Sarah Saulsberry, PT, COMT, is a physical therapist in Kansas City, Missouri. She works for Cancer Wellness For Life and has a private practice, Loveberry Physical Therapy, where she helps people do fun things even after injury, trauma, illness, and pain have interrupted their lives. View Ms. Saulsberry’s disclosures. 

The orthopedic surgery world has taught the cancer community a lot about how to get the best surgical outcomes. For example, we know that people having knee surgery benefit from physical therapy to improve their strength and mobility before having the operation. Orthopedic surgeons also encourage their patients to quit smoking and improve their nutrition to promote healing after their procedure. They have found that, together, physical therapy, good nutrition, and stopping smoking and alcohol use leads to improved surgical outcomes. The benefits of this approach also ring true for people with lung cancer who are going to have cancer surgery.

In May 2022, the American Society of Clinical Oncology (ASCO) published its “Exercise, Diet, and Weight Management During Cancer Treatment” guideline, which included recommendations around exercise for people with lung cancer. One of the recommendations within this guideline states: “Oncology providers should recommend regular aerobic and resistance exercise during active treatment with curative intent and may recommend preoperative exercise for patients undergoing surgery for lung cancer.” So, not only are people with lung cancer who are going to have surgery allowed to exercise; they should be encouraged to exercise before treatment.

Exercising ahead of cancer treatment is part of a process called prehabilitation, also called “prehab.” The focus of prehabilitation is to prepare people with cancer physically and mentally for their treatment and can also lead to easier recovery following the treatment. It is different from cancer rehabilitation, or “rehab,” which is focused on helping with the physical, psychological, and cognitive problems that occur during and after cancer treatment.

According to the ASCO guideline, studies have found that 1 to 2 weeks of supervised exercise with a physical therapist or certified exercise professional can improve a patient’s ability to breathe deeply and effectively before and after surgery, reducing their risk for pneumonia. Through prehabilitation, patients can also expect to have improved physical functioning during their postoperative hospital stay, so things like getting out of bed, walking, bathing, and dressing will be easier. Plus, that hospital stay is often shorter for patients who participated in prehabilitation.

“Surgery is an integral part of cancer therapy for early-stage lung cancer. Emerging evidence suggests that a focused exercise program in advance of surgery can help patients prepare for the best surgical outcome.” – Charu Aggarwal, MD, MPH, the Leslye Heisler Associate Professor of Medicine in the Hematology-Oncology Division at the University of Pennsylvania’s Perelman School of Medicine and the 2022 Cancer.Net Associate Editor for Lung Cancer

Getting started with lung cancer prehabilitation

There are a couple of ways you can get started with prehabilitation ahead of lung cancer surgery. If exercise is new or difficult for you, or if you want personalized support, the first step is to find a physical therapist who specializes in working with people with cancer. Ask your oncology provider for a referral to a great physical therapist near you. A skilled physical therapist can help you with joint and muscle concerns that may be bothering you, in addition to helping you improve your balance, endurance, and strength before surgery. Then, after surgery, you already have a great therapist on your team to help you recover!

Meanwhile, if you are already physically active and your doctor has told you it is safe for you to work out on your own, you may want to focus on finding a prehabilitation exercise program that involves both strengthening and cardio. Increasing your walking or cycling time and/or speed are ways to improve your cardiovascular endurance. Talk with your doctor about the specific prehabilitation plan that is recommended for you.

Prehabilitation exercises to do at home

Below are a few of my favorite prehabilitation exercises that are easy to do at home. However, always talk with your doctor before starting any new type of exercise at home.

As you start these exercises, remember to avoid holding your breath as you do them. Instead, try to exhale during the most difficult part of the exercise. If you are finding it challenging to breathe regularly during the exercise, try reducing the intensity of the exercise. Stop the exercise if breathing becomes too difficult.

1: Belly breathing

How it helps you during recovery: Improves your breathing ability, reduces your risk of pneumonia, reduces whole-body pain, and reduces anxiety.

Try it: Inhale through your nose, breathing deeply into your belly. Allow your belly to puff out with air. Try to not shrug your shoulders to assist with breathing in. Exhale through your mouth forcefully. Try 3 to 5 repetitions of this deep breathing 2 to 3 times per day, or when you are feeling anxious or having pain. It is important to note that this exercise may cause you to cough and can even make your muscles a bit sore if they are not used to expanding so far. These side effects should lessen the more often you do the exercise.

2: Grip strength

How it helps you during recovery: Improves your ability to push or pull yourself out of the hospital bed and perform dressing, bathing, and kitchen activities without help.

Try it: Make a fist with your hand, then open your hand fully. Repeat until your hands are loosened, then grab something you can squeeze, such as a stress ball, hand towel, or a grip strength trainer. Squeeze the object and hold for 5 seconds, then relax. Repeat 10 times with each hand. 

3: Standing balance

How it helps you during recovery: Improves your safety when walking and standing and reduces your risk of falling.

Try it: Stand at a clean, sturdy countertop, setting your hands on the countertop for balance. Try not to lean on the countertop any more than you need to for safety. Your goal is to stand in a challenging position safely for 10 seconds. Try these foot positions below. As one position gets easier, move down the list for a more challenging balance pose.

1. Narrow stance: Keep your feet close together.

2. Semi-tandem: Put 1 foot slightly in front of the other, then switch and put the other foot in front.

3. Tandem: Stand heel to toe, then switch and put the other foot in front.

4. Single leg: Only stand on 1 leg at a time, then switch and try the other leg.

4: Sit to stand

How it helps you during recovery: Improves your leg strength and makes getting out of chairs and off the toilet seat easier

Try it: Find a sturdy chair; no rockers, rollers, or recliners. Practice standing up and sitting down from this chair without using your hands. If you must use your hands, try to use them as little as possible. Do this several times consecutively, building up to 10 times in a row of sitting and standing as you build endurance.

No matter if you do prehabilitation with a therapist or at home, this kind of exercise is beneficial for most people preparing for lung cancer surgery. The challenge is finding what works for you and following through! If you have questions about whether prehabilitation is right for you, talk with your health care team for guidance.