IMPORTANCE: While total knee replacement (TKR) is the definitive treatment for knee osteoarthritis, physical activity remains unchanged after surgery. OBJECTIVE: The objective of this trial was to examine the efficacy of a physical therapist-administered physical activity intervention to increase moderate-to-vigorous physical activity (MVPA) over 6 months for adults after TKR. DESIGN: This was a randomized controlled trial. SETTING: The study took place in an outpatient physical therapist clinic. PARTICIPANTS: Included were 120 adults over the age of 45 years seeking outpatient physical therapy following a unilateral TKR. INTERVENTIONS: Participants received standardized physical therapy after TKR and a wearable activity tracking device, individualized step goals, and face-to-face feedback provided by a physical therapist (intervention), or standardized physical therapy alone (control). MAIN OUTCOME AND MEASURE: The primary outcome was change in MVPA recorded by a hip-worn Actigraph GT3X accelerometer from baseline to 6 months after discharge from physical therapy. RESULTS: MVPA similarly increased from baseline to 6 months within the intervention (median 6.0 minutes per day (semi-interquartile range 11.9)) and control group (median 5.9 minutes per day (semi-interquartile range 14.3)). There was no between-group difference in MVPA change over time. CONCLUSION: A physical therapist-administered physical activity intervention resulted in a similar increase in MVPA over 6 months compared to standardized physical therapy for adults after TKR. RELEVANCE: Adding a wearable activity tracking device and individualized step goals may not increase physical activity for adults after TKR receiving outpatient physical therapy.

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