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PEP-TALK is a pragmatic multi-centre, randomised controlled trial which will test a group exercise and behaviour change treatment which targets barriers people have which can stop them being physically active, to maximise their 'whole-body' health and the effect of this on their NHS needs.


Over 206,000 hip and knee replacements were performed in the United Kingdom (UK) last year. As well as joint pain, half of these people have other diseases such as high blood pressure, heart disease, diabetes and depression.

Physical activity is known to improve these conditions. Before a hip or knee replacement, it can be difficult to be physically active because of pain and fatigue. It is hoped that after joint replacement, this improves so people can be more active. However, people after hip or knee replacement are often no more active than before and, importantly, do not know how to be. They miss out on some of the health benefits which joint replacement can offer.

Aims and objectives

The aim of this trial is to answer the research question: Does a group exercise and behaviour-change intervention targeted to increase physical activity participation increase health related quality of life (HRQoL) and clinical outcomes following a total hip or total knee replacement?

Study design

The PEP-TALK trial is being conducted across three cities in the UK (Oxford, London, Norwich). In total 250 people will be randomised to have treatment consisting of either (a) six sessions (once weekly) behaviour change treatment and physiotherapy group exercise with other people after their hip or knee replacement, and three follow-on telephone calls, or (b) six sessions (once weekly) physiotherapy group exercise alone (no behaviour change treatment nor follow-up phone calls). Patients will be asked to complete questionnaires to measure the benefits of each treatment six and 12 months after their operation.

If shown to be effective, this group-based treatment for people who have difficulty in being more active, could improve these individual's health and well-being, and could save the NHS money by reducing visits to GP practices because of other medical problems which physical activity can reduce.


PEP-TALK is led by Dr Toby Smith (NDORMS, University of Oxford). If you would like to know more about the study, please contact the research team on


Miss Caroline Hing (St George’s University Hospital NHS Foundation Trust)

Professor Iain McNamara (Norfolk and Norwich University Hospitals NHS Foundation Trust)

Miss Ines Reichert (Kings College London Hospital NHS Foundation Trust)

Trial Publications

The study protocol publication can be found here.

The statistical analysis plan publication can be found here.

The primary publication can be found here.

Related research themes