Maintenance of Preoperative Fitness by Home-Based Prehabilitation Following Supervised Prehabilitation in Patients Awaiting Total Hip or Knee Arthroplasty

Background: Prehabilitation is the process of optimising patient functional capacity and health status in preparation for surgery. Supervised prehabilitation is considered gold standard, however it is resource intensive. The purpose of this study was to examine the effect of a personalised home-based exercise intervention, for maintaining cardiorespiratory fitness and physical and mental health, after completion of a supervised prehabilitation intervention. Methods: Eighteen participants awaiting total hip or knee arthroplasty who had completed a prior supervised prehabilitation programme and not had their surgery scheduled, performed a 12-week home-based physical activity or exercise intervention. Assessment of peak oxygen consumption, anaerobic threshold and resting blood pressure were performed pre- and post-supervised prehabilitation and post-maintenance. Results: Peak oxygen consumption increased by 12% following supervised prehabilitation (p = 0.014) but decreased by 9% following maintenance (p = 0.007). Anaerobic threshold increased 15% across supervised prehabilitation (p = 0.013) and remained 11% higher after maintenance (p = 0.009). Mean resting systolic blood pressure decreased by 14 mm Hg across supervised prehabilitation (p = 0.001) and remained 9 mm Hg lower post-maintenance (p = 0.032). Conclusion: Home-based maintenance was not effective for maintaining improvements in peak oxygen consumption following supervised prehabilitation; however, anaerobic threshold was increased above surgical prognostic cut-offs and maintained with the maintenance intervention. This study provides preliminary evidence for maintaining some fitness and health measures using a relatively low-cost and safe delivery of prehabilitation.