Exercise with lung cancer: breathlessness and recovery

Yes, for most people, as long as your doctor or specialist nurse agrees first. Macmillan says "Most people with heart or lung problems can benefit from regular physical activity" and that "It is important to check with your doctor or specialist nurse before you start any exercise programme" [7].

The 2019 international exercise guidelines for cancer survivors concluded that "exercise training and testing were generally safe for cancer survivors" and that every survivor should "avoid inactivity" [16].

Breathlessness with lung cancer has several causes, and only some improve with exercise. Macmillan lists the cancer, fluid around the lungs, anaemia, infections, anxiety and treatment, and notes that "the muscles that help breathing can become weak" [6].

Asthma + Lung UK explains why resting more can backfire: "moving less means that your muscles become weaker, and this can make breathing harder" [9]. Anxiety plays a part too: Macmillan says it "can make you breathe too fast and take shallow breaths from the top of the lungs" [6].

The evidence that exercise eases breathlessness itself is weaker than the evidence that it improves fitness. After lung surgery, a Cochrane review rated the finding of "less dyspnoea" (breathlessness) as "very low-certainty evidence" [13]. In advanced lung cancer, a second Cochrane review found "no significant effects of exercise training on dyspnoea, fatigue" [15].

Breathe out during the hardest part of a movement, use slow breathing to recover, and pace yourself so you are a little out of breath but can still talk [10]. Asthma + Lung UK describes breathing control as "breathing gently, using the least effort" [9].

Techniques from UK lung charities:

• Blow as you go. "Breathe out while you're making the effort. For example, while lifting the heavy bag" [9]. This helps you avoid holding your breath during strength exercises.
• Paced breathing. Count your steps in and out to match your walking pace; Asthma + Lung UK says "This technique helps to avoid breath holding" [9].
• Pursed-lip breathing. Roy Castle Lung Cancer Foundation advises: "Exhale slowly through pursed lips (like you're going to whistle) for 4-6 seconds" [8].
• Recovery positions. Sitting leaning forward with your elbows on your knees, or leaning back against a wall with your feet slightly apart, can help you get your breath back [9].
• A fan. "Using an electric or handheld fan can help to reduce feelings of breathlessness" [8].

To judge effort, the NHS uses a simple talk test. At moderate effort, "you can still talk, but not sing"; at vigorous effort, "you will not be able to say more than a few words without pausing for breath" [10].

Recovery starts in hospital with breathing and leg exercises, then short walks that build up a little each day. Cancer Research UK says "You might be sitting in a chair within 12 hours of your operation" and "within a few days you'll be able to walk along the hospital corridor", and that staff check "you're doing your breathing and leg exercises" [1].

Operations range from removing a small area of the lung to a lobectomy ("removing one lobe of the lung") or a pneumonectomy, which removes the whole lung [2]. Cancer Research UK says "What you can do depends on how fit you were before your surgery and any problems you have afterwards" [1].

The first weeks at home. The Society for Cardiothoracic Surgery in Great Britain and Ireland (SCTS) advises that you "Build up your fitness gradually with gentle walking, and stair climbing, which are safe and are encouraged" and says "You should not do any heavy lifting for 6 weeks" [12]. Cancer Research UK says "It helps to do a bit more every day", while warning that "You're likely to feel very tired for several weeks and sometimes months after your surgery" [1]. Our guide to cancer-related fatigue explains how to pace your energy.

Later recovery. The SCTS says "If you were fit before your operation, after about six weeks try walking two to three miles a day", aiming for distance rather than speed [12]. If you were less fit before surgery, ask your team what a realistic target is for you.

What the trials show. A Cochrane review of eight trials with 450 people who had surgery for non-small cell lung cancer found that exercise training within 12 months increased six-minute walk distance by 57 metres on average in the five trials (182 people) that measured it ("high-certainty evidence") and improved thigh muscle strength [13].

