Objective To investigate the effect of early exercise therapy based on offline simulation and online education on CO-2 pneumoperitoneum after-effect of gynecological laparoscopic surgery. Methods A total of 124 patients undergoing elective gynecological laparoscopic surgery under general anesthesia were divided into a control group and an intervention group, with 62 cases in each groups. The control group was subjected to early exercise therapy based on routine communication and education in the form of "explanation-demonstration teaching-exercise" . The intervention group was subjected to early exercise therapy based on offline simulation and online education:CICARE communication mode was used to established the communication service process of early exercise therapy in laparoscopic surgery, and early exercise therapy was implemented relying on "Internet +" education. Patient adherence to exercise therapy, and the incidence of shoulder pain and abdominal distension were documented. Results Adherence to exercise therapy in the intervention group at varied time points was significantly better than in the control group; the scores of shoulder pain and abdominal distension, and the incidence rates of shoulder pain and abdominal distension within 48 h after surgery in the intervention group were significantly lower than those in the control group (P＜0.05,P＜0.01) . The time to first passage of flatus, and first bowel movement, and the time to get off bed in the intervention group were significantly shorter than those in the control group (P＜0.01 for all). Conclusion Early exercise therapy based on offline simulation and online education could improve patients′ adherence to exercise therapy, reduce the incidence rates of CO-2 pneumoperitoneum after-effect, and promote rapid recovery after surgery.