Skip to main content
Log in

Light intensity physical activity increases and sedentary behavior decreases following total knee arthroplasty in patients with osteoarthritis

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To describe objectively measured changes in the volume and pattern of physical activity and sedentary behavior in patients undergoing total knee arthroplasty for osteoarthritis.

Methods

Physical activity and sedentary behavior were measured in patients (13 males, 76 females) with a mean age of 64 years (range 55–80) and end-stage osteoarthritis of the knee, using an accelerometer (ActiGraph GT3X+) for seven consecutive days (24 h/day) prior to, 6 weeks and 6 months after total knee arthroplasty. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), University of California Los Angeles (UCLA) Activity index and range of motion (ROM) were also assessed.

Results

Proportion of time spent in sedentary behavior decreased from baseline to 6 months (mean 70.1 vs. 64.0%; p = 0.009) and the interruptions to sedentary behavior improved between baseline and 6 months after total knee arthroplasty (mean 85.0–93.0 breaks/day, p = 0.014). Proportion of time spent in light physical activity increased from baseline to 6 months after total knee arthroplasty (29.0 vs. 34.8%; p = 0.008). There was no change in time spent in moderate to vigorous physical activity after total knee arthroplasty. WOMAC (median 71.0 vs. 4.0, p < 0.001), UCLA (median 2.0 vs. 5.0, p < 0.001) as well as ROM [median (0.0°–90.0°) vs. (0.0°–110°), p < 0.05] scores improved between baseline and 6 months after total knee arthroplasty.

Conclusion

Clinically, functional improvements in patients following total knee arthroplasty may be assessed by objectively measuring changes in low intensity activity behaviors. The use of accelerometers in this study gives new insights into activity accumulation patterns in a clinical population and highlights their use in determining a behavioral response to an intervention.

Level of evidence

II.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, Christy W, Cooke TD, Greenwald R, Hochberg M, Howell D, Kaplan D, Koopman W, Longley S, Mankin H, McShane DJ, Medsger T, Meenan R, Mikkelsen W, Moskowitz R, Murphy W, Rothschild B, Segal M, Sokoloff L, Wolfe F (1986) Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Arthritis Rheum 29:1039–1049

    Article  CAS  PubMed  Google Scholar 

  2. Arnold JB, Walters JL, Ferrar KE (2016) Does physical activity increase after total hip or knee arthroplasty for osteoarthritis? A systematic review. J Orthop Sports Phys Ther 46:431–442

    Article  PubMed  Google Scholar 

  3. Beenackers MA, Kamphuis CBM, Giskes K, Brug J, Kunst AE, Burdorf A, van Lenthe FJ (2012) Socioeconomic inequalities in occupational, leisure-time, and transport related physical activity among European adults: a systematic review. Int J Behav Nutr Phys Act 9:116

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bellamy N (2002) WOMAC Osteoarthritis Index User Guide. https://www.rheumatology.org/I-Am-A/Rheumatologist/Research/Clinician-Researchers/Western-Ontario-McMaster-Universities-Osteoarthritis-Index-WOMAC. Accessed 19 May 2017

  5. Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P (2012) What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open 2:e000435

    Article  PubMed  PubMed Central  Google Scholar 

  6. Bradshaw D, Steyn K (2001) Poverty and chronic disease in South Africa: Medical Research Council. http://www.mrc.ac.za/bod/povertyfinal.pdf. Accessed 20 May 2017

  7. Brandes M, Ringling M, Winter C, Hillmann A, Rosenbaum D (2011) Changes in physical activity and health-related quality of life during the first year after total knee arthroplasty. Arthritis Care Res 63:328–334

    Google Scholar 

  8. Chaput J-P, Carson V, Gray CE, Tremblay MS (2014) Importance of all movement behaviors in a 24 h period for overall health. Int J Environ Res Public Health 11:12575–12581

    Article  PubMed  PubMed Central  Google Scholar 

  9. Chastin SFM, Palarea-Albaladejo J, Dontje ML, Skelton DA (2015) Combined effects of time spent in physical activity, sedentary behaviors and sleep on obesity and cardio-metabolic health markers: a novel compositional data analysis approach. PLOS One 10:e0139984

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Choi L, Liu Z, Matthews CE, Buchowski MS (2011) Validation of accelerometer wear and nonwear time classification algorithm. Med Sci Sports Exerc 43:357–364

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ethgen O, Bruyère O, Richy F, Dardennes C, Reginster J-Y (2004) Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am 86-A:963–974

    Article  Google Scholar 

  12. Finger JD, Tylleskär T, Lampert T, Mensink GBM (2012) Physical activity patterns and socioeconomic position: the German National Health Interview and Examination Survey 1998 (GNHIES98). BMC Public Health 12:1079

