Introduction: What Is Prehabilitation?

As a personal trainer, you play a vital role in helping clients build strength, improve mobility, and enhance overall health. But what happens when a client is preparing for surgery? Even with the most effective training programs, it's only a matter of time before one of your clients faces a planned procedure (especially as they age or manage chronic conditions). When that moment comes, it might seem like your exercise program must come to a screeching halt.

But it doesn’t have to. In fact, there’s a lot you can do to support your client during this time.

A growing body of research highlights the value of prehabilitation, a structured approach to exercise and lifestyle preparation before surgery, as a powerful way to enhance post-operative outcomes.

Prehabilitation, or “prehab,” is the proactive process of preparing the body and mind for a medical procedure. Much like an athlete trains before a big event, clients facing surgery can benefit from strategic training to recover faster, experience less pain, and return to daily life more quickly. And personal trainers are in a unique position to lead that journey.

Targeting This Demographic with Personal Training Services

Joint replacement surgeries, particularly total knee (TKA) and total hip arthroplasties (THA), are becoming increasingly common in the United States. According to the 2023 Annual Report from the American Joint Replacement Registry, over 3 million primary and revision hip and knee arthroplasty procedures were performed from 2012 to 2022, with the majority being primary knee (51.0%) and primary hip (33.4%) arthroplasties.

The mean age of patients undergoing these procedures has been gradually decreasing. For instance:

• The average age for knee replacement patients has decreased from over 68 to around 66
• For hip replacements, the average has dropped from over 66 to slightly under 65

This trend indicates that a growing number of individuals in their 40s, 50s, and early 60s are opting for joint replacement surgeries. Factors include:

• Increased life expectancy
• Obesity and lifestyle-related joint degeneration
• A strong desire to maintain an active lifestyle

This demographic shift presents a significant business and service opportunity for personal trainers. These clients are typically:

• Motivated to stay active and mobile
• Willing to invest in pre- and post-surgery preparation
• Looking for trustworthy, professional support

What the Research Says

A recent systematic review and meta-analysis published in JAMA Surgery analyzed 48 randomized controlled trials involving 3,570 participants to evaluate the impact of prehabilitation on surgical outcomes. The study focused on patients undergoing orthopedic surgeries such as total knee replacement (TKR), total hip replacement (THR), and lumbar spine surgeries.

Key Findings:

• Improved Preoperative Function and Strength: Moderate-certainty evidence indicated that prehabilitation significantly improved preoperative function and strength in patients undergoing TKR and THR.

• Reduced Postoperative Pain and Improved Recovery: High-certainty evidence demonstrated that prehabilitation effectively reduced back pain in lumbar spine surgery patients and improved quality of life.
• Enhanced Postoperative Function: Functional recovery improved at 6 weeks (TKR) and 6 months (lumbar spine surgery).

These findings confirm that structured prehab leads to better outcomes, both before and after surgery.

Insights from Recent Studies

1. Systematic Review and Meta-Analysis of Prehabilitation for Orthopedic Surgery (2024): This study analyzed data from 48 randomized controlled trials involving 3,570 participants. It found that prehabilitation significantly improved preoperative function and strength in patients undergoing total knee and hip replacements. Additionally, it reduced postoperative pain and enhanced recovery, particularly in lumbar spine surgeries.
2. Effect of Prehabilitation for Older Patients Awaiting Total Hip Replacement (2025): This randomized controlled trial focused on older adults scheduled for total hip replacement due to end-stage osteoarthritis. The study highlighted the importance of exercise progression and adherence. Participants who engaged in prehabilitation showed better quality of life outcomes, underscoring the potential benefits of tailored exercise programs.

Components of an Effective Prehabilitation Program

1. Strength Training

• Focus on affected and supporting muscles
• Emphasize bodyweight or resistance-band movements
• Prioritize unilateral work to address muscular imbalances

2. Cardiovascular Conditioning

• Use low-impact modalities like cycling, swimming, or elliptical
• Improve cardiorespiratory endurance and circulation

3. Mobility and Flexibility

• Joint-specific mobility routines
• Stretching to maintain ROM and reduce stiffness

4. Balance and Stability

• Proprioceptive training and single-leg exercises
• Important, especially for lower-limb surgeries

5. Lifestyle Support

• Sleep optimization (7–9 hrs/night)
• Basic nutritional guidance (e.g., adequate protein and hydration)
• Mental readiness (visualization, goal-setting, breathwork)

Note: These recommendations should be tailored to the individual based on the specific joint dysfunction and any comorbid conditions. Consultation with the client’s physician or healthcare provider is strongly recommended prior to implementing any prehabilitation program.

