Exercise as Therapy for Lung Cancer

Medically Reviewed by Carol DerSarkissian, MD on July 27, 2022
Written by Amanda Gardner
6 min read

Lung cancer attacks your respiratory system, which is so central to exercise that people with this condition probably shouldn’t do it, right?

Wrong.

Research shows that lung cancer exercise programs are not only safe but can bring many benefits, including improved quality of life, fewer complications after surgery, shorter hospital stays, fewer disease symptoms and treatment side effects, and possibly a chance at a longer life.

In its 2019 recommendations, the American College of Sports Medicine concluded that exercise was “generally safe” for cancer survivors and that aerobic and resistance training could fight anxiety, depression, and fatigue while improving quality of life and overall physical abilities.

There’s no one exercise prescription for all lung cancer patients. Each needs to be tailored to the type of lung cancer, how advanced it is, your condition before your diagnosis, and many other factors.

Exercises will vary depending on how far the cancer has advanced. And that depends partly on which type of lung cancer you have. There are two main ones, based on what the cancer cells look like. Non-small-cell lung cancer (NSCLC), the less aggressive of the two, accounts for 80%-85% of all cases. Small-cell lung cancer (SCLC), which spreads much faster, makes up most of the rest of cases. People can also have both types at the same time.

Exercises for advanced lung cancer may be different than those for early lung cancer.

Because NSCLC lung cancer tends to be diagnosed earlier than SCLC, doctors often do surgery. That affects the timing and type of exercise. SCLC is more likely to have spread by the time it is diagnosed. Doctors often skip surgery and move straight to chemotherapy and radiation. This affects your options for physical activity.

Almost 90% of patients with any type of lung cancer are diagnosed after they start having symptoms. Those symptoms – coughing, chest pain, trouble breathing, and coughing up blood – also affect exercise decisions.

If you’ve been diagnosed with lung cancer, always talk to your doctor about the best way to exercise. You may even be referred to someone who specializes in exercise training for people with cancer. To get started:

  • Start slowly and move forward in stages. This could be 5 or 10 minutes of easy walking or swimming several times a day, gradually working your way up (with your doctor’s OK).
  • Use a pedometer – a gadget or app that counts your steps – to track your progress and stay motivated.
  • While group exercise provides great social benefits, don’t exercise in a gym or large group if you have a weakened immune system. This ups the risk of infection.

Carol Michaels, an exercise specialist and creator of Recovery Fitness, an exercise program to help people with cancer recover from treatment, divides exercises for people with lung cancer into four basic categories: breathing, stretching, aerobics, and strength – ideally done in that order. “If someone has lung cancer and undergone some treatment, they would get started slowly with nice deep breathing, stretching, then they will be able to very slowly add different types of exercises,” says Michaels.

  • Breathing exercises for lung cancer patients can make your diaphragm stronger. Your diaphragm is the muscle between your lungs and abdomen. Building its strength, in turn, makes it easier to breathe. One of the most effective breathing exercises is diaphragmatic breathing through pursed lips.
    • Sit or stand with one hand on your abdomen.
    • Inhale through your nose and feel your abdomen pushing out, lowering the diaphragm and allowing your lungs to fill with air.
    • Exhale through pursed lips, pushing up and in with your hand to get all the air out.
  • Simple stretching exercises can also be done at any stage of disease and in any setting. These get your blood and oxygen flowing to the muscles. That makes your lungs stronger and increases the amount of air your lungs can hold. Stretching can also help with some of the side effects of radiation therapy, such as tight muscles, and help clear scar tissue from surgery. Stretching has the added benefit of improving your posture, which helps open your lungs.
  • Aerobic exercise, even short walks, makes your heart and lungs stronger and improves sleep quality in people with lung cancer. If your energy level is limited by symptoms or by treatment, try walking around the house, resting, then moving again. In one study, people with lung cancer who worked out with both aerobics and strength training three times a week for 12 weeks reported improved quality of life, fatigue, and cardiorespiratory (heart and lung) fitness.
  • Strength training can fight fatigue, build back muscles, make bones stronger, and improve balance and posture. Participants in one trial who did 20 minutes of warm-up, then resistance training 3 days a week for 12 weeks gained back all their muscle mass and strength. The people had stage I, II, or III lung cancer and had gone through some combination of surgery, chemotherapy, and radiation. Strength training can help with simple tasks, like going to the toilet, which some people find difficult after treatment.

Yoga and tai chi combine breathing, stretching, and sometimes strength training. Both have shown benefit in lung cancer survivors. Research with people who had early and advanced NSCLC and SCLC and were having chemotherapy found that tai chi every other day lessened fatigue better even than low-impact exercise.

Other research showed that 15 1-hour yoga sessions extended endurance, increased physical ability, and improved mental health in people with advanced lung cancer who’d undergone radiation and chemo.

Surgery is more common when cancer is in earlier stages. Research shows that exercise before surgery helps keep people out of the ICU, reduces days spent in the hospital, and reduces complications by increasing oxygen consumption. These exercise programs – including walking, cycling, resistance training, and respiratory muscle training – usually last only 1-4 weeks (the time between diagnosis and surgery) and can be twice a day to five times a week.

Right after surgery, exercise is focused on basic movement, like getting out of bed and walking in the hospital. The earlier the exercise begins, the stronger the effect.

Once discharged from the hospital, you can go at your own pace, usually starting 5-10 weeks after surgery. Exercise plans under study range from moderate-intensity aerobic exercise, high-intensity interval training on a stationary bike or treadmill, and resistance training. Benefits included more endurance, better quality of life, less shortness of breath, and more muscle strength.

The goal of exercise for advanced lung cancer, or for those with earlier disease who can’t have surgery, is to ease symptoms, keep fitness level and quality of life, and reduce treatment side effects.

Moderate-intensity aerobics and resistance training have been shown to be safe and can lessen anxiety and improve physical abilities. One small study involving people with advanced NSCLC and extensive SCLC reported better oxygen intake and mental health. A similar plan of strength and endurance training improved muscle strength and shortness of breath in advanced-stage patients who were getting chemotherapy.

This, in turn, may improve survival. Research shows that people with better lung capacity in advanced NSCLC have slightly lower risk of dying.

Slow walking is a safe option for many. “I always recommend walking with somebody, maybe holding their hand,” says Michaels. “It gives you more confidence.” It also helps with balance.

Even people with cancer that has spread to the bones or who are getting palliative care (which focuses on relief from symptoms and stress of your condition) can benefit from exercise, as long as it’s done in partnership with a doctor or specialist.

Exercise has been shown to improve the quality of life for people who have lung cancer, in all stages. In fact, some people who have lung cancer say the quality of their lives is just as important as how long they live.