Why prehab, and what it can (and can’t) do
Doing exercises before your knee replacement is called “prehabilitation,” or prehab. Research on prehab for total knee replacement (TKA) is encouraging but not definitive. A 2022 AHRQ-funded review of 13 clinical trials found that prehab may reduce hospital stay by 1–2 days and may increase strength after surgery, with pain, motion, and daily-activity outcomes about the same as usual care — but the evidence was rated low strength (Pinto et al., AHRQ, 2022). A larger 2025 review of reviews found prehab was linked to fewer complications and better strength, function, and quality of life, mostly in the first 6 months after surgery, though study quality ranged from critically low to moderate (JOSPT, 2025). A separate 2025 meta-analysis found prehab helped with pain but not much with hospital stay or knee function — a reminder that studies don’t all agree (Hu et al., Frontiers in Medicine, 2025).
What this means for you: think of this program as a way to go into surgery stronger — not a guarantee of a shorter hospital stay, fewer complications, or a faster recovery. No single program has been proven better than standard physical therapy.
This program is not for everyone. Check with your surgical team before starting, especially if you have heart or lung conditions, uncontrolled pain, balance problems, or other health conditions that affect exercise.
Program structure
3 sessions per week, non-consecutive days, for 6 weeks. Each session = mobility warm-up + strengthening (quads, glutes, hips, core) + optional low-impact conditioning. This sample covers Week 1, part of the “Weeks 1–2: Foundation” block.
Week 1: Foundation
Goal: Learn correct form, build tolerance, wake up the muscles around the knee and hip.
Each session (3x/week):
- Mobility warm-up (5 minutes)
- Quad sets — 3 sets of 10, holding 5–10 seconds
- Straight leg raises — 2 sets of 10 per leg
- Heel slides (knee bend mobility) — 2 sets of 10
- Standing hip abduction (holding a counter) — 2 sets of 10 per leg
- Glute bridges — 2 sets of 10
- Seated marches (core/hip flexor) — 2 sets of 10 per leg
- Optional: 10 minutes low-impact conditioning (walking or stationary bike, easy pace)
Exercise library — Week 1 moves
Quad sets
- Purpose
- Activates the quadriceps (front-of-thigh muscle) that supports the knee; this is the same exercise used immediately after surgery, so practicing it now builds a head start (AAOS OrthoInfo).
- Sets/reps/frequency
- 3 sets of 10, holding each 5–10 seconds. 3x/week (can also do daily).
- How to
- Sit or lie down with your leg straight. Tighten the muscle on top of your thigh like you’re trying to push the back of your knee flat against the surface below you. Hold, then relax.
- Stop if
- You feel sharp pain in the knee or thigh, or your knee locks up.
- Easier version (regression)
- Do fewer reps or shorter holds (3–5 seconds) until comfortable.
- Harder version (progression)
- Add a small rolled towel under your ankle to increase the stretch, or hold longer (up to 10 seconds).
Straight leg raises
- Purpose
- Builds thigh and hip flexor strength without bending the knee, which is often more comfortable for painful or stiff knees (AAOS OrthoInfo).
- Sets/reps/frequency
- 2–3 sets of 10 per leg, 3x/week.
- How to
- Lie on your back with one knee bent and the other leg straight. Tighten your thigh muscle, then lift the straight leg a few inches off the surface. Hold 5–10 seconds, then lower slowly.
- Stop if
- You feel pinching or sharp pain in the hip or knee.
- Easier version (regression)
- Do the exercise with your knee slightly bent instead of fully straight, or reduce range of lift.
- Harder version (progression)
- Add a light ankle weight (1–2 lb) once you can do 3 sets of 10 easily.
Heel slides (knee bend mobility)
- Purpose
- Maintains and improves knee bending range of motion.
- Sets/reps/frequency
- 2 sets of 10, 3x/week.
- How to
- Lie on your back with legs straight. Slowly slide your heel toward your buttocks, bending your knee as far as comfortable, then slide it back out straight.
- Stop if
- Sharp pain, not just muscle tightness or mild discomfort.
- Easier version (regression)
- Reduce how far you bend the knee.
- Harder version (progression)
- Loop a towel around your foot and gently assist the pull for a deeper bend.
Standing hip abduction
- Purpose
- Strengthens the hip abductor muscles (outer hip/glute), important for balance and walking stability (AAOS OrthoInfo).
- Sets/reps/frequency
- 2–3 sets of 10–12 per leg, 3x/week.
- How to
- Stand and hold onto a counter or sturdy chair. Keeping your body upright and your knee straight, lift one leg out to the side, then lower it back down with control.
- Stop if
- Sharp hip or knee pain, or loss of balance.
- Easier version (regression)
- Do the movement lying on your side instead of standing.
- Harder version (progression)
- Add a light resistance band around your ankles.
Glute bridges
- Purpose
- Strengthens glutes and core, which support the hip and knee during walking and stair climbing.
- Sets/reps/frequency
- 2–3 sets of 10, 3x/week.
- How to
- Lie on your back with knees bent, feet flat, hip-width apart. Squeeze your buttocks and lift your hips off the surface into a straight line from knees to shoulders, then lower slowly. Do not let your lower back arch (NHS Wye Valley pre-op hip exercise guide).
- Stop if
- Low back pain or cramping.
- Easier version (regression)
- Lift hips only partway, or place feet closer to your body.
- Harder version (progression)
- Lift one leg straight while holding the bridge position (single-leg bridge).
Seated marches
- Purpose
- Engages hip flexors and core while seated, useful for people with limited standing tolerance.
- Sets/reps/frequency
- 2 sets of 10 per leg, 3x/week.
- How to
- Sit tall in a chair. Lift one knee up toward your chest, then lower it, alternating legs.
- Stop if
- Sharp hip or back pain.
- Easier version (regression)
- Reduce how high you lift the knee.
- Harder version (progression)
- Add ankle weights, or hold each lift for 2–3 seconds.
General stop conditions (apply to every exercise in this program)
- Stop and rest if you feel sharp or stabbing pain (mild muscle fatigue or soreness is expected and different from sharp pain).
- Stop if your knee gives way, locks, or you feel unsteady.
- Stop and contact your surgical team or seek care now if you experience chest pain, severe shortness of breath, calf swelling or pain, or a fall.
- If any exercise consistently causes pain that lasts more than an hour afterward, use the regression option and check with your physical therapist or surgeon.
Equipment note
Week 1 needs no equipment at all — just a chair and a countertop. As the program progresses, later weeks add light resistance bands and, for some exercises, light weights. You don’t need a home gym: a band set and one light kettlebell or pair of dumbbells covers everything. If you want one reliable place to look, Rogue Fitness carries all of it.
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The bottom line
This program is designed to help you go into surgery stronger using the same categories of exercise (strengthening, mobility, and optional conditioning) found across published prehab research and hospital exercise guides (AHRQ CER, 2022; AAOS OrthoInfo). It is not proven to guarantee a shorter hospital stay, prevent complications, or outperform standard physical therapy — always confirm your specific plan with your surgical team.