Home-Based Physical Therapy: The Key to Recovery After Abdominal Surgery

After major abdominal surgeries such as esophagectomy, gastrectomy, colectomy, or inguinal hernia repair, restoring physical function is a key factor in helping patients return to normal life as soon as possible. Home-based physical therapy plays an important role in accelerating recovery, reducing pain, and preventing postoperative complications. This article from University Medical Center Ho Chi Minh City (UMC) provides detailed guidance on safe and effective physical therapy exercises that patients can confidently perform at home.

1. Introduction

Abdominal surgery, including complex procedures such as esophagectomy, gastrectomy, colectomy, and inguinal hernia repair, often presents significant challenges during recovery. Patients may experience pain, fatigue, reduced mobility, and an increased risk of postoperative complications [1]. Personalized and scientifically designed home-based physical therapy is an essential component of comprehensive care, helping patients regain their health and quality of life [2].

2. The Importance of Home-Based Physical Therapy After Abdominal Surgery

Home-based physical therapy provides many practical benefits and plays an important role in patients' overall recovery after abdominal surgery:

Promoting Wound Healing

Gentle and appropriate movement helps improve blood circulation and deliver oxygen and nutrients to the surgical site, thereby supporting faster wound healing [1]. Exercise can also help reduce swelling and improve the flexibility of soft tissues surrounding the incision.

Preventing Complications (Pneumonia, Thrombosis, and Adhesions)

Prolonged immobility after surgery can lead to various serious complications. Physical therapy can help:

Prevent pneumonia: Deep-breathing exercises and controlled coughing help keep the airways clear, remove mucus, and expand the alveoli, reducing the risk of atelectasis and pneumonia [3, 4].
Reduce the risk of thrombosis: Leg exercises and early mobilization improve blood circulation and help prevent blood clots from forming in the lower limbs, known as deep vein thrombosis (DVT) [5].
Reduce the risk of intestinal adhesions: Early mobilization after abdominal surgery has been shown to help reduce the risk of intestinal adhesions, a common complication that can cause bowel obstruction [1].

Improving Strength and Physical Function

After surgery, muscles often become weaker due to reduced physical activity and the effects of the surgical procedure. Home-based physical therapy involving strengthening and balance exercises can gradually help patients regain:

Muscle strength, particularly in the abdominal and leg muscles.
Joint range of motion.
Balance and coordination [1].

Reducing Pain and Dependence on Medication

Gentle movement may help reduce postoperative pain and discomfort, thereby reducing reliance on pain medication. One study found that bed exercises could significantly reduce pain and anxiety in patients after abdominal surgery [2]. As patients become more independent in their movement, anxiety may also improve.

3. General Principles of Home-Based Physical Therapy

To ensure safe and effective rehabilitation, patients should follow these principles when performing physical therapy at home:

Listen to Your Body and Avoid Overexertion

Never push yourself beyond your limits or try to tolerate pain during exercise. Pain may indicate that you are doing too much or performing an exercise incorrectly. Stop, rest, and modify the exercise if you experience sharp pain or severe discomfort.

Start Gently and Gradually Increase the Intensity

Recovery is a step-by-step process. Begin with simple, gentle exercises and gradually increase the duration, number of repetitions, or difficulty as your body adapts. This allows the body to rebuild strength safely [1].

Maintain Consistency

Consistency is more important than intensity. Try to exercise several times a day for short periods rather than completing one long session. For example, walking short distances several times throughout the day is generally preferable to walking a long distance all at once.

Maintain Proper Posture and Breathing Technique

Always pay attention to your posture when performing exercises. Proper breathing technique—breathing in through the nose, breathing out through the mouth, and engaging the diaphragm—is fundamental to many pulmonary and abdominal rehabilitation exercises [4].

Monitor for Abnormal Signs

During exercise, watch for any unusual symptoms, such as:

Increasing or persistent pain.
Fever, redness, swelling, or unusual discharge from the surgical wound.
Shortness of breath or chest tightness.
Dizziness or nausea.
Swelling or pain in the legs [1].

If any of these symptoms occur, stop exercising and contact your doctor or physical therapist immediately.

4. Home-Based Physical Therapy Exercises by Recovery Stage

The exercises below are divided into recovery stages to make them easier for patients to follow.

Early Stage (Immediately After Discharge – Weeks 1–2)

During this stage, the main goals are to maintain blood circulation, prevent pulmonary complications, and begin gentle movement.

