Reducing Sedentary Time After Knee Replacement Using a Multicomponent mHealth Intervention: Randomized Controlled Trial

Clinical Snapshot

Key Findings

• P Value: P=0.04 for sit-to-stand transitions

• Effect Size: Significant increase in sit-to-stand transitions in NEAT!2 group vs substantial decrease in control group

• Primary Outcome: No significant reduction in sedentary time between groups at 2 or 5 months

• Nnt Or Sensitivity: Not calculable due to lack of clinically meaningful primary outcome achievement

• Confidence Interval: Mean difference 4.06 sit-to-stand transitions (95% CI 0.13-7.99)

Clinical Application

Moderate feasibility - requires smartphone technology and coaching resources, but high participant engagement demonstrated Relevant to Australian practice given aging population and high TKR rates. Could integrate with existing rehabilitation pathways, though cost-effectiveness unclear without PBS support Adults within first year post-TKR, particularly those with sedentary lifestyles and smartphone access

Abstract

BACKGROUND: Total knee replacement (TKR) is a common surgery for end-stage knee osteoarthritis. Although reductions in pain and improvements in mobility occur after surgery, physical activity levels often do not change. Given the challenges of increasing physical activity in this population, targeting reductions in sedentary behavior may be a first step; however, no prior studies have examined the feasibility and effects of a sedentary reduction intervention after TKR. OBJECTIVE: This study examined the effects of a 2-month multicomponent mobile health sedentary reduction intervention (NEAT!2) on sedentary time in adults with TKR. METHODS: Adults (N=83; mean age 65.3, SD 9.4 years; mean BMI 32.7, SD 6.9 kg/m2; 62/83, 74.7% female; 64/83, 77.1% White) with a TKR ≤1 year ago were randomized to the NEAT!2 group (n=42, 50.6%) or the attention-matched control group (n=41, 49.4%). The NEAT!2 intervention focused on reducing sedentary time via a smartphone app designed to interrupt prolonged bouts (≥30 minutes) of sedentary behavior and through 5 coaching calls emphasizing goal setting and problem solving. The control group focused on surgery recovery via an app or website and 5 educational calls. Sedentary time, total physical activity, physical function, and pain were measured at 2 and 5 months. Linear mixed-effects models examined intervention effects and differences between groups at each time point. RESULTS: Retention was 96% and 95% at 2 and 5 months, respectively, with no differences between groups. Participants in the NEAT!2 group completed an average of 4.95 (SD 0.2) calls, used the app on an average of 40.3 (SD 13.8) days (out of 56 days), and received an average of 9.6 (SD 6.0) notifications per day. At 5 months, there was a significant increase in sit-to-stand transitions in the NEAT!2 group and a substantial decrease in the control group, resulting in a significant difference between groups (mean difference 4.06, 95% CI 0.13-7.99; P=.04); however, the NEAT!2 intervention did not result in significant effects on any of the other study outcomes at 2 or 5 months. Additionally, more days of app use were associated with greater increases in moderate-to-vigorous intensity physical activity (r=0.335; 95% CI 0.017-0.585; P=.04). CONCLUSIONS: This study highlights the challenges of reducing sitting time in adults with TKR. Future studies should explore alternative behavior change techniques across different levels of influence (eg, environmental and social) to support interventions implemented within the first year after TKR. TRIAL REGISTRATION: ClinicalTrials.gov NCT04482400; https://clinicaltrials.gov/ct2/show/NCT04482400.

References

1. 1.Pellegrini, C. A., Kennerley, C. L., Wilcox, S., Lee, J., DeVivo, K., Horn, K., Jamieson, S., Hopkins, J., Davis, H. T., & Jackson III, J. B. (2026). Reducing sedentary time after knee replacement using a multicomponent mHealth intervention: Randomized controlled trial. JMIR mHealth and uHealth. https://doi.org/10.2196/83148