Adherence to the Dutch recommendation for physical activity: prior to and after primary total hip and knee arthroplasty

Abstract

Purpose

To determine the course of adherence to physical activity (PA) recommendation in hip/knee osteoarthritis patients before and after hip/knee arthroplasty (THA/TKA). Moreover, we explored predictors for non-adherence 12 months postoperatively.

Materials and methods

Primary THA/TKA were included in a multicenter observational study. Preoperatively and 6/12 months postoperatively, patients reported engagement in moderate-intensity PA in days/week in the past 6 months (PA-recommendation (≥30 min of moderate-intensity ≥5 days/week)). We included predictors stratified by preoperative adherence: sex, age, BMI, comorbidities, smoking, living/working status, season, mental health, HOOS/KOOS subscales before and 6 months postoperatively, and 6-month adherence.

Results

(1005 THA/972 TKA) Preoperatively, 50% of the population adhered. Adherence increased to 59% at 6 and 12 months. After 12 months, most patients remained at their preoperative PA level, 11% of the preoperative adherers decreased, while 20% of the preoperative non-adherers increased their PA level. In all different groups, adherence to the PA recommendation at 6 months was identified as a predictor (OR-range: 0.16–0.29). In addition, BMI was identified as predictor in the THA adherent (OR = 1.07; 95%CI [1.02–1.15]) and TKA non-adherent groups (OR = 1.08; 95%CI [1.03–1.12]). THA non-adherent group not having paid work (OR = 0.53; 95%CI [0.33–0.85]), and in the TKA adherent group, lower KOOS subscale symptoms (OR = 1.03; 95%CI [1.01–1.05]) were associated with non-adherence.

Conclusions

Majority of patients remained at their preoperative PA level. Non-adherence at 6 months was highly predictive for 12-month non-adherence.

Implications for rehabilitation

• Physical activity (PA) is crucial to decrease mortality risk, especially among patients suffering from osteoarthritis, as these patients have the potential to become more physically active after arthroplasty surgery.

• We found that physical function and pain improved, but 69% of the patients remained at their preoperative PA level, while 11% decreased and 20% increased their PA levels.

• Using this information shortly after surgery, orthopedic surgeons and other health care professionals can address patients at risk for decreased PA levels and provide PA advice.

Keywords:

• Physical
• activity
• hip
• knee
• arthroplasty

Acknowledgements

We would like to acknowledge the members of the LOAS study group in addition to the authors: W.J. Marijnissen, Albert Schweitzer Hospital, Dordrecht; PJ Damen, Waterland Hospital, Purmerend; HMJ van der Linden and BL Kaptein, Leiden University Medical Center, Leiden; SHM Verdegaal, Alrijne Hospital, Leiderdorp; HH Kaptijn, LangeLand Hospital, Zoetermeer; SBW Vehmeijer, Reinier de Graaf Hospital, Delft; R Onstenk, Groene Hart Hospital, Gouda: the Netherlands for the provision of patients and general support.

Ethical approval

The Medical Ethics Committee of the LUMC approved the study P12.047 “Longitudinal Leiden Orthopaedics Outcomes of Osteoarthritis Study (LOAS)”. The nature of the study, the interests of involved subjects and article 3 of the Law Medical-Scientific Research with Human Subjects were taken into consideration and resulted in a positive judgement of the execution of the study.

Disclosure statement

The authors report no conflicts of interest.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Additional information

Funding

This work was supported by the Dutch Arthritis Foundation [Grant Number LLP13] and the Department of Orthopaedics from the Leiden University Medical Center, Leiden, the Netherlands.