Latest / The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement / Episode 122: Which Prehab Exercises Help Most? (What New Research Says Before Knee Replacement)

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Episode 122: Which Prehab Exercises Help Most? (What New Research Says Before Knee Replacement) · The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement

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  people in resistance training programs had better
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  thigh muscle strength and completed a test called
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  the timed up and go faster than people receiving
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  usual preoperative care without those structured
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  training programs. Are you ready to get back
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  to what you love after knee replacement? The
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  Total Knee Success podcast is your trusted guide
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  with practical tips, evidence -based strategies,
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  and no fluff. It's not personal medical advice,
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  just solid education to help you manage pain,
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  regain mobility, and get back to living the life
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  you love. Let's dive in. Welcome back to the
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  Total Knee Success Podcast. I'm Michelle. If
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  your knee replacement is on the calendar, you
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  may be wondering what to work on before surgery.
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  Which kind of training is most useful when your
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  knee already hurts? For example, some people
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  start with simple exercises such as seated knee
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  extensions. where you straighten your leg while
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  sitting in a chair to build thigh strength without
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  putting extra weight on your knee. A new research
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  review compared several approaches and found
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  benefits for different parts of physical preparation.
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  By the end of this episode, you'll have a better
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  idea of how different kinds of prehab can help
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  and how to choose a starting point that fits
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  what you want to improve before surgery. This
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  is the second episode in our What's New in Knee
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  Replacement Research series. Episode 121 was
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  all about heavier strength training after surgery
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  and why more weight on the machine does not automatically
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  mean better walking. Today we're moving on to
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  the weeks before surgery. The question is now,
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  can the work you do prior to surgery have an
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  effect on what you're able to do afterwards and
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  does the type of training make a difference?
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  Prehabilitation, usually shortened to prehab,
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  means preparing before an operation. For a knee
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  replacement, that can include physical training,
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  learning to use a walking aid, and getting ready
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  for daily life at home afterward. Today, we're
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  focusing on the physical training, building strength,
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  and keeping moving in ways you can manage with
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  your knee as it is now. Prehab exercises can
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  be adapted to fit your pain level and mobility
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  limitations, making it a safe approach when tailored
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  to your needs. And remember, this podcast provides
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  general education. Your own plan should follow
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  your surgeon's and physical therapist's guidance.
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  In August 2026, Yuxiang Wu and colleagues published
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  a systematic review and network meta -analysis
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  involving 22 randomized trials and 1 ,458 people
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  preparing for knee replacement. A systematic
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  review brings together studies on a question.
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  In this one, the researchers compared several
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  kinds of prehab. they used a network meta -analysis
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  to compare results both from trials that tested
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  programs against each other and from separate
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  trials with a shared comparison group. That let
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  them examine more options than any one trial
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  had tested. The review included measurements
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  before and after surgery, so its results cover
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  different stages rather than one fixed point
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  afterward. For someone preparing for surgery,
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  the useful question is which kind of training
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  helped with strength, movement, or pain. So let's
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  start with resistance training, movements in
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  which your muscles work against a load, such
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  as a leg press or straightening your knee against
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  resistance. In Wu's review, people in resistance
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  training programs had better thigh muscle strength
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  and completed a test called the timed up and
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  go faster than people receiving usual preoperative
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  care without those structured training programs.
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  In the timed up and go test, a person stands
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  from a chair, walks a set distance, turns, returns,
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  and sits down while someone records the time.
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  Completing the sequence requires strength, balance,
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  and the ability to change direction while walking.
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  The improvement gives us a practical reason to
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  include strengthening when weakness is a limiting
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  factor. The starting resistance should fit what
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  you can do now. Someone whose knee is easily
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  aggravated may need a lighter load or a smaller
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  movement at first. While someone who already
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  manages an exercise comfortably may need more
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  resistance to challenge their muscles. A simple
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  self -check is to notice if you can do the exercise
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  with only mild discomfort and without sharp or
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  worsening pain. You should be able to carry on
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  a conversation, talk while exercising. If you're
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  breathless or find that the pain is lasting beyond
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  the exercise, the activity may be too hard. Your
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  physical therapist can help select movements
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  and the amount of work, taking your symptoms
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  and other health conditions into account. There
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  isn't one exercise that's perfect for everyone.
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  As you get stronger, you can gradually increase
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  the challenge within that plan. For pain, people
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  in programs involving neuromuscular training,
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  aerobic work, education, or a combination of
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  approaches did better on average than groups
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  receiving usual preoperative care. Neuromuscular
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  training means practicing how you control movement
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  and balance, such as keeping steady while shifting
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  your weight or stepping in a different direction.
