before surgery, download the free two
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  -week launch plan. Click the link in the show
• 11:22
  notes. And if you want a simple step counter
• 11:24
  and don't already have one on your watch or phone,
• 11:28
  I linked some useful ones on Amazon. Those are
• 11:30
  also in the show notes. And finally, if you want
• 11:33
  some more education on what to do before surgery,
• 11:37
  I'll be publishing a prehab handbook soon. called
• 11:40
  the knee replacement game plan. It's educational
• 11:43
  in nature. Stay tuned, and if you want to be
• 11:46
  notified when it's ready, you can sign up on
• 11:48
  TotalKneeSuccess .com. I'll also drop a link
• 11:51
  in the show notes. In episode 82, we'll finish
• 11:55
  this prehab series with prehab for warriors and
• 11:58
  warriors. What to practice so the first two weeks
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  go better. Thanks for joining me. I'm Michelle,
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  and this has been the Total Knee Success podcast.
• 12:10
  This podcast is for educational purposes only.
• 12:15
  Discover more at TotalMeSuccess .com and be sure
• 12:18
  to subscribe and share because every step forward
• 12:21
  takes you closer to living the life you love.