Physical activity significantly impacts long-term morbidity and mortality risks [[1], [2], [3], [4], [5], [6]]. The World Health Organization and the United States (U.S.) Department of Health and Human Services advocate for a minimum of 150 min of moderate-intensity or 75 min of vigorous-intensity aerobic exercise per week, equivalent to 500 metabolic equivalent of task minutes (MET-mins) per week [7,8]. The adherence rate to these physical activity guidelines among all U.S. adults is estimated at approximately 65%. The adherence rate among adults over 65 years is as low as 49%. Additionally, the time spent on sedentary behavior has been increasing over time [9]. Simultaneously, adults taking 8000 steps per day have been linked to a noteworthy reduction in all-cause mortality [4,7], with the average number of daily steps taken by healthy adults estimated at 8500 steps per day [10]. While extensive evidence supports the long-term benefits of exercise, its influence on short-term postoperative outcomes and recovery following gynecologic oncology surgery remains largely unexplored.

In the context of surgical procedures, gynecologic oncology surgeries vary widely in complexity and patient health statuses. Patients may also have benign or malignant diseases. For patients with malignancies, prolonged recovery negatively impacts adjuvant treatment plans and overall survival [11,12]. Therefore, a more comprehensive understanding of how preoperative activity influences postsurgical outcomes and recovery can provide important information to optimize health and mitigate postoperative morbidity. An actigraphy is a wearable device that measures movement and provides continuous and objective data. It also offers a promising alternative to self-reported assessments, as it can capture incidental or unstructured activity [13]. The aims of this study were to utilize an actigraphy ring to objectively investigate the impact of preoperative activity on postoperative complications and achievement of recovery milestones in patients undergoing surgery with gynecologic oncologists. The goal is to inform clinical decision-making, enhance preoperative counseling, and contribute insights into patients' postoperative milestones.