Get stronger before surgery
A 2 to 4 week plan you can do at home with a sturdy chair: four moves and a daily walk, three days a week, building up slowly. Below it: when to stop, and what the research actually shows, including where it is weak.
Your surgeon or physical therapist decides; stop if pain is sharp. Show them this page before you start. If they give you their own list, use theirs instead of this one.
Ask first. They know your joint, your heart and your date.
Bring this page to your pre-op visit or call the office. Three questions: “Is this plan safe for me?” “Is there a move I should skip or change?” “Can I see a physical therapist before surgery?”
You need a sturdy chair that will not slide, a bed or a mat on the floor, and comfortable shoes. Nothing to buy, no account, and this page sends nothing.
Three days a week, with a rest day between. Walk every day.
Only 2 weeks until surgery? Do weeks 1 and 2. On move days, walk first as the warm-up: the AAOS conditioning programs start with 5 to 10 minutes of low-impact activity such as walking, and they list 8 to 20 repetitions per set, on 2 to 7 days a week, depending on the move. Most prehab trials met at least twice a week (see the research below). Three days a week sits inside both, and it is this page’s choice, not a tested dose.
Four moves at a chair, and a walk.
1. Walk
Every day · 5 to 10 minutesAn easy pace, on a flat path or indoors. Use your cane or walker if you already do.
From the AAOS knee and hip conditioning programs (warm-up).
2. Half squat, holding a chair
Move days · 8 to 10 per setStand behind a sturdy chair, hands on its back, feet about shoulder-width apart. Keep your chest lifted and lower your hips a short way, as if you were sitting down into a chair (AAOS: about 10 inches). Keep your weight in your heels, hold up to 5 seconds, then push through your heels to stand. Go only as low as is comfortable.
From the AAOS knee conditioning program (half squats).
3. Straight-leg raise, lying down
Move days · 8 to 10 per setLie on your back on a bed or mat, propped on your elbows if that is comfortable. Bend the other knee with that foot flat. Tighten the front of the thigh of the straight leg and lift it slowly 6 to 10 inches. Lower it slowly. Do both legs.
From the AAOS knee conditioning program (straight-leg raises).
4. Side leg lift
Move days · 8 to 10 per setLie on your side with the bottom knee bent for support and the top leg straight. Lift the top leg slowly, no higher than about 45°, keeping the knee straight but not locked, and hold up to 5 seconds. Lower it slowly. Turn over and do the other side.
From the AAOS hip and knee conditioning programs (hip abduction).
5. Calf raises, holding a chair
Move days · 10 per set, 2 sets at mostStand holding the back of the chair, weight on both feet. Rise up onto your toes, then lower your heels slowly. (The AAOS version is on one foot; start on two.)
From the AAOS knee conditioning program (calf raises, 2 sets of 10).
Stop if pain is sharp.
The AAOS programs put it plainly: you should not feel pain during an exercise, and if you do, talk to your doctor or physical therapist. Working muscles and feeling tired are not pain.
- Muscles working, a little tired afterwards
- Breathing a bit harder on the walk
- Sharp or sudden pain during a move
- Your usual joint ache gets clearly worse
- The joint gives way, or you feel unsteady
- Chest pain, or trouble breathing
- Feeling faint or dizzy
- In an emergency, call 911
A modest head start, mostly before surgery and in the first weeks after.
Before surgery, people who did a prehab program were usually a little stronger and moved a little better than people who did not. After a knee replacement, that edge showed up in the first weeks to about 3 months; by 6 to 12 months the two groups looked about the same. For hips there is less research, and it is less clear. Most of the trials were small or had a high risk of bias.
Mostly knee and hip replacement. Before surgery, moderate-certainty evidence of better function for knees (SMD 0.70) and stronger hip muscles for hips (SMD 1.03). After surgery, the only moderate-certainty finding was better knee function at 6 weeks (SMD 0.51); every other difference after surgery was low or very low certainty.
39 of the 48 trials ran for at least 4 weeks, and most met at least twice a week. The authors suggest at least 4 to 6 weeks, twice a week.
Where it stops: only 10 of the 48 trials had a low risk of bias. PubMed
Better knee function before surgery and up to 3 months after it. At 6 to 12 months there was no difference between the groups (SMD 0.07).
Where it stops: low to very low certainty of evidence. PubMed
For knees, prehab may increase strength and shorten the hospital stay, may not cause more harm, and may make little difference to pain, range of motion or daily activities. For hips, there was not enough evidence to say anything about any outcome.
Where it stops: low strength of evidence, and the programs differed a lot. PubMed
After knee replacement, the pooled numbers favoured prehab for function, pain, quality of life, strength, range of motion and functional mobility, but 24 of the 28 trials had a high risk of bias and the results varied widely, so the authors say no firm conclusion is possible. Only 2 hip trials, and they disagreed.
Across 24 reviews and meta-analyses, prehab with strength training favoured fewer complications and better strength and function after hip and knee replacement, with the effects generally confined to the first 6 months.
Where it stops: the reviews it pooled ranged from critically low to moderate quality. PubMed
What this means for a 2 to 4 week plan. Most trials ran 4 weeks or longer, so 2 to 4 weeks is at the short end of what was tested, and the gains may be smaller. It is still practice for the moves your physical therapist will ask for after surgery. If your date is further away, ask whether to keep going: the AAOS programs run 4 to 6 weeks.
SMD (standardized mean difference) is the size of a difference measured in units of how much people vary; a bigger number is a bigger difference. Certainty ratings are the reviews’ own (GRADE or strength of evidence).
Check what you know.
Five questions, each keyed to a line on this page with its source. Tap an answer and the lesson’s own line appears. Scored on this device; nothing is sent. It measures what the lesson taught, not whether you are ready for surgery.
- Punnoose A, et al. Prehabilitation for patients undergoing orthopedic surgery: a systematic review and meta-analysis. JAMA Netw Open 2023;6(4):e238050. PubMed 37052919 · doi
- Gränicher P, et al. Prehabilitation improves knee functioning before and within the first year after total knee arthroplasty: a systematic review with meta-analysis. J Orthop Sports Phys Ther 2022;52(11):709-725. PubMed 36125444 · doi
- Konnyu KJ, et al. Prehabilitation for total knee or total hip arthroplasty: a systematic review. Am J Phys Med Rehabil 2023;102(1):1-10. PubMed 35302954 · doi
- Adebero T, et al. Effectiveness of prehabilitation on outcomes following total knee and hip arthroplasty for osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Disabil Rehabil 2024;46(24):5771-5790. PubMed 38349251 · doi
- Keogh JAJ, et al. The effects of structured prehabilitation on postoperative outcomes following total hip and total knee arthroplasty: an overview of systematic reviews and meta-analyses. J Orthop Sports Phys Ther 2025;55(5):344-365. PubMed 40298246 · doi
- AAOS OrthoInfo: Knee Conditioning Program (warm-up, half squats, straight-leg raises, hip abduction, calf raises; 4 to 6 weeks; no pain during an exercise).
- AAOS OrthoInfo: Hip Conditioning Program (hip abduction to about 45°, 8 to 12 repetitions; 4 to 6 weeks; no pain during an exercise).
General education, not medical advice. It does not replace your surgeon or physical therapist.