Returning after illness or surgery

How soon can you exercise after surgery?

After most major operations, hospitals encourage very gentle movement almost straight away. You may be asked to sit up in bed or stand briefly on the day of surgery, then get up and walk around your bed the next day¹.

Early movement is said to help blood flow, wound healing and muscle strength². The earlier you get out of bed and start walking, the shorter your recovery tends to be⁵. Even so, don't rush: start by moving from your bed to a chair¹, then build up gradually, and don't push on because you have had a good day.

Your surgical team sets the limits for your operation, so follow the restrictions they give you. Keep a healing wound out of water, such as baths and swimming pools, until it has completely healed or your doctor says it is safe². Ask your team too about when you can return to more vigorous exercise or sport.

For some operations, a guided exercise programme adds to this. After a knee replacement, physiotherapy exercise is linked with better physical function and less pain at 3–4 months than minimal physiotherapy, although the benefit was short-term⁶. After hip fracture surgery, gait, balance and functional training probably gives a moderate improvement in mobility⁷.

How do you rebuild after a long illness?

Start very small and build up slowly. If you are not used to walking outside, begin with about 20 metres and, if possible, add about 10 metres a day³. Walk at a speed that is comfortable, where you could still hold a conversation, and stop and rest when you are tired³. Resting is part of rebuilding.

Set small goals for time out of bed: sitting in a chair, standing next to your bed and taking short walks⁴. Break bigger jobs into smaller steps and spread them through the day.

Some physical activity is better than none. The WHO's longer-term goal for adults is 150–300 minutes of moderate-intensity activity a week, or 75–150 minutes of vigorous-intensity activity. It advises starting with small amounts and gradually increasing how often, how hard and how long you are active⁸. Doing less than the goal isn't wasted.

Adults living with a long-term condition (such as high blood pressure, type 2 diabetes, HIV or after cancer) or with a disability should aim for the same amounts where they can. If they can't, any activity they're able to do brings benefits.

For adults with post-COVID-19 condition, people given a rehabilitation programme walked about 36 metres further in a 6-minute walking test than those given usual care⁹.

Who should guide your return to activity?

After surgery or a hospital stay, your hospital team is your first guide. On the ward, nurses and physiotherapists can help you get moving and give pain relief if you need it⁴. Ask for help if you need it¹.

Depending on your operation, you may see a physiotherapist before you leave hospital, who can advise you about any exercises to do¹⁰. You can also ask your doctor which exercises you should be doing after the operation². Once you are home, ask your doctor whether a supervised or home-based rehabilitation programme is available to you.

Home-based rehabilitation looked similar to centre-based programmes in adults with heart failure¹¹. After a knee replacement, home-based and outpatient physiotherapy gave similar results for physical function and pain, although whether they are fully equivalent isn't yet conclusive⁶.

If you have post-COVID-19 condition, supervised programmes are favoured, and health professionals should monitor you closely while you build up⁹. If you have had COVID-19 and are struggling with fatigue, ask your doctor about supervised rehabilitation before you start building up.

When to check with a health professional

Exercise doesn't replace prescribed medicines or treatment. Keep taking them as prescribed, and talk to your doctor before changing or stopping them.

If you're starting exercise after a long break, it's always a good idea to see your doctor first. For an injury or a health condition, see a health professional, such as your doctor or a physio.

Call your local emergency number for chest pain or pressure (or pain spreading to the arm, neck, jaw or back, especially with sweating or feeling sick), severe breathlessness, fainting or collapse, signs of a stroke, a serious injury, or someone who isn't safe.

For anything else, such as a sore muscle or joint, or pain that makes an activity hard, ease off. Get advice from a doctor or physiotherapist if it persists or gets worse. Some muscle soreness is expected when you build up gradually, but exercise doesn't have to hurt to work. If you develop new symptoms as you increase your activity, talk to a healthcare provider. If you feel unusually tired, don't push through it: get it checked by a doctor.