By Raisha Ismail, MD

Historically, patients with chronic respiratory disease were advised to avoid any activity that could cause shortness of breath to avoid worsening their symptoms. Although pulmonary rehabilitation (PR) programs were developed in the 1960s with a focus on patients with chronic obstructive pulmonary disease (COPD)^[i], it took decades for people to see benefits of PR, and only recently, there has been a push to include patients with other lung conditions aside from COPD in these programs.

Lung cancer is the No. 1 cause of cancer deaths in the United States and, therefore, has become another target population for PR intervention in an effort to improve outcomes.^[ii] In addition, about 40% to 70% of lung cancer patients also have a diagnosis of COPD, which can affect functional status, exercise capacity, and surgical risk.^[iii] For patients with a specific type of lung cancer, non-small cell lung cancer (NSCLC), surgery often is the best treatment for cure, but this can be accompanied by numerous complications.^[iv] However, lung cancer patients who completed a standard exercise training before surgery went home sooner after surgery, were able to exercise more, and had improved lung function. Participating in PR before or after surgery could allow more lung cancer patients to undergo surgery and experience a better quality of life after treatment.  

In addition to surgical cancer patients, it’s important to include lung cancer patients who are receiving chemotherapy or radiation therapy. Patients who participated in exercise training programs either performed during chemotherapy or interspersed throughout consecutive rounds of chemotherapy showed improvements in exercise tolerance and lung function compared to patients who did not complete these programs.^[v]

Most of the prior studies about lung cancer patients described exercise training programs rather than a standard PR regimen and primarily looked at surgical patients and those with NSCLC. Guidelines should be created specifically for lung cancer patients with special attention to early participation to avoid delaying surgery. PR programs also should consider the type of treatment a patient is receiving (surgery, chemotherapy, radiation) and their current stage of treatment as these conditions may all require different programs to achieve the maximum benefit. Expanding PR participation criteria to include lung cancer could allow these patients to exercise better, have increased lung function, and recover quicker after treatment.

Raisha Ismail, MD, is a resident physician in Internal Medicine at the University of Vermont.

REFERENCES

^[i]Casaburi R. A brief history of pulmonary rehabilitation. Respir Care. 2008;53(9):1185-1189.

^[ii]Group USCSW. U.S. Cancer Statistics Data Visualizations Tool, based on 2021 submission data (1999-2019). U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute. Updated November 2022. https://www.cdc.gov/cancer/dataviz. Accessed May 8, 2025.

^[iii]Young RP, Hopkins RJ, Christmas T, Black PN, Metcalf P, Gamble GD. COPD prevalence is increased in lung cancer, independent of age, sex and smoking history. Eur Respir J. 2009; 34(2):380-386. doi:10.1183/09031936.00144208.

^[iv]Granger C, Cavalheri V. Preoperative exercise training for people with non-small cell lung cancer. Cochrane Database Syst Rev.2022; 9(9):CD012020. doi:10.1002/14651858.CD012020.pub3.

^[v] Rutkowska A, Jastrzebski D, Rutkowski S, et al. Exercise training in patients with non-small cell lung cancer during in-hospital chemotherapy treatment: a randomized controlled trial. J Cardiopulm Rehabil Prev. 2019; 39(2):127-133. doi:10.1097/HCR.0000000000000410.