Exercise Therapy

Isometric quadriceps strength testing is considered suitable for TKR patients and may cause less pain than isotonic testing. Combined exercise programmes may have broader effects than aerobic exercise alone by improving respiratory function and upper airway stability. Strengthening exercises target a Borg rating of perceived exertion of 17–18 to promote maximal strength development and muscle hypertrophy. Each intervention session lasts 60 minutes including rest periods. The programme includes weekly high-intensity interval training, moderate aerobic exercise, and strength training. Participants must complete at least three exercise sessions and at least 2.5 hours of exercise per week. Each exercise session lasts 40 minutes and is delivered once daily, five days per week, for three weeks. The structured presleep exercise programme includes breathing, aerobic, strengthening and oropharyngeal exercise with rest breaks. Exercise progression varies by individual and is guided by preference, pain response, and functional progression. Exercise therapy starts within 5 minutes after active or sham stimulation. Strength training workload is adjusted by coaches to target 8 to 10 repetitions…