Get Fit for Hip and Knee Joint Replacement Surgery: a pre-operative program of education, self-management and exercise for people waiting for hip and knee joint replacement surgery. (Study 2)

The intervention is the same as the intervention for the current ANZCTR registered trial (study 1) (ACTRN12611000539932, http://www.anzctr.org.au/ACTRN12611000539932.aspx). Please note: The aim of study 1 (ACTRN12611000539932) is to determine the benefit of the intervention BEFORE joint replacement surgery. The aim of this study (study 2) is to determine the benefit of the same intervention AFTER joint replacement. Some of the participants in study 2 may have participated in study 1. The details of the intervention are detailed below: Pre-operative Education and Exercise program: The program, the 'Get Fit for Hip and Knee Joint Surgery program' is an existing group program integrating exercise and self-management strategies. The program runs at two sites within Eastern Health - Peter James Centre and Box hill Hospital. The program runs twice-weekly for six weeks. Each session comprises one hour of education/self-management and one hour of exercise (either land or pool based). All sessions are led by allied health professionals. The education/self management component includes the following topics: self-management principles, goal setting and action plans, physical activity and osteoarthritis, pacing and activity-rest cycle, food and osteoarthritis, medications and osteoarthritis, reviewing goals, equipment needs pre and post joint replacement, and community exercise options. The exercise component of the program will be a land-based program at Box Hill Hospital or a water-exercise program at Peter James Centre. Participants will be allocated to either land-based or water-based exercises based on personal preference and their proximity to each centre, consistent with usual practice. There is evidence that there is no difference in the outcomes of pre-operative land-based and water-based exercise programs (Gill et al 2009). The program will contain both aerobic and muscle training exercises with exercises typically performed at moderate intensity with resistance progressed according to participants capability. The program will also contain functional exercises and balance training. The exercise program is designed to improve lower limb strength, endurance, flexibility, balance and general function. Land-based exercises include: -Exercise bike -Rocker board -Wobble board -Standing one leg -Sit to stand -Step ups / downs -Wall squats -Heel Slides – to increase knee flexion range of motion -Muscle training for knee extensors eg quadriceps over fulcrum & quads bench -Shuttle walks -Foot alphabet – endurance & quads control exercise Pool Based Exercise includes: -Walking -Forward -Backward -Sideways -Lunge walking -Toe walking -Lower limb ROM exercises in standing -Hip/knee flexion -Hip abduction / adduction -Hip extension -Knee flexion -Squats -Lower limb ROM exercise in supine -Cycling -Hip extension -Hip abduction/adduction