A recent randomized controlled [trial](https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-025-08468-4) conducted across three Norwegian hospitals examined whether preoperative exercise programs benefit older adults awaiting total hip replacement (THR). The study, published in BMC Musculoskeletal Disorders, found that prehabilitation did not improve post-surgical outcomes compared to standard care.
Researchers recruited 98 community-dwelling adults aged 70 or older with severe hip osteoarthritis. Half received the AktivA program, a tailored exercise regimen plus education lasting six to 12 weeks before total hip replacement surgery. The control group received standard care.
Measuring gait speed as the primary outcome, researchers followed participants before surgery and at multiple intervals up to 12 months after surgery. The prehabilitation group showed some pre-surgery improvements in [walking speed](https://www.mcknights.com/news/senior-dog-walkers-demonstrate-better-balance-and-fewer-falls/) and quality of life scores, with a particularly significant improvement in the Hip Disability and Osteoarthritis Outcome Score (HOOS) quality of life subscale. However, these advantages disappeared after surgery.
“Both groups demonstrated significant improvement in gait speed and performed well relative to Western reference values 12 months post-surgery,” the study authors noted. “Thus, replacing painful hip joints through total joint replacement seems to outweigh the efficacy of prehabilitation.”
The study found that walking speed for men in both groups improved from substantially below average at baseline to near-normal levels 12 months after surgery. Similar improvements in both groups occurred in the Timed Up and Go test, where participants started near the 75th percentile (indicating worse performance) for their age group but improved to the 10th-25th percentile range after recovery.
The findings suggest that while prehabilitation provided short-term benefits before surgery, the hip replacement itself was the primary driver of functional improvement. However, researchers noted potential benefits of prehabilitation in preventing functional deterioration for patients facing extended surgical waiting times.
The study had limitations, including a 40% dropout rate by the 12-month follow-up, partly due to COVID-19 pandemic disruptions.