Intensive care unit-acquired weakness (ICU-AW) affects approximately 50% of critically ill patients, leading to prolonged recovery, increased healthcare costs and reduced quality of life. Early mobilisation is a promising intervention to mitigate ICU-AW, but its effectiveness is often limited by inconsistent patient participation and a lack of patient-centred approaches.To explore how varying levels of patient participation in early mobilisation are associated with ICU-AW incidence, thereby informing personalised intervention strategies.A prospective cohort observational study.A total of 152 patients were enrolled in the study between July and November 2023. After excluding 11 patients with incomplete data, 141 patients were included in the final analysis. An association was observed between levels of early mobilisation participation and muscle strength at ICU discharge (area under the curve = 0.788, cut-off ≥ 3, 95% CI: 0.712-0.864, p < 0.001). Patients with higher participation (≥ 3) demonstrated significantly stronger muscle strength and lower ICU-AW incidence than those with lower participation (< 3). Factors influencing participation included age, sex, surgical status and mechanical ventilation.Patient participation is a critical determinant of recovery outcomes in early mobilisation interventions. Tailored, patient-centred strategies are essential to optimise recovery and reduce ICU-AW risk.This study underscores the importance of integrating patient-centred approaches into ICU care, particularly highlighting the crucial role of critical care nurses in enhancing participation in early mobilisation. By fostering a supportive and personalised environment, nurses can significantly improve recovery outcomes, reduce ICU-AW and lower healthcare costs.© 2025 British Association of Critical Care Nurses.