Why walking isn’t enough after lung cancer surgery

After lung cancer surgery, patients often feel short of breath during exercise because their oxygen supply doesn't recover as quickly as before surgery. Consequently, many patients experience fear of breathlessness and limit their exercise to longer durations of low-intensity “walking exercises.”

However, merely extending walking time can actually be counterproductive for lung cancer patients.

After lung cancer surgery, if patients feel short of breath during exercise, it's because the oxygen supply doesn't recover as quickly as before surgery. Consequently, many patients feel anxious about their breathlessness and often limit their exercise to simply increasing the duration of low-intensity “walking.” However, merely extending walking time can actually be counterproductive for lung cancer patients. (Credit: Getty Images)

“Exercises that don't cause breathlessness merely increase calorie expenditure without strengthening cardiopulmonary function,” said Professor Kong Sung-a of Samsung Advanced Institute for Health Sciences and Technology on the Korean Association for Lung Cancer's YouTube channel, “Ask Anything About Lung Cancer.” “Such exercise only results in increased calorie burn, potentially leading to long-term muscle loss.”

Professor Kong said, “Exercises like walking slowly for two hours without using the gluteal muscles, thigh muscles, or ankle muscles at all are hardly what you'd call exercise.” She explained the reason, noting that “the effects are minimal, and prolonged aerobic exercise lasting over an hour can actually cause muscle loss.”

Exercise that maintains muscle mass is critically important for lung cancer patients, as muscle mass directly impacts survival. Professor Kong advised, “Studies show patients with sarcopenia have a 2.5 to three times higher mortality rate. Therefore, effectively maintaining muscle while improving cardiopulmonary function can help enhance patient prognosis.”

Immediately after lung cancer surgery, slow walking exercises aid recovery. However, once patients can walk independently for about 30 minutes, additional exercise becomes necessary.

“Fundamentally, once patients can walk for about 30 minutes, they should then focus on building additional muscle strength,” Kong said. She also emphasized the need to incorporate exercises to restore elasticity in the respiratory muscles, as respiratory function is often compromised post-surgery.

During lung cancer surgery, part of the lung is removed, reducing lung capacity and potentially decreasing respiratory function. Furthermore, the elasticity of the accessory respiratory muscles that assist breathing is also diminished, making it difficult to effectively expand and contract the lungs. If the surrounding muscles related to breathing are not used properly due to surgical pain, it can lead to the adverse outcome of the body stiffening.

“Lung cancer surgery reduces lung capacity by 15–30 percent, and this loss is irreversible. The remaining lung capacity must be utilized effectively, which requires the surrounding respiratory muscles to have elasticity,” Professor Kong said. “Patients need to engage in aerobic exercise, but increasing intensity is difficult because the respiratory muscles cannot support it, leading to poorer oxygen supply. Therefore, additional exercises to restore respiratory muscle elasticity are necessary.”

So, what exercises help restore respiratory muscle elasticity?

The first is neck rotation exercises. “Sometimes the neck and shoulder area become extremely stiff,” Kong said. “In such cases, sitting in a chair, holding onto the chair with one hand for support, and using the other hand to gently lower the neck diagonally downward at a 45-degree angle—this ‘stretching to lengthen the neck and shoulders’—is helpful when repeated on both sides.”

The second is an exercise to straighten the thoracic spine. “After neck exercises, the thoracic spine can tilt or bend forward,” Kong said. “An exercise to straighten the thoracic spine is necessary at this point.” She added that since patients often don't move their arms after lung cancer surgery, causing significant shoulder problems, stretching to make the shoulders flexible is also necessary.

The exercise recommended for this involves repeatedly stretching by extending the arms at waist height and bending the torso. The exercise intensity should be adjusted based on the patient's shoulder condition and the time since surgery. “Adjusting the height is more helpful when starting from above waist level and lowering down,” Kong said. “Typically, flexibility is reduced in the operated shoulder, so it's best to perform the stretch with the operated arm elevated about one hand's width.”

Following this, exercises stretching the core muscles are recommended. The core refers to the muscles around the waist, particularly the lumbar region. Due to prolonged bed rest and reduced activity during lung cancer surgery, these core muscles often become significantly weakened.

“That leads patients to rely solely on chest breathing instead of diaphragmatic breathing,” Professor Kong said, emphasizing that once the muscles are softened through stretching, exercises that enhance muscle elasticity are necessary.

Neck rotation exercise (Source: Screenshot from the Korean Association for Lung Cancer’s YouTube channel, “Ask Anything About Lung Cancer”)

The recommended exercise involves holding a 500 mL water bottle in each hand while standing upright, then repeatedly performing movements like spreading the arms out to the sides or bringing the arms up from below and behind the back. Start with two sets of five to eight repetitions for these stretching movements, gradually increasing the number of repetitions up to a maximum of 15 to build intensity. There's an important tip here: perform the stretching exercises while breathing properly.

“When doing stretching and strength training, you should continuously exhale well to activate the respiratory muscles more effectively,” Kong said. “Exhaling while performing the movements makes it more effective. Before engaging in full-fledged cardio exercises like jogging, running, or cycling, it is crucial to perform preparatory work such as elasticity exercises for respiratory muscle recovery to ensure sufficient oxygen supply.”

By preventing patients from avoiding high-intensity exercise that could strengthen cardiopulmonary function due to shortness of breath after lung cancer surgery, these routines can positively impact survival rates. Professor Kong said, “Research shows that good cardiopulmonary function in lung cancer patients can reduce mortality by 50 percent,” stressing that maintaining muscle while increasing cardiopulmonary function helps improve prognosis.

“Patients tend to choose what's easy and comfortable. Walking is easy. It's not strenuous, so they just walk. But if you want to get back to your old self quickly and slow down the aging process, you need a bit of exertion,” Professor Kong pointed out. She stressed that the exercise needed for lung cancer patients is “cardio-respiratory function–strengthening exercise,” which requires combining strength training with respiratory muscle recovery and elasticity exercises that push you to the point of breathlessness.