OBJECTIVE: To estimate whether specific ambulation goals affect the adequacy or perceived barriers to ambulation in hospitalized surgical patients after major gynecologic surgery. METHODS: One hundred forty-six surgical inpatients were randomized to specific ambulation goals or routine care. We assessed the number of pedometer-recorded steps in the 24 hours preceding discharge as well as patient-identified barriers to ambulation. Groups were compared using the Mann-Whitney U test. RESULTS: Of the 129 participants with outcome data, 12% were discharged without any pedometer-recorded steps. We did not detect an effect of specific ambulation goals by group (routine care: 87 compared with ambulation goals: 80, P=.7). The three main barriers to ambulation from a patient perspective were indwelling catheters (38.5%), intravenous poles (28%), and pain (12.5%) The median number of postoperative steps was higher after minimally invasive surgery (143) compared with laparotomy (27) (P=.035). CONCLUSION: Approximately 12% of gynecologic surgical patients do not walk while hospitalized despite formal encouragement to ambulate. Ambulation is easily quantified and may improve with attention to modifiable barriers, potentially improving postoperative recovery.