What is the recommended amount and frequency of walking for a post-operative patient on day 3?

Postoperative Day 3 Walking Recommendations

On postoperative day 3, patients should walk twice daily under physiotherapy supervision, with the goal of mobilizing for at least 1-2 hours total per day (approximately 7-13% of waking hours), as early mobilization significantly reduces respiratory complications and improves functional recovery. 1

Optimal Walking Frequency and Duration

• Walk twice daily with physiotherapy supervision, as this represents the evidence-based standard for early postoperative mobilization 1
• Patients should aim to spend 1.2 to 1.9 hours per day mobilized (sitting, standing, or walking combined), which translates to approximately 7-13% of monitored time 2
• Intensive mobilization (multiple sessions daily) achieves functional objectives faster than once-daily mobilization, though both approaches show benefit 1

Critical Implementation Strategy

• Remove all impediments to mobilization by day 3, including chest tubes, urinary catheters, and invasive lines, as these barriers significantly restrict movement 1
• Ensure adequate pain control before mobilization attempts, as pain is the primary barrier to effective early movement—patients with average pain scores ≤3 mobilize 1.9 hours/day versus only 1.2 hours/day for those with pain scores ≥6 2
• Supervised exercise is superior to unsupervised activity, with physiotherapist-directed protocols demonstrating significantly better outcomes 1

Specific Walking Protocol

• Begin with short walking distances progressing as tolerated, incorporating sitting and standing exercises between walking bouts 1
• Include active range of motion exercises for all extremities during mobilization sessions, as muscular exercise reduces respiratory morbidity 1
• Consider static cycling or bicycling exercises as validated alternatives that provide systemic benefit when walking is limited 1

Clinical Context by Surgery Type

For Total Knee Arthroplasty Patients:

• Full weight-bearing walking with twice-daily physical therapy should be initiated on day of surgery and continued through day 3 3
• Patients are typically discharged on postoperative day 3 and enrolled in outpatient physical therapy 3 days per week 3

For Cardiac Surgery Patients:

• No physical restrictions apply after 2 weeks, but by day 3-4 patients should be ambulatory enough for discharge 3
• Standard sternal precautions are unnecessary for thoracotomy approaches 3

Critical Pitfalls to Avoid

• Waiting beyond day 3 to mobilize results in increased atelectasis, pleural effusion, and pneumonia requiring antibiotic therapy 1
• Inadequate pain control is the primary modifiable barrier—each unit increase in pain score decreases mobilization time by 0.12 hours/day 2
• Poor mobilization correlates with complications: patients in the lowest mobilization quartile had 6% complication rates versus 0% in the highest two quartiles 2
• Failing to remove drains and catheters promptly impedes mobilization and prolongs hospital stay 1

Monitoring and Progression

• Early mobilization starting on postoperative days 1-3 significantly decreases atelectasis, pleural effusion, and pneumonia requiring antibiotic therapy 1
• Patients should be assessed daily for appropriate and safe methods of transfer and mobilization using early warning scoring systems to identify those at risk for adverse events 1
• Mobilization should occur 7 days per week with progressive increases in duration and intensity based on tolerance 1