Increasing daily steps may boost recovery after surgery

In the study, researchers analyzed data from the All of Us Research Program, which included 1,965 adults undergoing inpatient surgery. The team found consistent links between higher daily step counts and meaningful improvements in recovery outcomes.

These benefits were observed across a wide range of procedures and patient health profiles.

After accounting for factors such as age, sex, and surgical risk, the researchers found that each additional 1,000 steps taken per day after surgery was associated with an 18% reduction in the odds of complications, a 16% reduction in the likelihood of hospital readmission, and a 6% shorter hospital stay.

The research team also compared step counts with other common recovery indicators, such as heart rate variability and self-reported wellness scores.

In the study, neither of these measures predicted better recovery, nor were they linked to how long patients stayed in the hospital, whether they had complications, or whether they were readmitted.

Clinicians have long encouraged patients to walk after surgery, but have lacked precise ways to track how much activity actually occurs. These results suggest that wearable devices could provide objective data on patient movement and a reliable way to monitor recovery in real time.

While the findings are promising, they raise an important question: do patients recover better because they walk more, or do they walk more because they feel better?

According to the researchers, the answer is likely a combination of both. However, the strength of the association suggests that physical activity plays an active role in recovery, rather than just reflecting it.

Medical News Today asked senior author of the study and professor and chair of the Department of Surgery at The Ohio State University Wexner Medical Center in Columbus, OH, Timothy Pawlik, MD, PhD, MPH, whether increasing steps directly improves outcomes, or reflects that a patient is already recovering well.

“This is an important question. Our study shows a strong association between higher postoperative step counts and better surgical outcomes, including shorter length of stay, fewer complications, and lower readmission risk. However, because this was an observational study, we cannot say with certainty that walking more directly caused those better outcomes.”
–Timothy Pawlik, MD, PhD, MPH, MTS, MBA, FACS

“That said, we were very mindful of this issue in our analysis. One concern in this type of study is reverse causation — meaning that a complication could occur first, and then the patient’s step count drops because they became sick,” he added.

“To reduce that possibility, for outcomes such as complications and readmissions, we focused on wearable data collected before the first documented complication or readmission, rather than including step-count data after the event had already occurred,” Pawlik continued.

“The most accurate interpretation is that step count likely functions in two ways,” he told MNT. “First, it is a marker of recovery: Patients who are doing well are more likely to move more.”

“Second, it may also be a modifiable part of recovery, because early mobility can help preserve lung function, reduce deconditioning, lower the risk of blood clots, and support overall physiological recovery. So, step count should not be viewed as a magic number by itself, but rather as a real-time signal that helps clinicians understand whether a patient is recovering as expected,” Pawlik noted.

“The next step would be prospective studies or clinical trials where patients are assigned structured, personalized mobility goals to determine whether increasing steps can directly improve outcomes,” he said.

The researchers add that a drop in step count could also serve as an early warning sign, prompting clinicians to intervene sooner by involving physical therapy or increasing follow-up, for example.

“A drop-in-step count should be treated as a signal, not as a diagnosis,” Pawlik told MNT. “It should prompt the care team to ask why the patient is moving less.”

“Sometimes the reason may be expected fatigue or pain. But in other cases, a sudden or sustained decline could reflect an emerging problem such as poorly controlled pain, dehydration, nausea, shortness of breath, infection, anemia, wound issues, medication side effects, or another postoperative complication,” he explained.

According to him: “The most useful response would be a targeted clinical check-in. That could include a phone call or telehealth visit, review of symptoms, pain-control optimization, physical therapy support, respiratory therapy when appropriate, medication adjustment, hydration and nutrition support, or bringing the patient in for evaluation if concerning symptoms are present.”

The results are also consistent with earlier findings presented at the ACS Clinical Congress in 2023, which showed that patients who took more than 7,500 steps per day before surgery had a 51% lower risk of postoperative complications.

Together, these studies highlight the importance of maintaining and restoring mobility both before and after surgery.

A key advantage of utilizing step tracking is its simplicity. Unlike more complex physiological measures, step counts are easy to understand and act on.

The researchers suggest that incorporating step goals into surgical care plans could help guide decisions, such as when a patient is ready for discharge or whether they may need additional support at home.

“In general, patients should begin mobilizing as soon as it is medically safe and consistent with their surgical team’s instructions,” Pawlik told MNT.

“For many operations, this may begin in the hospital within the first day after surgery, even if that simply means sitting up, standing, or taking short, assisted walks. The goal is usually gradual progression rather than sudden increases,” he added.

“Our study evaluated step-count changes over the postoperative period, so it does not identify one exact day when mobility becomes beneficial,” Pawlik cautioned.

“However, the broader clinical principle is that early, safe, and progressive mobilization is an important part of enhanced recovery after surgery. Wearable devices may help us move from vague advice like ‘try to walk more’ to more precise guidance, such as whether a patient is steadily moving back toward their own baseline.”
–Timothy Pawlik, MD, PhD, MPH

While the findings are promising, it is important to note that activity goals should always be tailored to the individual. Factors such as overall health, type of procedure, and existing medical conditions all influence what level of activity is safe and appropriate.

“Step-count targets should be personalized,” Pawlik emphasized to MNT. “A healthy patient undergoing a lower-risk procedure should not have the same goal as an older patient with multiple medical conditions recovering from a major abdominal or thoracic operation.”

“For that reason,” he said, “we believe the most useful target may not be a universal number, such as ‘10,000 steps,’ but rather a patient-specific trajectory: How quickly the patient is returning toward their own preoperative baseline.”

“This was also how we approached the analysis in the study. Rather than only looking at a single absolute step-count cutoff, we used each patient as their own point of reference by comparing postoperative activity with that patient’s preoperative baseline. That is important because a meaningful recovery target for one person may be very different from the target for another person,” noted the researcher.

“For example, a patient who normally walks 8,000 steps per day may have a very different recovery target than someone whose baseline is 2,000 steps per day. A meaningful warning sign may be a sustained drop from that individual’s usual activity level, especially if it does not improve over time,” he said.

“Our study did not define a precise step-count threshold where benefits plateau. It is very possible that the relationship is not linear forever,” Pawlik told us.

“At some point, more steps may not add additional benefits, and excessive activity could even be inappropriate depending on the surgery. The key message is not that every patient should simply walk as much as possible, but that wearable data can help clinicians set safe, individualized, and risk-adjusted mobility goals,” the researcher concluded.

This study adds to growing evidence that movement is a key component of recovery. By turning something as simple as step counts into a measurable target, wearable technology could help transform how recovery is monitored, and improved, after surgery.