# Breathing and exercise capacity after lung resection

Source: https://onco.cc/technologies/rejuv-rehab-respiratory/  
OnCo record `rejuv-rehab-respiratory` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Taking out a lobe takes away lung, and breathlessness on stairs is what people notice. Across 18 randomised trials and 1,795 patients, pulmonary rehabilitation after lung resection improved lung function, six-minute walk distance and physical quality of life, with bigger gains from programmes of twelve weeks or more.

## Summary

Lung cancer surgery removes functioning lung and leaves a chest wall that hurts to expand. The result is reduced exercise capacity, breathlessness, a weak cough and a tendency to retain secretions. Pulmonary rehabilitation is the same structured programme of aerobic exercise, resistance training, breathing technique and inspiratory muscle training used in chronic obstructive pulmonary disease, applied here.

After the operation. A 2026 systematic review and meta-analysis identified 18 randomised trials with 1,795 patients. Pulmonary rehabilitation including exercise and breathing training significantly improved lung function such as forced vital capacity, physical capacity, six-minute walking distance and the physical domain of quality of life, compared with controls. Subgroup analysis found interventions of twelve weeks or longer produced greater improvement. The review states plainly that only three of the eighteen studies were rated at low risk of bias, which is the figure to carry alongside the conclusion.

A single-centre randomised comparison illustrates the size of the difference between a full programme and breathing exercises alone. Sixty-six patients who had resection for non-small cell lung cancer and received no chemotherapy or radiotherapy were allocated to an eight-week comprehensive outpatient programme or to respiratory exercise training. The programme group improved forced vital capacity, six-minute walking distance and several quality of life domains and reduced dyspnoea and anxiety; the breathing-exercise group improved only dyspnoea and one symptom score, and the reduction in breathlessness was significantly greater with the full programme.

Before the operation. Prehabilitation has the strongest evidence anywhere in this file for lung surgery and is covered in its own record: pooled across 29 randomised trials, exercise prehabilitation reduced overall postoperative pulmonary complications with a risk ratio of 0.42 and shortened stay by 2.22 days. A 2024 multicentre trial also showed that home-based preoperative training protected postoperative quality of life: clinically important deterioration in global quality of life occurred in 71.4 per cent of controls against 30 per cent of the trained group.

What the programme contains. Supervised aerobic training, resistance training, inspiratory muscle training with a threshold device, airway clearance technique, education and, in most programmes, smoking cessation support. It is the same team and often the same class as respiratory rehabilitation for lung disease, which is why it is one of the few cancer rehabilitation services that already exists in most health systems with somewhere to refer into.

What comes back, and when: exercise capacity falls sharply after the operation and recovers over three to six months, and the amount of lung removed sets the ceiling. A lobectomy typically costs a measurable but tolerable fraction of lung function in someone with otherwise healthy lungs; a pneumonectomy does not. Breathlessness on exertion frequently persists and is managed rather than cured.

## Fields

- Kind: Technology
- Status: established
- Last checked: 2026-10-02
- Tags: rejuvenation; survivorship; rehabilitation; evidence:moderate
- Principle: After resection the limit on exercise is partly the reduced gas exchange surface and partly deconditioning, chest wall pain and inefficient breathing, and only the second group responds to training. Aerobic and inspiratory muscle training raise the efficiency with which the remaining lung is used, which is why six-minute walk distance improves more than spirometry does.
- Strengths: Pooled improvement in walking distance, lung function and physical quality of life; Programmes of twelve weeks or more work better than short ones; The service already exists in most health systems for lung disease
- Limitations: Only three of eighteen pooled trials were at low risk of bias; The amount of lung removed sets a ceiling training cannot lift; Most trials are small and single-centre

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Pulmonary_rehabilitation
- Effects of pulmonary rehabilitation in people with lung cancer after lung resection: systematic review and meta-analysis (J Cancer Surviv 2026): https://doi.org/10.1007/s11764-025-01952-9
- Outcomes of pulmonary rehabilitation after lung resection in patients with lung cancer (Turk Gogus Kalp Damar Cerrahisi Derg 2022): https://doi.org/10.5606/tgkdc.dergisi.2022.21595
- Effect of preoperative home-based exercise training on quality of life after lung cancer surgery: a multicentre randomized controlled trial (Ann Surg Oncol 2024): https://doi.org/10.1245/s10434-023-14503-2
- Preoperative exercise-based prehabilitation for reducing postoperative pulmonary complications after lung cancer surgery (Front Med 2026): https://doi.org/10.3389/fmed.2026.1899789

## Connected records

- cancers: [Mesothelioma](https://onco.cc/cancers/mesothelioma/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Oesophageal cancer](https://onco.cc/cancers/esophageal/), [Small-cell lung cancer](https://onco.cc/cancers/sclc/)
- fronts: [Recovery & Rejuvenation](https://onco.cc/fronts/rejuvenation/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/), [Surgery & Interventional](https://onco.cc/fronts/surgery/)
- technologies: [Cancer rehabilitation: the discipline that puts function back](https://onco.cc/technologies/rejuv-rehab-cancer-rehabilitation/), [Extended pleurectomy/decortication & radical mesothelioma surgery](https://onco.cc/technologies/pleurectomy-decortication/), [Going back to driving, lifting and exercise](https://onco.cc/technologies/rejuv-rehab-driving-and-exercise-return/), [Smoking cessation in cancer patients](https://onco.cc/technologies/smoking-cessation-after-diagnosis/), [The exercise prescription after cancer: the dose the guidelines state](https://onco.cc/technologies/exercise-prescription-after-cancer/), [What the randomised trials of prehabilitation found, operation by operation](https://onco.cc/technologies/rejuv-rehab-prehabilitation-evidence/)
- terms: [Late effects and survivorship toxicity](https://onco.cc/terms/late-effects/), [Quality of life](https://onco.cc/terms/quality-of-life/)
- bottlenecks: [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)

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