Josh, there is a lot that you can have her do in the water ... not just traditional swimming ... I have treated many arthritic people pre-op in the pool.
1. She can do HIIT type walking (remember that intervals are individual, so a "sprint" for her might just be a fast walk, while recover might be a slow walk) forwards, sideways, and backwards. The deeper the water, the less impact on her joints ... chest deep is ideal for her probably but even waist deep would help.
2. Open-chain hip movements ... hip abduction, adduction, extension (with knee straight and bent), flexion, and circumduction; knee flexion (like kicking herself in the butt); as well as squats, lunges, step ups, heel/toe raises. With the open-chain stuff, have her do it bilaterally so that she is working on stability when doing it on her "good" leg.
3. Kicking with a kickboard ... flutter and whip/frog ...
4. Treading water.
As for diet, if the low-carb thing is working for now, then stick with it ... best of luck to her ... also feel free to PM me any questions related to her surgery/recovery ... I've treated many overweight people who've been very successful with THR.
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