Physical Therapy
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Recovering from major surgery, such as Cytoreductive Surgery (CRS) with or without HIPEC is a journey - and movement is one of the most powerful tools you have for rebuilding strength, preventing complications, and returning to normal life. Physical therapy (PT) is more than just exercise; it is a structured, medically informed plan designed to help your body heal safely and steadily. And physical therapy doesn’t end when you leave the clinic - physical therapy can and should continue at home!
This guide explains why PT is so important, what you’ll be doing in the hospital and at home, and how physical therapy supports long-term recovery.
Why Physical Therapy Is Essential After CRS/HIPEC
CRS/HIPEC is a major abdominal operation. The body needs time to recover, but it also needs intentional movement to avoid complications and rebuild strength.
Physical therapy is important because it helps with several critical elements of healing: Preventing serious complications, Restoring strength and stamina, Reducing pain and stiffness, Supporting digestion and bowel function, Improving mood and confidence, Returning to daily life [1,3].
Movement reduces the risk of:
Blood clots [1]
Pneumonia [6]
Pulmonary issues from shallow breathing [6]
Postoperative ileus (slowed bowel function) [1]
Muscle loss [1]
Even a few days in bed can weaken muscles. PT helps you regain:
Core and leg strength [1]
Balance [1]
Endurance for walking [1]
Functional movement (getting in/out of bed, chairs, stairs) [1]
Movement improves circulation and decreases:
Surgical soreness
Back pain
Gas and bloating pressure
Joint stiffness
And walking is one of the most effective ways to stimulate the return of normal bowel activity after CRS/HIPEC. [1]
PT supports a return to:
Work
Family responsibilities
Hobbies
Social activities
Independence in self-care
Physical activity naturally boosts mental health and helps patients feel more in control of their healing.
Physical Therapy in the Hospital
Physical therapy usually begins on postoperative day 1, as part of Enhanced Recovery After Surgery (ERAS) guidelines [2]. Your hospital PT team will guide you through safe activities, such as:
Breathing Exercises: To prevent pneumonia and improve lung expansion. [6]
Bed Mobility: Learning how to move, roll, and sit up with minimal strain on the surgical site.
Transfer Training: Learning how to safely get in and out of bed, chairs, toilet, car, and others. [1]
Assisted Walking: You’ll start with short distances, then gradually increase as tolerated. Many patients walk several times a day before discharge. [1]
Gentle Leg and Core Activation: Very simple movements to wake up the muscles and prevent weakness.
Stair Training: Before discharge, PT will make sure you can navigate stairs safely if you have them at home.
These sessions are tailored to your energy level and medical status—slow and steady is the goal.
Physical Therapy After You Go Home
After discharge, your physical therapy plan expands to help you rebuild long-term strength. Most patients engage in structured home exercise and walking programs, which are shown to improve recovery, endurance, and quality of life. [1,3]
Home exercises through simple routines such as:
Gentle stretching
Leg and core strengthening
Posture and balance exercises
Walking schedules
Walking Program: Movement is one of the most important parts of recovery. It is helpful with improving energy levels, digestion, emotional well-being, and - importantly - sleep. A typical progression may look like:
Week 1–2: Short walks several times a day
Week 3–4: Increased distance and pace
Month 2–3: Longer daily walks, increasing stamina
Outpatient Physical Therapy (If Recommended): Some patients benefit from formal outpatient PT, especially if they experience:
Significant deconditioning
Weakness or mobility issues
Pain that limits movement
Balance concerns
An outpatient therapist will help you regain full strength and function.
Understanding Your Limits: Listening to Your Body
PT after CRS/HIPEC is not about pushing to exhaustion. Movement should help you feel better — not worse. Here are some simple guidelines to keep in mind. [1,3]
Mild soreness is normal
Sharp or increasing pain is a signal to stop
Fatigue means it’s time to rest
Hydration is essential
Slow progress is still progress
Your therapist will teach you how to pace activity and rest effectively.
