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Reducing Sedentary Time After Knee Replacement Using a Multicomponent mHealth Intervention: Randomized Controlled
Christine A Pellegrini1, Clare L Kennerley1, Sara Wilcox1,2
1Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.
JMIR Mhealth and Uhealth
|May 26, 2026
Summary
Reducing sedentary time after total knee replacement (TKR) is challenging. A mobile health intervention showed no significant overall reduction in sitting time but increased sit-to-stand transitions and moderate-to-vigorous physical activity with app use.
Area of Science:
- Orthopedics
- Rehabilitation Medicine
- Digital Health
Background:
- Total knee replacement (TKR) is common for end-stage knee osteoarthritis.
- Patients often don't increase physical activity post-TKR, despite pain reduction and mobility improvements.
- Reducing sedentary behavior may be a feasible first step, but interventions are unstudied in TKR patients.
Purpose of the Study:
- To assess the feasibility and effects of a 2-month mobile health intervention (NEAT!2) targeting sedentary time reduction in adults post-TKR.
- To evaluate the intervention's impact on sedentary time, physical activity, function, and pain.
Main Methods:
- 83 adults within 1 year of TKR were randomized to the NEAT!2 intervention or a control group.
- NEAT!2 used a smartphone app to interrupt prolonged sitting and included 5 coaching calls.
- Outcomes were measured at 2 and 5 months using linear mixed-effects models.
Main Results:
- High retention rates (95-96%) were observed in both groups.
- The NEAT!2 group showed a significant increase in sit-to-stand transitions compared to controls at 5 months (P=.04).
- No significant effects on overall sedentary time were found, but increased app use correlated with higher moderate-to-vigorous physical activity.
Conclusions:
- Reducing sitting time in adults post-TKR presents significant challenges.
- Future research should explore broader behavior change strategies, including environmental and social factors.
- Interventions implemented within the first year after TKR require further investigation.