Deep-breathing exercises:
- Lie on your back or sit upright, placing one hand on your chest and the other on your abdomen.
- Slowly breathe deeply through your nose and feel your abdomen rise.
- Slowly exhale through your mouth and feel your abdomen fall.
- Perform 5–10 repetitions, 3–4 times a day [2, 4].
Controlled coughing exercises:
- Sit upright and hold a soft pillow against your abdomen to support the surgical site.
- Take a deep breath.
- Cough firmly and deliberately 2–3 times in succession.
- This exercise helps clear mucus and prevent atelectasis [4].
Bed-based leg exercises (ankle pumps and knee flexion/extension):
- While lying on your back, flex and extend your ankles up and down 10–15 times.
- Rotate each ankle clockwise and counterclockwise 10 times in each direction.
- Flex and extend each leg on the bed, sliding your heel along the mattress.
- Perform these exercises 3–4 times a day to improve circulation in the lower limbs [2].
Changing positions (rolling and sitting up):
- Slowly roll onto one side and use your elbow and hand for support to raise your upper body.
- When sitting up, place both hands on the bed and slowly push yourself up while bringing your legs over the side of the bed. Avoid excessively engaging your abdominal muscles [2].
Gentle walking indoors:
- Start by walking short distances around the room or hallway, with assistance if needed.
- Gradually increase the duration and distance as you become more comfortable.
- The goal is to walk for a few minutes every hour while awake [2, 6].

Intermediate Recovery Stage (Weeks 3–6)

During this stage, patients can gradually increase exercise to improve strength and endurance.

Increasing walking:
- Gradually increase the duration and distance walked each day. You may walk outdoors on level ground.
- Goal: 15–30 minutes per session, 2–3 times a day.
Gentle core-strengthening exercises (abdominal contractions and gentle leg raises):
+ Abdominal contractions: Lie on your back, breathe deeply, and gently draw your abdominal muscles inward. Hold for 5 seconds, then relax. Do not hold your breath.
+ Straight-leg raises: Lie on your back with one leg bent and the other extended. Slowly raise the extended leg a few centimeters off the floor, hold for 3–5 seconds, and then lower it.
- Perform 10–15 repetitions on each side, 1–2 times a day.
Full-body stretching: Gentle stretching exercises for the legs, arms, shoulders, and back help maintain flexibility and reduce muscle tension.
Balance exercises: Stand upright and balance on one leg for 10–15 seconds, then switch legs. Hold onto a chair or wall for support if necessary.

Advanced Recovery Stage (After 6 Weeks and Beyond)

Once the surgical wound has fully healed and your health is stable, you may progress to more advanced exercises.

Increasing walking intensity and duration: You may progress to brisk walking or begin other light physical activities, such as stationary cycling or swimming, after receiving approval from your doctor.
Light strengthening exercises (light weights and bodyweight squats):
+ Light weights: Use small hand weights (0.5–1 kg) for arm and shoulder exercises.
+ Bodyweight squats: Stand upright with your feet shoulder-width apart. Slowly lower your hips as if sitting in a chair while keeping your back straight.
- Always begin with light resistance and a small number of repetitions, then gradually increase as your body adapts.
Flexibility exercises: Continue stretching exercises and gradually incorporate gentle yoga or tai chi.
Daily physical activities: Gradually resume normal daily activities and work, while continuing to avoid heavy lifting or sudden strenuous exertion.

5. Special Considerations for Different Types of Surgery

Although there are general principles, each type of surgery has specific considerations.

After Esophagectomy/Gastrectomy

Prioritize breathing exercises: Patients undergoing esophagectomy or gastrectomy may have a higher risk of pulmonary complications [3]. Therefore, deep-breathing exercises, controlled coughing, and the use of an incentive spirometer are particularly important and should be performed regularly [4].
Early mobilization: Early movement and position changes can improve pulmonary function and reduce the length of hospital stay [3, 6].
Monitor nutritional status: Poor nutritional status before surgery may affect recovery of muscle strength and respiratory function [3].

After Colectomy

Focus on overall mobility: Walking and upper- and lower-limb exercises can help stimulate bowel motility, reduce bloating, and prevent intestinal adhesions [1].
Support the abdominal area: When coughing, sneezing, or standing up, gently support the abdomen with your hand or a soft pillow to reduce pressure on the surgical site.

