title: High-intensity preoperative training improves physical and functional recovery in the early post-operative periods after total knee arthroplasty: a randomized controlled trial.
abstract: OBJECTIVE
  The benefits of preoperative training programmes compared with alternative treatment are unclear. The purpose of this study was to evaluate the effectiveness of a high-intensity preoperative resistance training programme in patients waiting for total knee arthroplasty (TKA).
  
  
  METHODS
  Forty-four subjects (7 men, 37 women) scheduled for unilateral TKA for osteoarthritis (OA) during 2014 participated in this randomized controlled trial. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Physical Functioning Scale of the Short Form-36 questionnaire (SF-36), a 10-cm visual analogue scale (VAS), isometric knee flexion, isometric knee extension, isometric hip abduction, active knee range of motion and functional tasks (Timed Up and Go test and Stair ascent-descent test) were assessed at 8 weeks before surgery (T1), after 8 weeks of training (T2), 1 month after TKA (T3) and finally 3 months after TKA (T4). The intervention group completed an 8-week training programme 3 days per week prior to surgery.
  
  
  RESULTS
  Isometric knee flexion, isometric hip abduction, VAS, WOMAC, ROM extension and flexion and all the functional assessments were greater for the intervention group at T2, T3 and T4, whereas isometric knee extension was greater for this group at T2 and T4 compared with control.
  
  
  CONCLUSIONS
  The present study supports the use of preoperative training in end-stage OA patients to improve early postoperative outcomes. High-intensity strength training during the preoperative period reduces pain and improves lower limb muscle strength, ROM and functional task performance before surgery, resulting in a reduced length of stay at the hospital and a faster physical and functional recovery after TKA. The present training programme can be used by specialists to speed up recovery after TKA.
  
  
  METHODS
  I.
authors.affiliation: Prevention Health Exercise and Sport Research Group, Department of Physical Education and Sports, University of Valencia, Valencia, Spain. ximo86@hotmail.com.|National Research Centre for the Working Environment, Lersø Parkalle 105, 2100, Copenhagen, Denmark. ximo86@hotmail.com.
authors.forename: Joaquin
authors.initials: J
authors.lastname: Calatayud
authors.affiliation: Prevention Health Exercise and Sport Research Group, Department of Physical Education and Sports, University of Valencia, Valencia, Spain.|Department of Physical Therapy, University of Valencia, Valencia, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Casaña
authors.affiliation: Prevention Health Exercise and Sport Research Group, Department of Physical Education and Sports, University of Valencia, Valencia, Spain.|Department of Physical Therapy, University of Valencia, Valencia, Spain.
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Ezzatvar
authors.affiliation: Muscle Physiology and Biomechanics Research Unit, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.|National Research Centre for the Working Environment, Lersø Parkalle 105, 2100, Copenhagen, Denmark.
authors.forename: Markus D
authors.initials: MD
authors.lastname: Jakobsen
authors.affiliation: Muscle Physiology and Biomechanics Research Unit, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.|National Research Centre for the Working Environment, Lersø Parkalle 105, 2100, Copenhagen, Denmark.
authors.forename: Emil
authors.initials: E
authors.lastname: Sundstrup
authors.affiliation: National Research Centre for the Working Environment, Lersø Parkalle 105, 2100, Copenhagen, Denmark.|Physical Activity and Human Performance Group, SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
authors.forename: Lars L
authors.initials: LL
authors.lastname: Andersen
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D057234:Preoperative Period; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D055070:Resistance Training; D011795:Surveys and Questionnaires
keywords: Ageing; Knee; Osteoarthritis; Prehabilitation; Resistance training; Strength training