Early postoperative physical activity is associated with oral energy sufficiency at discharge after esophagectomy: a retrospective cohort study

Objective To examine the association between early postoperative physical activity and oral energy sufficiency at discharge after esophagectomy. Methods This retrospective cohort study included 142 patients who underwent radical esophagectomy. Physical activity was assessed as the mean daily step count on postoperative days (POD) 8 to 14. The primary outcome was the oral energy sufficiency rate relative to nutritional requirements (oral-E/NR) at discharge. Secondary outcomes included percentage changes in body weight, skeletal muscle index (SMI), and 6-min walk distance (6MWD) from preoperative assessment to discharge. Associations between physical activity and outcomes were evaluated using Spearman's rank correlation. Multivariable linear regression was performed to examine the association between physical activity and oral-E/NR while adjusting for potential confounders. Results The median oral-E/NR at discharge was 52.0%. Physical activity was positively correlated with oral-E/NR (ρ = 0.257, P = 0.002). In multivariable analysis, physical activity remained associated with oral-E/NR, with a 2.2% higher oral-E/NR for each additional 1000 daily steps (B = 2.23, P = 0.002). Higher physical activity was associated with better preservation of 6MWD (P = 0.004), but not with changes in body weight or SMI. Conclusions Higher early postoperative physical activity was associated with greater oral energy sufficiency and better preservation of exercise capacity after esophagectomy. These findings should be interpreted as hypothesis-generating and require prospective validation.