Physical Therapy, the Core, and the Incision
CRS/HIPEC involves major abdominal incisions and sometimes muscle disruption. [1,2]
PT helps you safely rebuild:
Deep core stabilizers
Back muscles
Pelvic floor strength
Balance and functional movement
Rebuilding the core is essential for:
Lifting
Standing
Walking long distances
Preventing back pain
Returning to work or physical hobbies
Therapists will guide you in protecting the incision while gradually reactivating the abdominal wall.
Gentle Movement, Stretching, and Yoga
Many patients benefit from:
Gentle yoga
Light stretching
Balance exercises
Pelvic floor relaxation
Controlled breathing
These support flexibility, mobility, and stress reduction. [1,3]
You should avoid:
Heavy lifting
Intense core exercises
High-impact workouts
Twisting or straining movements until cleared by your surgeon or PT
Physical therapy supports not only the immediate postoperative period but also the months of healing that follow.
Long-term benefits include:
Reduced risk of long-term stiffness
Improved abdominal wall strength
Better posture
Increased resistance to fatigue
Confidence in daily activities
Improved overall quality of life
Patients who commit to consistent movement typically regain independence more quickly and feel more in control of their recovery.
Continuing Movement Beyond Formal Physical Therapy
For many patients, structured physical therapy eventually comes to an end — but recovery and strength-building should not. Physical therapy can be thought of as exercise in the presence of injury. Once that injury is rehabilitated, movement shifts toward building strength for a long, healthy, active life.
Finishing medically necessary PT does not mean your body has reached its full potential for healing. In fact, the months after discharge are often when long-term strength, stamina, and resilience are developed.
It is important to understand:
Feeling “better” does not always mean strength and endurance are fully restored
Muscles, especially the core and legs, continue rebuilding for many months after surgery
Stopping movement too early can lead to deconditioning, fatigue, stiffness, and recurring discomfort
Consistent exercise helps protect the abdominal wall and reduces the risk of future weakness or back pain
After completing formal PT, many patients benefit from transitioning into:
A structured home strength routine
Supervised medical fitness or small-group training programs
Ongoing walking and progressive endurance training
Core-focused strengthening under guidance
Lifestyle habits that support healing (sleep, hydration, balanced nutrition)
Think of physical therapy as the foundation — and ongoing movement as what builds upon it.
CRS/HIPEC is a life-altering surgery. Rebuilding strength is not just about returning to baseline; it is about creating a stronger, more resilient body moving forward. Patients who continue intentional movement beyond formal therapy often experience improved energy, reduced pain, greater confidence in physical activity, and better overall health and independence.
Movement is not just part of recovery — it becomes part of long-term health.
When to Contact Your Care Team
Call your team if you experience:
Sudden severe pain during movement
Dizziness or fainting
Chest pain or shortness of breath
Incision opening or new drainage
Calf redness, warmth, or swelling
Rapid fatigue with no improvement over time
These may require medical assessment.
Final Encouragement
Physical therapy is one of the most impactful parts of your CRS/HIPEC recovery. Even when movement feels challenging, every step, no matter how small, is progress.
Walk a little. Rest. Hydrate. Repeat.
You are rebuilding strength every day.
References
1. Kalisch BJ, Lee KH, Dabney BW. Outcomes of inpatient mobilization: a literature review. J Clin Nurs. 2014;23(11-12):1486-1501. 2. Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: a review. JAMA Surg. 2017;152(3):292-298. 3. Kehlet H, Wilmore DW. Fast-track surgery. Br J Surg. 2005;92(1):3-4. 4. Lawrence VA, Cornell JE, Smetana GW. Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery. Ann Intern Med. 2006;144(8):596-608. 5. Chua TC, Moran BJ, Sugarbaker PH, et al. Cytoreductive surgery and HIPEC outcomes. J Clin Oncol. 2012;30(20):2449-2456. 6. Mustian KM, Sprod LK, Janelsins M, et al. Exercise recommendations for cancer-related symptoms. CA Cancer J Clin. 2017;67(6):493-512.
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