After Inguinal Hernia Repair

Avoid increased intra-abdominal pressure: Do not lift heavy objects, forcefully cough, or strain during bowel movements during the first few weeks after surgery to reduce the risk of hernia recurrence.
Gentle core exercises: Once the surgical wound has stabilized, gentle core-strengthening exercises may be initiated to support the abdominal wall, but they should be performed under the guidance of a physical therapist.
Walking: Gentle walking is an appropriate exercise during the early recovery period, helping improve blood circulation without placing excessive stress on the surgical site.

6. When to Follow Up or Contact Your Doctor/Physical Therapist

Contact your surgeon or physical therapist immediately if you experience any of the following:

Increasing or persistent pain: Pain does not improve or becomes worse despite taking pain medication and resting.
Fever, redness, or swelling at the surgical site: These may be signs of infection.
Shortness of breath or chest tightness: These may indicate pulmonary or cardiovascular complications.
Other abnormal symptoms: Swelling, pain, warmth, or redness in the leg, which may indicate deep vein thrombosis; dizziness; persistent nausea; or inability to eat, drink, or have a bowel movement.

7. Frequently Asked Questions (FAQ)

Can I start exercising immediately after discharge? Yes. Early mobilization is important. Begin with gentle exercises such as deep breathing, ankle movements, and short walks indoors as soon as your doctor allows [2].
How long should I exercise each day? During the early stage, exercise 3–4 times a day for 5–10 minutes each session. Gradually increase the duration to 15–30 minutes per session as your body adapts, or follow the recommendations of your physical therapist [1].
Are there any exercises I should avoid? During the first few weeks, avoid exercises that place significant strain on the abdominal muscles, heavy lifting, twisting, or sudden bending. Specifically, do not lift objects weighing more than 2–3 kg during the first 4–6 weeks [1].
Can I exercise if my surgical wound is still painful? Mild pain may be normal, but you should not exercise to the point of experiencing sharp or severe pain. Listen to your body and reduce the intensity or stop if the pain increases. You may use your hand or a pillow to support the surgical site during movement.
When can I return to normal activities? Full recovery varies depending on the individual and the type of surgery. It may take several weeks to several months to return to normal activities. Always consult your doctor or physical therapist before resuming strenuous physical activities or physically demanding work.

8. Medical Review and References

Medical Consultant:

Tran Phuong Lien, RN – Department of Gastrointestinal Surgery, University Medical Center Ho Chi Minh City

References:

[1] Thomas J Hoogeboom, Jaap J Dronkers, Erik HJ Hulzebos, Nico LU van Meeteren. Merits of exercise therapy before and after major surgery. Curr Opin Anaesthesiol, 2014. PMC4072442. Accessed: 2025-12-05.
[2] Zuleyha Simsek Yaban, Semra Bulbuloglu, Gurkan Kapikiran, Huseyin Gunes, Sennur Kula Sahin, Serdar Saritas. The effect of bed exercises following major abdominal surgery on early ambulation, mobilization, pain and anxiety: A randomized-controlled trial. Int Wound J, 2023. PMC10824625. Accessed: 2025-12-05.
[3] Karina H Tukanova, Swathikan Chidambaram, Nadia Guidozzi, George B Hanna, Alison H McGregor, Sheraz R Markar. Physiotherapy Regimens in Esophagectomy and Gastrectomy: a Systematic Review and Meta-Analysis. Ann Surg Oncol, 2021. PMC8990957. Accessed: 2025-12-05.
[4] Anandi R Dave, Tejaswini B Fating. Optimizing Recovery: A Comprehensive Case Report on Physiotherapy Rehabilitation in Esophagectomy Patients. Cureus, 2024. PMC11285731. Accessed: 2025-12-05.
[5] N Schuring, S J G Geelen, M I van Berge Henegouwen, S C M Steenhuizen, M van der Schaaf, M van der Leeden, S S Gisbertz. Early mobilization after esophageal cancer surgery: a retrospective cohort study. Dis Esophagus, 2022. PMC10226266. Accessed: 2025-12-05.
[6] Mateusz Rubinkiewicz, Jan Witowski, Michael Su, Piotr Major, Michał Pędziwiatr. Enhanced recovery after surgery (ERAS) programs for esophagectomy. J Thorac Dis, 2019. PMC6503272. Accessed: 2025-12-05.

The information above is provided for reference purposes only and does not constitute medical advice or recommendations. Please contact your doctor for detailed medical consultation.