    Article  PubMed  PubMed Central  Google Scholar 

  13. Focht BC, Garver MJ, Devor ST, Dials J, Lucas AR, Emery CF, Hackshaw KV, Rejeski WJ (2014) Group-mediated physical activity promotion and mobility in sedentary patients with knee osteoarthritis: results from the IMPACT-pilot trial. J Rheumatol 41:2068–2077

    Article  PubMed  Google Scholar 

  14. Freedson PS, Melanson E, Sirard J (1998) Calibration of the computer science and applications, Inc. accelerometer. Med Sci Sports Exerc 30:777–781

    Article  CAS  PubMed  Google Scholar 

  15. Groot IB de, Bussmann HJ, Stam HJ, Verhaar JA (2008) Small increase of actual physical activity 6 months after total hip or knee arthroplasty. Clin Orthop Relat Res 466:2201

    Article  PubMed  PubMed Central  Google Scholar 

  16. Guthold R, Ono T, Strong KL, Chatterji S, Morabia A (2008) Worldwide variability in physical inactivity a 51-country survey. Am J Prev Med 34:486–494

    Article  PubMed  Google Scholar 

  17. Hammett T, Simonian A, Austin M, Butler R, Allen KD, Ledbetter L, Goode AP (2017) Changes in physical activity after total hip or knee arthroplasty: a systematic review and meta-analysis of 6 and 12 months outcomes. Arthritis Care Res. https://doi.org/10.1002/acr.23415

    Article  Google Scholar 

  18. Harding P, Holland AE, Delany C, Hinman RS (2014) Do activity levels increase after total hip and knee arthroplasty? Clin Orthop Relat Res 472:1502–1511

    Article  PubMed  Google Scholar 

  19. Herbolsheimer F, Schaap LA, Edwards MH, Maggi S, Otero Á, Timmermans EJ, Denkinger MD, van der Pas S, Dekker J, Cooper C, Dennison EM, van Schoor NM, Peter R, Eposa Study Group (2016) Physical activity patterns among older adults with and without knee osteoarthritis in six European countries. Arthritis Care Res 68:228–236

    Article  Google Scholar 

  20. Jones CA, Beaupre LA, Johnston DWC, Suarez-Almazor ME (2007) Total joint arthroplasties: current concepts of patient outcomes after surgery. Rheum Dis Clin N Am 33:71–86

    Article  Google Scholar 

  21. Katzmarzyk PT, Mason C (2009) The physical activity transition. J Phys Act Health 6:269–280

    Article  PubMed  Google Scholar 

  22. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Lee J, Chang RW, Ehrlich-Jones L, Kwoh CK, Nevitt M, Semanik PA, Sharma L, Sohn M-W, Song J, Dunlop DD (2015) Sedentary behavior and physical function: objective evidence from the osteoarthritis initiative. Arthritis Care Res 67:366–373

    Article  Google Scholar 

  24. Lützner C, Kirschner S, Lützner J (2014) Patient activity after TKA depends on patient-specific parameters. Clin Orthop Relat Res 472:3933–3940

    Article  PubMed  PubMed Central  Google Scholar 

  25. Matthews CE, Chen KY, Freedson PS, Buchowski MS, Beech BM, Pate RR, Troiano RP (2008) Amount of time spent in sedentary behaviors in the United States, 2003–2004. Am J Epidemiol 167:875–881

    Article  PubMed  PubMed Central  Google Scholar 

  26. Matthews CE, Hagströmer M, Pober DM, Bowles HR (2012) Best practices for using physical activity monitors in population-based research. Med Sci Sports Exerc 44:S68

    Article  PubMed  PubMed Central  Google Scholar 

  27. McVeigh JA, Winkler EAH, Healy GN, Slater J, Eastwood PR, Straker LM (2016) Validity of an automated algorithm to identify waking and in-bed wear time in hip-worn accelerometer data collected with a 24 h wear protocol in young adults. Physiol Meas 37:1636

    Article  PubMed  Google Scholar 

  28. Meier W, Mizner RL, Marcus RL, Dibble LE, Peters C, Lastayo PC (2008) Total knee arthroplasty: muscle impairments, functional limitations, and recommended rehabilitation approaches. J Orthop Sports Phys Ther 38:246–256

    Article  PubMed  Google Scholar 

  29. Meiring RM, Frimpong E, Mokete L, Pietrzak J, Van Der Jagt D, Tikly M, McVeigh JA (2016) Rationale, design and protocol of a longitudinal study assessing the effect of total knee arthroplasty on habitual physical activity and sedentary behavior in adults with osteoarthritis. BMC Musculoskelet Disord 17:281

