By Graeme Marsh

Updated 1/30/2010

Q. I had a total knee replacement several months ago and would like some advice on getting back into exercise as I have put on weight.

A. The total knee replacement usually follows a long period of pain and a loss of functional ability. A replacement will go a long way to helping restore quality of life, though active participation in the healing process is important to achieve this. It can be hard work getting back into some sort of exercise program. The degenerative changes that lead up to a knee replacement can cause a loss of strength in the muscles at the front of the thigh and poor muscle function.

Replacement knee joints are unfortunately not as durable as the actual human joint. They are far more likely to get damaged and worn by any compressive or shear forces, seen in high impact activities such as running or jumping. However, technology has advanced considerably and they are generally now more durable and longer lasting than in the past.

Before you get started it is very important you are able to fully bear weight on your involved leg, have no pain or swelling at the front of the knee, and be able to move your knee from a straight leg position (knee extended) through 90 degrees (knee bent). In most cases it will be at least 12 weeks from the operation before you will be ready to exercise independently, before that you should consult your Physiotherapist or GP for advice.

To help protect the knee, your initial exercise goals should focus on strength and stability around the joint, improving balance and joint range of motion. To help with your weight loss goals, you can combine cardiovascular exercise with resistance training. Stationary Biking is ideal, combining leg strengthening with aerobic benefits. Use a high seat setting to avoid excessive bending at the knee. The bottom of the foot should just touch the pedals with the knee straight.

Swimming is another ideal activity. Far more of a whole body exercise, it can provide excellent all-round benefits. Avoid using leg kicking actions such as the ???Frog-leg??? action often used with Brest Stroke. As an alternative, support legs with a float initially, progressing onto an up and down action.

Remember you should always consult your GP or Physiotherapist prior to starting an exercise program of this type. Any increased in pain or swelling should be reported to your Doctor. As strength and mobility increase, you should experience less discomfort. The key to any successful rehabilitation is not to overdo it and use your commonsense to find the activities that are best for you.

Graeme Marsh MSc MES is director of Aegis Training Ltd and one of the U.K’s top fitness experts. He holds a Masters degree in the Science of Sports coaching and is certified as a personal trainer through ACSM and NASM. Graeme is also an AAHFRP Medical Exercise Specialist dealing with exercise for post-rehabilitation. He is a sought after writer and personal trainer currently based at his own private studio in the city of London.