Physical activity and lifestyle management after joint replacement surgery (PALMS): A feasibility study

To assess the feasibility of a program to increase physical activity as part of lifestyle management after joint replacement surgery (PALMS).

This pragmatic pre-post feasibility study included participants referred to community rehabilitation post total hip or knee replacement surgery. Participants attended in-person for 1 h, twice-weekly for six weeks. PALMS consisted of a health screen, including point-of-care testing for metabolic syndrome, a group exercise program based on a cardiac rehabilitation model, and education. Feasibility outcomes were acceptability, demand, implementation and practicality. Secondary exploratory outcomes included physical activity and physical functioning.

Forty-six participants (23 men, 23 women), mean age 62 (SD 8) years and a mean of 7 (SD 4) weeks post knee (n = 27) or hip (n = 19) joint replacement surgery were enrolled. PALMS was well accepted by participants and clinicians, was implemented with high rates of adherence (mean 10.4/12 (SD 3.0) sessions attended), and 76% (28 of 37) had metabolic syndrome indicating high demand. However, recruitment did not meet threshold targets of 7 recruits each month (achieved 5.1) and 50% of eligible clients agreeing to participate (achieved 38%). There were no serious adverse events. Post-program, physical activity (mean change 1,678 METS min/wk, 95%CI 997 to 2,359) and physical functioning (6-min walk test mean change 167 m, 95%CI 120 to 215) increased.

The PALMS group program was feasible and associated with short-term improvements in physical activity and physical functioning. With attention paid to recruitment strategies the next step is to evaluate program effectiveness with an adequately powered trial.