A comparison of ward and aquatic exercise programs for inpatients after total hip or knee replacement using measures of pain, physiological demand and effort.

On day 4 post-operatively, all participants completed a general water exercise program lasting 40 minutes, supervised by an experienced physiotherapist, in 10% weight-bearing (neck-deep water) at a slow speed, involving exercises such as marching and single-leg standing on the non-operated leg, walking forwards and general upper limb strengthening exercises. On Day 5 post-operatively, all participants completed a 40 minute specific aquatic physiotherapy program, supervised by an experienced physiotherapist, which consisted of exercises in 30% weight-bearing (chest deep water) focusing on strength using speed of movement as well as functional activities such as step ups and squats, walking forwards, backwards and sideways, balance exercises and open-chain strengthening exercises using equipment for increased resistance eg flippers. The ward exercise program undertaken on Day 6 was the standard inpatient physiotherapy intervention at Day 6 following the hospital’s clinical pathway, and included gait re-education on crutches, standing strengthening exercises in parallel bars and practice of stairs in addition to bed exercises focusing on range and strength.