Introduction Although early rehabilitation for acute inpatients is widely recommended, the effectiveness of early physical rehabilitation for interstitial pneumonia in the acute setting remains unclear. Objective To investigate the impact of early rehabilitation on mortality in patients with interstitial pneumonia in the acute setting. Design Retrospective cohort study used a hospital‐based database created by the Japan Medical Data Center. Setting Over 100 acute‐care hospitals across Japan. Participants Inpatients hospitalized due to interstitial pneumonia from 2014 to 2018. Interventions Early rehabilitation provided by physical therapists and/or occupational therapists within 2 day of admission. Main Outcome Measures Thirty‐ and 90‐day in‐hospital mortality. Results Among the included inpatients, 847 (50%) underwent early rehabilitation. Mortality was significantly lower in the early rehabilitation group compared with the delayed rehabilitation group (30‐day mortality: 6.8% vs 12.1%, 90‐day mortality: 13.0% vs 19.8%). The differences were significant after propensity score adjustment using inverse probability weighting (30‐day mortality: 7.6% vs 11.0%, 90‐day mortality: 14.3% vs 18.0%). Conclusion Early rehabilitation was associated with decreased mortality in hospitalized patients with interstitial pneumonia.