Lung cancer — and lung-cancer-directed treatments — can make exercise feel inadvisable, if not altogether impossible.
“Many people with lung cancer are under the impression that they should be ‘resting up,'” explains Dr. Jae Kim, chief of thoracic surgery at City of Hope, a National Cancer Institute-designated comprehensive cancer center in Southern California.
And while the body certainly needs some rest when recovering from lung cancer, it also needs healthy activity. As a 2020 review published in The Oncologist emphasizes, exercise should be a mainstay in treatment of lung cancer, dramatically improving survivability from the disease, longevity and quality of life.
How Exercise Improves Lung Cancer Outcomes
— Fighting cancer. Physical activity affects cancer at a microscopic level, Kim says. In fact, a 2017 study in the journal Cancer Research shows that physical activity reduces tumors’ ability to grow, slowing cancer progression and metastasis to neighboring tissues. Exercise may reduce the risk of cancer reoccurrence, he says.
— Reducing the risk of surgical complications. Like all forms of major surgery, lung cancer resections and lobectomies carry some risk. The most common complications include pneumonia, wound infections and blood clots — all of which are “very much dependent on” baseline cardiopulmonary function, he says.
— Aiding cellular recovery. “Exercise can change the way our body responds to inflammation, improve immune function and even change the way our cells repair their DNA,” Kim says. This means improved healing of tissues affected by surgery, radiation or chemotherapy.
— Improving energy levels. “One of the biggest complaints I hear from patients undergoing cancer directed therapies is fatigue,” says Ashley Adamczyk, oncological physical therapy team leader at Rush University Medical Center in Chicago. “Exercise is the most successful and only evidence-based intervention to reduce fatigue during and following cancer treatment.” The exact mechanisms aren’t clear, but exercise may work its magic by directly affecting the central nervous system.
— Boosting sleep quality. Move during the day to sleep well at night. In a 2016 British Journal of Cancer study, a 12-week at-home walking routine was enough to significantly improve sleep quality in people with lung cancer. This may be one more reason energy levels improve when people exercise.
— Decreasing muscle and joint stiffness. “Both radiation and surgical interventions can trigger the buildup of scar tissue, stiffening joints and limiting their range of motion,” Adamczyk says. The shoulders and chest are among the most common areas to feel locked up, but exercise in those areas increases the flow of blood, oxygen and other nutrients to the muscles and joints while improving tissue elasticity.
— Increasing lung capacity. “Regular activity, stretching and moving your body can improve back, rib, shoulder mobility to allow for freer movement of the diaphragm and the other muscles that support respiration,” Adamczyk says. The result: You’re able to take in more oxygen and expel more carbon dioxide with each breath.
— Improving mental and emotional health. “Physical activity helps patients with their emotional and psychological well-being, which is a critical aspect of long-term outcomes for cancer,” Kim says. He notes that depression and anxiety are major problems for people battling lung cancer and can reduce overall quality of life as well as make it more difficult to make healthy choices that will benefit lung cancer recovery.
— Supporting muscle. “Loss of muscle mass during or after lung cancer treatment is associated with an increased risk of cancer recurrence,” Kim says. “Maintaining physical activity is an important part of preserving muscle mass.” He notes that muscle loss commonly occurs with cancer-directed treatments, with excessive sedentary time only exacerbating muscle degradation.
— Reducing the risk and severity of comorbidities. People with lung cancer often have heart disease and other lung conditions that can compromise their overall health and quality of life, Kim says. Exercise is a great tool in the management of most common preexisting health conditions you may have.
How to Exercise with Lung Cancer
“Nearly all patients can engage in some type of physical activity during all aspects of their treatment, but type and amount will vary,” says Kim, emphasizing the need to work with your entire medical team to figure out the best strategy for your body and recovery.
For example, medical teams recommend all people with lung cancer participate in “prehab” exercises even before treatments start, he says. And people coming out of surgery can perform gentle physical therapy exercises such as diaphragmatic breathing once medically stable with solid vitals, according to Adamczyk. That said, people undergoing surgery will have some activity restrictions (no pushing, pulling or raising the arms above 90 degrees) in the weeks following their procedure, she says.
Furthermore, following surgery, some medical plans include at-home visits from physical and occupational therapists. “If receiving skilled therapy services at home, it is important to continue exercising and being physically active on the days therapy is not scheduled in order to avoid functional decline,” Adamczyk says.
As a general rule, integrate some form of intentional movement into each day. “I encourage my patients, even on their worst fatigue days, to do something that they enjoy and is meaningful to them to move their bodies,” Adamczyk says. “That might be to spend as much time out of bed during waking hours as possible, go for a short walk or do a few bodyweight exercises.”
The key is training at intensities that are appropriate for your overall health, and understanding that, even under the best circumstances, strength and endurance can decrease with lung cancer and treatments. Practice patience and focus on using physical activity as a way to feel better, she says. If you experience any shortness of breath, dizziness, lightheadedness, chest pains, palpitations or new pain, weakness or balance difficulties, stop what you’re doing and talk to your doctor for advice on how to best move forward in your recovery.
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