How 'Prehab' and Rehab Can Change the Game for Lung Cancer Patients

Increasingly, pre-rehabilitation or prehabilitation — occurring after a lung cancer diagnosis and before surgical treatment — is understood to be an important approach in lung cancer treatment. A prehabilitation (“prehab”) program prepares you physically and emotionally for surgery, as well as chemotherapy or radiation.

Newly diagnosed lung cancer patients don’t necessarily begin treatment immediately, says Nicole Stout, DPT, a doctor of physical therapy and the senior director of survivorship and wellness at the American Cancer Society. She notes that there’s often at least a several-week period in which a fairly intensive prehab program can have measurable effects.

“Many people with lung cancer come in with comorbidities, such as chronic obstructive pulmonary disease (COPD) and cardiovascular disease, that make them not the best surgical candidates,” says Megan Burkart, DPT, an assistant professor of physical therapy at West Virginia University in Morgantown. “They may be sedentary. They usually have trouble breathing so they don’t exercise.” For patients who are deemed operable or who are borderline, “Prehab is an exciting place,” she says. And for patients in overall poor health for whom surgery is too risky, prehab has the potential to make it a safer option.

Prehab for lung cancer is kind of like boot camp, says Dr. Burkart: “We have patients doing some form of supervised, monitored aerobic exercise for 20 to 30 minutes, five days a week, at a moderate to vigorous pace.” The aim is to get the person to 60 to 80 percent of their VO₂ max, or maximal oxygen uptake, which is a measure of the cardiovascular system’s ability to get oxygen to body tissues.

In prehab for lung cancer patients, a physical therapist or physiotherapist might also engage you in breathing exercises and work on posture and range of motion. They’ll also help patients quit smoking, if needed.

The overall goals are to:

• Make You a Better Candidate for Surgery One study found that patients who underwent a four- to six-week preoperative pulmonary rehab program improved their odds of being able to undergo curative lung-resection surgery.

  [4]

   And other research has shown that prehab made previously inoperable patients operable.

  [5]

• Speed Surgical Recovery “We’ve found that patients who received prehab exercise training return to baseline levels of cardiopulmonary fitness after surgery within two months,” says Burkart.
• Boost Confidence Part of what exercise physiologists or physical therapists offer patients during prehab, says Stout, “is showing them that there is someone on their medical team who understands exercise and who will work with them in an educational capacity.” That kind of support can give patients the confidence boost they need to push themselves to get stronger.

Not everyone is fortunate enough to be treated at a cancer center that offers prehabilitation or access to a supervised exercise program. If that’s your experience, “even having an assessment with a local physical therapist before or after treatment can help,” Burkart says. “They can offer a postural and breathing assessment and give you some exercises to do on your own.” The simplest form of exercise, walking, can have profound effects on your health and well-being.

“Even five minutes a day is worthwhile,” Burkart says. “Do whatever feels good and is successful in the moment, and build up from there.”

• Help Ease Cancer-Related Fatigue Treatment-linked fatigue is a pervasive issue for lung cancer patients, and several studies have confirmed, note the authors of a review of research, that increased physical activity may improve “fatigue in patients with early- and advanced-stage lung cancer.”

  [7]

   Other researchers, conducting a meta-analysis of studies, state that “promoting long-term and sustained participation in daily physical activity is essential for pulmonary rehabilitation” and that a physically active lifestyle may help reduce cancer-related fatigue.

  [8]

• Improve Overall Function Although most people will have times they feel better and times they feel worse during cancer treatment, “Lung cancer patients experience at least some degree of continual functional decline,” says Stout. “If we are able to intervene during treatment with exercise, they have a chance of recovering back to their baseline, or at least not losing function.”
• Increase Mental and Emotional Well-Being Lung cancer treatment can be a prolonged time period filled with mental and emotional ups and downs. If you have a physical therapist or physiologist on your care team, says Stout, that person can motivate you as well as monitor your response to exercise, and make sure you’re safe. “If you have had some prehab, even better, because you then get the message that ‘This is the way we do business in treating cancer,'” Stout says. You can’t underestimate the emotional lift that can provide, she adds. Researchers note that, with respect to lung cancer therapy, exercise has been “unequivocally” effective in improving the quality of life for patients undergoing challenging treatments.

  [9]

• Improve Survival Some research suggests that exercise may have a positive effect on survival. One study found older women who are physically active when they have lung cancer have improved survival outcomes. The study authors write: “Physical activity may be protective for lung cancer incidence and mortality in postmenopausal women, particularly in non-obese women.”

  [10]

  Other researchers note that evidence suggests that postdiagnosis activity levels help reduce mortality risks, including those for lung cancer. They recommend cancer survivors increase their levels of activity after diagnosis to improve their probability of survival.

  [11]

Surviving cancer is a big deal, but too often, both patients and their doctors neglect to focus on what comes next. You get to live — but how? “People think, ‘This is how it’s going to be. I can’t breathe when I walk uphill or pick up my grandkids, but I’m alive so I can’t complain,’” says Burkart.

Post-treatment exercise can:

• Dramatically Improve Quality of Life Exercise isn’t just about health and fitness, but about well-being: “It allows people to reengage in social activity and work,” says Stout. Rather than quietly accept a “new normal” after treatment, you can continue to make improvements in how you feel, both physically and emotionally. A study found that a three-month home-based walking regimen improved measures of quality of life in patients with advanced stage lung cancer.

  [13]

• Prevent Falls “Cancer survivors fall at a significantly higher rate than their age-matched cohorts in the population,” says Stout, due in part to the effects of chemotherapy drugs (which can lead to peripheral neuropathy) and to weaker muscles and bones. Working with a physical therapist or cancer exercise specialist can help prevent falls by improving balance and strength.
• Protect Your Heart Among what are called “late effects” of chemotherapy is heart damage, particularly to the left ventricle, that over time can diminish cardiac function. “There’s a huge body of research that says exercise can help mitigate the left-ventricular decline that can happen during cancer treatment,” Stout says.

• Get up and out every day. Set achievable goals, like taking a short walk.
• Do some light stretching. It helps you stay mobile without overexerting yourself.
• Check out exercise programs online or on apps.

The American College of Sports Medicine (ACSM) developed the Moving Through Cancer initiative to provide people with cancer resources to stay engaged in an appropriate exercise and rehabilitation program. The project also aims to raise awareness about the benefits of physical activity and exercise, specifically for cancer survivors. The ACSM offers a searchable directory to help you locate providers and exercise professionals in your area.

The Takeaway

• Prehabilitation, including tailored exercise, nutrition, and psychological support, can significantly improve lung cancer patients' outcomes and recovery post-surgery. Consider consulting your healthcare provider about starting a prehabilitation program if you’re diagnosed with lung cancer.
• For those undergoing treatment or unable to access supervised "prehab," incorporating even small amounts of physical activity, like walking for five minutes daily, can provide substantial benefits in managing fatigue and emotional well-being.
• Rehabilitation after treatment can improve quality of life, reduce fall risk, and protect heart health, benefiting long-term recovery.
• Prehab and rehabilitation offer many advantages for lung cancer patients, but individual medical needs should always guide these activities; talk with your care team to maximize safety and benefits.