Prehabilitation to improve outcomes for patients undergoing hip and knee replacement surgery.

Prehabilitation sessions will be 60 minutes in duration conducted by a physiotherapist. The program will be conducted twice weekly, for up to 4 weeks prior to the patients surgery date, with a maximum 6 clients per group. The exercise component will take a circuit training approach where various stations are set out that participants move around during the session. These exercises will include 1. Warm up for all at rails in standing (5 minutes) 2. Plinth – Hip knee flexion/quads over fulcrum/Hip Abduction/Bridging 3. Chair – Knee flexion and extension 4. Rails – gait re-education 5. Rails – Hip abduction/ Hip Flexion/ Hip Extension/ Squats/ Heel Raises/ Ham string curls/ calf stretch 6. Pedals/stairs/exercise bike 7. Lunges 8. Hands on therapy on plinth with Physiotherapist (Usual care rehabilitation phase) / Education station (prehabilitation phase) Despite the circuit format, all of these exercises will have individually tailored dosages / difficulty levels set to ensure that therapeutic benefit and participant safety are maximized. Education will also be provided to participants through provision of hip and knee care booklets with a view to clarifying the operation, pain management, gait aids, (giving a general post-surgical concept) as well as educating the patient regarding ongoing exercise at home. Participants allocated to the intervention group will also be given a “passport” which they will be required to bring to all appointments eg. Community rehabilitation centre, their hospital inpatient stay, to have their attendance recorded and signed off by staff.