    Article  PubMed  PubMed Central  Google Scholar 

  30. Migueles JH, Cadenas-Sanchez C, Ekelund U, Nyström CD, Mora-Gonzalez J, Löf M, Labayen I, Ruiz JR, Ortega FB (2017) Accelerometer data collection and processing criteria to assess physical activity and other outcomes: a systematic review and practical considerations. Sports Med. https://doi.org/10.1007/s40279-017-0716-0

    Article  PubMed  PubMed Central  Google Scholar 

  31. Petterson SC, Mizner RL, Stevens JE, Raisis L, Bodenstab A, Newcomb W, Snyder-Mackler L (2009) Improved function from progressive strengthening interventions after total knee arthroplasty: a randomized clinical trial with an imbedded prospective cohort. Arthritis Rheum 61:174–183

    Article  PubMed  Google Scholar 

  32. Physical Activity Guidelines Advisory Committee Report (2018) Recap: 2018 Physical Activity Guidelines Advisory Committee Meeting 3| Health.gov. News Media Heal

  33. Schache MB, McClelland JA, Webster KE (2014) Lower limb strength following total knee arthroplasty: a systematic review. Knee 21:12–20

    Article  PubMed  Google Scholar 

  34. Straker L, Campbell A, Mathiassen SE, Abbott RA, Parry S, Davey P (2014) Capturing the pattern of physical activity and sedentary behavior: exposure variation analysis of accelerometer data. J Phys Act Health 11:614–625

    Article  PubMed  Google Scholar 

  35. Sun F, Norman IJ, While AE (2013) Physical activity in older people: a systematic review. BMC Public Health 13:449

    Article  PubMed  PubMed Central  Google Scholar 

  36. Tsonga T, Kapetanakis S, Papadopoulos C, Papathanasiou J, Mourgias N, Georgiou N, Fiska A, Kazakos K (2011) Evaluation of improvement in quality of life and physical activity after total knee arthroplasty in Greek elderly women. Open Orthop J 5:343–347

    Article  PubMed  PubMed Central  Google Scholar 

  37. Tudor-Locke C, Schuna JM, Barreira TV, Mire EF, Broyles ST, Katzmarzyk PT, Johnson WD (2013) Normative steps/day values for older adults: NHANES 2005–2006. J Gerontol A Biol Sci Med Sci 68:1426–1432

    Article  PubMed  Google Scholar 

  38. Vissers MM, Bussmann JB, de Groot IB, Verhaar JAN, Reijman M (2013) Physical functioning 4 years after total hip and knee arthroplasty. Gait Posture 38:310–315

    Article  CAS  PubMed  Google Scholar 

  39. Walker DJ, Heslop PS, Chandler C, Pinder IM (2002) Measured ambulation and self-reported health status following total joint replacement for the osteoarthritic knee. Rheumatol Oxf Engl 41:755–758

    Article  CAS  Google Scholar 

  40. Wallis JA, Webster KE, Levinger P, Taylor NF (2013) What proportion of people with hip and knee osteoarthritis meet physical activity guidelines? A systematic review and meta-analysis. Osteoarthr Cartil 21:1648–1659

    Article  CAS  PubMed  Google Scholar 

  41. Webber SC, Strachan SM, Pachu NS (2017) Sedentary behavior, cadence, and physical activity outcomes after knee arthroplasty. Med Sci Sports Exerc 49:1057–1065

    Article  PubMed  Google Scholar 

Download references

Funding

Costs associated with this study were internally funded by the School of Physiology, Faculty of Health Sciences, University of the Witwatersrand.

Author information

Authors and Affiliations

Authors

Contributions

EF participated in conceptualization of study, development of study design, collecting data, writing of drafts, editing of drafts. JAM participated in conceptualization of study, development of study design, writing of drafts, editing of drafts. DVDJ took part in conceptualization of study, development of study design, editing of drafts. LM took part in conceptualization of study, development of study design, editing of drafts. YSK took part in development of study design, collecting data, editing of drafts. MT took part in conceptualization of study, development of study design, editing of drafts. RMM participated in conceptualization of study, development of study design, writing of drafts, editing of drafts. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Rebecca M. Meiring.

Ethics declarations

Conflict of interest

LM wishes to declare that he has offered consultancy services for Implantcast for the development of a new prosthesis. No money has been paid for these consultancy services. The remaining authors declare that they have no conflict of interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (clearance certificate number M150323) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

An informed consent was obtained from all individuals participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Frimpong, E., McVeigh, J.A., van der Jagt, D. et al. Light intensity physical activity increases and sedentary behavior decreases following total knee arthroplasty in patients with osteoarthritis. Knee Surg Sports Traumatol Arthrosc 27, 2196–2205 (2019). https://doi.org/10.1007/s00167-018-4987-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-018-4987-2

Keywords

Navigation