Yes, the evidence suggests it reduces chest complications after the operation. A 2022 Cochrane review of 10 trials (636 people) found exercise before surgery for non-small cell lung cancer cut the risk of a postoperative lung complication (risk ratio 0.45, "high-certainty evidence") and probably shortened the hospital stay by about two days [14]. The authors urge caution "due to risk of bias" [14]. If you have a few weeks before your operation, our prehabilitation guide explains what a programme involves.

Usually yes, with gentle activity balanced against rest, but report any change in your breathing straight away. Cancer Research UK says tiredness during lung radiotherapy "tends to get worse as the treatment goes on", that "Some research has shown that taking gentle exercise can give you more energy" and that "It's important to balance exercise with resting" [3]. Our guide to exercise during radiotherapy covers timing and skin care for any area treated; this section covers the lungs.

Radiotherapy and your lungs. "Radiotherapy to the chest area might cause some inflammation of your lungs", with "a dry cough or shortness of breath" soon after treatment [3]. A longer-term form "might start months after treatment" [3]. Cancer Research UK advises: "Let your doctor know if you notice any changes in your breathing or if you cough up a lot of mucus" [3].

Immunotherapy. Side effects differ from drug to drug. For pembrolizumab, one immunotherapy drug, Cancer Research UK says breathlessness and cough are possible and "Occasionally this could be due to an infection (pneumonia) or inflammation of the lungs (pneumonitis)" [4]. It advises: "Let your doctor or nurse know straight away if you become breathless, develop a cough or chest pain" [4]. Ask your team what to watch for with your own drug, including targeted therapies.

Many people can, but the evidence is smaller and the programme needs to be tailored. A Cochrane review of six trials (221 people) with advanced lung cancer found walking distance about 63 metres higher with exercise in the four trials that measured it [15]. Effects on breathlessness and fatigue were not significant, and the authors say the findings "should be viewed with caution because of the heterogeneity between studies" [15].

If cancer has spread to your bones, Macmillan advises you to "speak to your healthcare team before doing or starting any exercise" and says "It is usually best to avoid high-impact activities" [7]. Our guide to bone health after cancer explains more. For people with advanced cancer, Macmillan says you can ask your cancer doctor or palliative care team "to refer you to a clinical exercise physiologist or physiotherapist" for advice before you start [7].

Some NHS pulmonary rehabilitation programmes accept people with lung cancer. For example, an Essex NHS programme says it is for people with breathing problems including "lung cancer", and takes "Referral from GP, healthcare professionals and local hospital(s)" [11]. Ask your lung cancer nurse or GP whether your local programme takes referrals for people with lung cancer.

If you also have COPD or another long-term lung condition, our pulmonary rehab guide explains how referral works.

Stop at once if you feel unwell, and call 999 if you have chest pain or difficulty breathing. Macmillan says "You should stop exercising if you get any sudden symptoms, including" "feeling dizzy", "chest pain", "a racing heart", "breathing problems", "feeling sick", "unusual back or bone pain", "unusual muscle pain" and "a headache that does not go away" [7].

For breathlessness, Macmillan advises [6]:

• "Contact your doctor straight away if:" "breathlessness is a new symptom", "you have pain when you breathe" or "the breathlessness gets worse quickly".
• If you cannot reach your doctor and it keeps getting worse, "go straight to your nearest A&E (emergency department)".
• "Always call 999 if you have chest pain or difficulty breathing."

After surgery, the SCTS says to contact your GP "If your wound becomes red, painful or starts discharging fluid", and "If you feel very unwell please attend A&E urgently, taking your discharge documents with you" [12].

Your lung cancer nurse, a physiotherapist and a clinical exercise physiologist can all help. Macmillan says "A physiotherapist gives advice about exercise and mobility" and "They can help you learn breathing techniques and relaxation and show you new ways of doing daily activities" [6]; ask your team or GP for a referral.

Clinical exercise physiologists (CEPs) are responsible for "prescribing and delivering evidence-based exercise" to "help patients prevent, treat and manage their long-term conditions" [17]. They work in oncology "with patients with different types of cancer and at different stages of treatment" [17]. If you live in the capital, see cancer rehabilitation in London.

Request a match with a verified clinical exercise physiologist through The Health Nav.