Does anyone actually get up and walk every hour, or is that advice for other people?

Honest question. Every guide says get up and walk regularly. On my last flight after knee surgery I got up twice in eight hours, and both times it was because I needed the toilet.

Middle seat, sleeping neighbour, seatbelt sign on half the time, and every time I stood up it took thirty seconds of leaning on the seat back before the knee would take me. So is the advice realistic, or is it written by people who have never tried to climb over a stranger with a stiff leg?

It is realistic if you book an aisle. It is basically fiction if you do not.

That is the whole trick and it costs about the price of a decent dinner. I will not fly post-op in a middle seat again. The difference is not comfort, it is whether the plan happens at all.

Nigel, you have put your finger on the thing that annoys me most about how this gets written up. The advice is sound and the delivery is naive.

What worked for me on the knee flight was splitting it into two habits rather than one. The walking is opportunistic: aisle seat, and I go whenever the belt sign is off and the aisle is clear, which on a long flight is more often than you think if you are watching for it. The seat exercises are the reliable part: ankle circles, foot pumps and pressing the heels down, roughly every hour, without standing up, without disturbing anybody, and without needing permission from the seatbelt sign. On my first flight I did neither and spent the last hour convinced my calf was a clot. On the second I did both and barely thought about my legs.

Set an hourly phone alarm. Nobody remembers unprompted at hour six half asleep. The full routine and the seat choice reasoning is in staying mobile while recovering.

Disagree slightly on the aisle, or at least add a caveat. I had an aisle seat after abdominal surgery and got knocked twice by the trolley and once by someone's elbow, and by the end I was flinching every time anything moved past. Bulkhead if you can get it, aisle if you cannot, but an aisle next to a fresh abdominal wound is not automatically the answer.

Both fair. I think what I was really asking is whether I had failed by getting up twice, and the answer seems to be that the seat exercises were the bit I skipped, not the walking.

That is exactly the right conclusion to draw, and worth saying plainly for anyone reading later.

The calf muscle pump is what moves blood back up the leg, and it works whether you are standing in an aisle or sitting still and flexing your ankles. Walking is better because it does other things too, but the seat exercises are the part that is available to everyone regardless of seat, neighbour or seatbelt sign, and they are not a consolation prize. Combined with staying hydrated, and graduated compression stockings where they have been advised, that is the practical core of it.

Whether you personally need anything beyond those measures on a particular flight is for your own surgeon or GP to say, especially in the weeks after major surgery.

The phone alarm is the single most useful thing in this thread. I felt ridiculous setting it and then it went off at hour five when I was dozing and I would absolutely not have done anything otherwise.