Early implementation of exercise to facilitate recovery after elective colorectal surgery—a randomized clinical pilot trial

Abstract Background Early mobilization is a key component of enhanced recovery after elective colorectal surgery. This pilot trial evaluated the safety and feasibility of an early supervised postoperative exercise intervention in addition to standard care. Methods In this single-center randomized controlled pilot trial, 31 patients undergoing elective colorectal surgery were randomized to an intervention group ( n = 16) or control group ( n = 15). One patient withdrew after randomization, leaving 30 patients for modified intention-to-treat analysis. The intervention consisted of individualized, physiotherapist-supervised exercise sessions on postoperative days 1, 3, and 5. The control group received standard postoperative care according to the institutional ERAS protocol. The originally registered primary endpoint was time to first bowel movement; prior to final analysis, safety and feasibility were designated as the primary outcomes in accordance with the pilot nature of the study. The change was documented transparently. Secondary outcomes included physical performance (Short Physical Performance Battery [SPPB], handgrip strength), time to first bowel movement, patient-reported outcomes, and postoperative complications. Results Thirty patients completed the study (retention 96.8%). Adherence to the intervention was 100%, and no intervention-related adverse events occurred. The intervention group showed significantly better preservation of physical performance, reflected by a more favorable change in SPPB score from baseline to postoperative assessment. No significant between-group differences were observed for time to first bowel movement, handgrip strength, postoperative complications, or other secondary outcomes. Conclusions Early supervised postoperative exercise after elective colorectal surgery was safe and feasible. Although no differences were found for most secondary outcomes, the intervention improved postoperative physical performance. These exploratory findings warrant confirmation in adequately powered randomized trials. Trial registration German Clinical Trials Register, DRKS00036327 (retrospectively registered, 22.04.2025).