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  Aerobic training includes sustained movement,
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  such as walking or cycling. These findings give
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  you several options to consider. If cycling is
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  more comfortable than walking, for example, it
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  may be a workable way to stay active while preparing
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  for surgery. Programs combining different kinds
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  of training produce the greatest improvement
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  in measured knee bending in this particular review.
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  A combined program might include strength work
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  alongside mobility and balance practice. That
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  can be useful when you have more than one limitation
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  to address before surgery. The mix should fit
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  what you can manage and what you need to improve.
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  Wu and colleagues found benefits for several
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  specific outcomes. giving people and their therapists
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  useful options when planning prehab. For broader
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  ratings of how people managed with their knee
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  and their quality of life, the results did not
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  establish that one approach worked better. So
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  the choice can reflect your current limitations,
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  your preferences, and what you can keep doing
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  consistently. Enjoying a form of movement can
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  help make it practical to include while the program
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  still needs to address the strength, mobility,
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  or balance that you want to improve. Earlier
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  research also found benefits from preparing before
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  surgery. A 2022 review by Grannacher and colleagues,
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  which I've spoken about at length before, found
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  better knee functioning before surgery and through
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  the first three months afterward, although the
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  certainty was low. A small 2024 pilot study from
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  the same group tested a personalized four - to
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  eight -week program combining exercise and education.
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  People in the prehab group completed most planned
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  training and their ratings of sports and physical
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  participation improved more over time than those
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  of people receiving usual care without prehab.
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  Its 20 -person sample provides a useful example
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  for larger studies to build on. How much of the
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  benefit continues after surgery is a bit less
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  certain. A separate 2026 review by Vandervoors
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  and colleagues found better thigh strength four
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  to eight weeks after surgery following prehab
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  strengthening, with a lower confidence in that
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  finding. At three months, the researchers could
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  not establish an advantage over usual care for
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  strength, pain, physical function, or quality
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  of life. Use the weeks before surgery for manageable
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  training directed at something you would like
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  to do more comfortably. If standing to prepare
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  a meal wears you out, consider what makes you
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  stop. Muscle fatigue, knee pain, or difficulty
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  staying steady. Those problems can call for different
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  adjustments. A prehab assessment can help identify
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  which part to work on and gives you a starting
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  level you can manage. Remember even small steps
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  forward count. Progress may be gradual and some
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  days will feel easier than others. But every
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  bit of improvement can make a difference. Give
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  yourself credit for the effort that you're putting
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  in. With limited stamina, you could begin with
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  short periods of walking or cycling and increase
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  the time as your tolerance improves. Strengthening
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  can be a part of the same plan when your leg
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  muscles tire quickly. If bending is restricted,
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  you may work on comfortable knee motion alongside
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  the strength work. You're doing the movements
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  and the amount you can manage will help guide
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  how the program progresses. A prehab assessment
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  also establishes a starting point. Your therapist
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  may measure knee motion or use a walking test,
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  then repeat the same measure later to check for
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  change. In everyday life, you may notice that
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  you can stand at the kitchen counter longer before
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  needing to sit. That gives the training a purpose
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  you can recognize, even when your knee is still
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  having some sore days. The time available before
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  surgery also affects your plan. Several weeks
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  allow time to practice and gradually increase
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  the challenge. The personalized pilot program
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  we just discussed lasted four to eight weeks.
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  Research has not established one minimum duration
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  that suits everyone. When surgery is closer,
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  use the remaining time for manageable preparation
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  and learning the movements you'll need afterward.
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  Keep the workload at a level that lets you continue
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  your usual daily tasks. If you're preparing now,
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  take action today. by downloading the free two
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  -week knee replacement launch plan from TotalKneeSuccess
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  .com. This resource organizes the final 14 days,
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  including home setup, equipment, and surgery
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  day details, giving you a step -by -step checklist
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  to get started immediately. If you want more
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  detailed preparation tools or need extra support
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  tailoring your plan, reach out to a physical
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  therapist or take a look at my upcoming book,
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  The Knee Replacement Game Plan. It's all about
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  preparing for surgery. which brings together
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  education and planning tools for the weeks before
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  knee replacement. You can find more information
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  on the game plan page at TotalKneeSuccess .com.
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  Prehab gives you time to build strength and practice
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  movements before your surgery. The work can help
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  with difficulties you have now and make the movements
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  you'll practice afterward more familiar. In episode
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  123, we'll look at fear of movement after knee
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  replacement. and research on whether rehabilitation
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  can help. If you're finding this podcast helpful,
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  please subscribe and leave a review. I'd really
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  appreciate it. Your review helps the podcast
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  reach more people who'd like this information
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  too. Thanks for joining me. I'm Michelle, and
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  this has been the Total Me Success podcast. This
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  podcast is for educational purposes only. Discover
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  more at TotalMeSuccess .com, and be sure to subscribe
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  and share. because every step forward takes you
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  closer to living the life you love.