Early postoperative exercise enhances recovery after gastrectomy: a randomized clinical trial

Background: Surgery for gastric cancer often leads to physical decline, delaying the return to normal life and adjuvant chemotherapy. This study evaluated whether an early, structured postoperative exercise program accelerates the recovery of physical function after gastrectomy. Materials and methods: This two-arm randomized trial was conducted from 3 January 2023 to 25 July 2024 at a tertiary referral center in Seoul, Korea. Fifty-two patients with stage I–III gastric cancer scheduled for minimally invasive surgery were randomly assigned (1:1) to either an exercise intervention or usual care. The exercise group received hybrid supervised and unsupervised inpatient exercise sessions [15–30 minutes on postoperative days (PODs) 1 and 2], plus a 4-week home-based program that included two 30-minute supervised remote sessions weekly and daily self-directed low- to moderate-intensity aerobic and body-weight exercises. The primary outcome was the recovery of physical function, defined as a Short Physical Performance Battery score ≥100% of baseline. Secondary outcomes included C-reactive protein (CRP) levels, grip strength, sit-to-stand performance, and complications. Analyses followed intention-to-treat principles. Results: Of 52 randomized participants, 51 (exercise, n = 26; usual care, n = 25) were analyzed and 45 (87%) completed the trial. At POD 3, 61.5% of participants in the exercise group achieved full physical function recovery compared with only 20% in the usual care group [risk ratio (RR), 3.08 (95% confidence interval [CI], 1.33–7.13); P = .006]. At 4 weeks, recovery remained significantly more likely in the exercise group (84.6% vs. 52.0%; RR, 1.63 [95% CI, 1.08–2.45]; P = .020). CRP levels were significantly lower over time in the exercise group ( P = .022). Grip strength and sit-to-stand performance did not differ between groups. No exercise-related adverse events occurred. Conclusion: An early, structured postoperative exercise program safely accelerated functional recovery and reduced systemic inflammation after gastrectomy in patients with gastric cancer. These findings support integrating early exercise into enhanced recovery protocols to promote earlier rehabilitation and the timely initiation of adjuvant therapy.