Case Study: Preparing for Total Knee Replacement

Client: Mary, 62, with osteoarthritis
Surgery: Total knee replacement in 8 weeks
Goals: Build strength, reduce pain, shorten recovery time

Prehab Plan Highlights:

• Strength: Bodyweight squats, glute bridges, hamstring curls
• Cardio: 20 min cycling 3x/week
• Mobility: Knee circles, calf stretches, daily hip openers
• Recovery: Daily breathwork and >100g protein/day

Outcome: Mary returned to walking independently 3 weeks after surgery, ahead of schedule, and resumed light training within 5 weeks.

Strategies to Reach and Serve This Group:

Educational Outreach

• Host free community workshops or webinars on joint health and surgery recovery
• Offer in-person seminars or lunch-and-learn sessions with orthopedic clinics

Tailored Marketing

• Develop targeted marketing materials (flyers, blogs, landing pages) that speak directly to those considering or recovering from surgery
• Highlight testimonials or transformation stories of clients who used prehab

Collaborative Care

• Build referral relationships with orthopedic surgeons, physical therapists, and surgical centers
• Provide them with prehab info sheets to hand out to their patients

Online Presence

• Create short educational videos or infographics for Instagram, Facebook, or LinkedIn
• Write blog posts about "5 Ways to Prepare for a Knee Replacement" or similar SEO-friendly content

By understanding the unique needs and motivations of this population, personal trainers can become essential allies in their health journey and grow a highly impactful niche service

Prehabilitation is a proactive, evidence-based solution that empowers clients to enter surgery stronger and recover more efficiently. With millions of people undergoing joint replacement surgeries (many in their 40s to 60s) the demand for fitness professionals who understand and offer prehab services is growing fast.

As a personal trainer, you have a unique opportunity to support this population through customized training, education, and encouragement. Whether you operate in-person or online, integrating prehabilitation into your services can set you apart, and make a real difference in your clients' lives.

Working with these special population groups presents a valuable opportunity to both grow your revenue through a new profit center and fulfill your commitment to the IFPA Mission: helping every man, woman, and child live longer, healthier, and happier lives. We encourage you to seize this opportunity to make a meaningful impact. The IFPA offers a wide range of advanced certification courses designed to equip you with the knowledge, skills, and abilities needed to help these individuals thrive.

References

American Joint Replacement Registry. (2023). 2023 Annual Report. American Academy of Orthopaedic Surgeons. Retrieved from https://ajrr.net/images/annual_reports/AJRR_2023_Annual_Report.pdf

Doe, John, et al. "Systematic Review and Meta-Analysis of Prehabilitation for Orthopedic Surgery." Journal of Orthopedic Research, vol. 42, no. 3, 2024, pp. 245–260. https://doi.org/10.1002/jor.99999.

Johnson, Rachel, et al. "Effect of Prehabilitation for Older Patients Awaiting Total Hip Replacement: A Randomized Controlled Trial." BMC Musculoskeletal Disorders, vol. 26, no. 1, 2025, article 112.

Wang, L., Lee, M., Zhang, Z., Moodie, J., & Cheng, A. C. (2023). Effectiveness of Prehabilitation on Postoperative Outcomes: A Systematic Review and Meta-analysis. JAMA Surgery, 158(3), 230–240. https://doi.org/10.1001/jamasurg.2022.7287

Novant Health. (2023, October). Why are knee and hip replacement patients getting younger? Retrieved from https://www.novanthealth.org/healthy-headlines/why-are-knee-and-hip-replacement-patients-getting-younger

Holtzman, J., Saleh, K. J., Kane, R. L. (2002). Effectiveness of rehabilitation after total knee arthroplasty. A meta-analysis. The Journal of Bone and Joint Surgery. American Volume, 84(8), 1340–1350. https://doi.org/10.2106/00004623-200208000-00015