Exercise guide
Exercise is safe and recommended with lung cancer, at every stage. Getting a little out of breath when you're active isn't dangerous, and it usually settles within a few minutes; going slowly and using breathing techniques make it easier. In trials, 1 to 4 weeks of exercise before surgery cut lung complications afterwards by more than half.
Exercise works alongside your treatment, not instead of it, and your own team's advice comes first, especially about lifting after surgery.
This guide covers getting fit for surgery, the breathing, coughing, shoulder and walking exercises UK hospitals give after lung surgery, managing breathlessness, and exercise during treatment and with advanced lung cancer, with moves on the 3D figure and a follow-along routine for the first weeks after surgery.
Exercise is safe with lung cancer, from before surgery to advanced cancer. Roy Castle Lung Cancer Foundation says many people wrongly presume they should avoid exercise. Getting a little out of breath isn't dangerous, and it usually settles within a few minutes of resting.
In a Cochrane review, exercise before lung cancer surgery cut lung complications afterwards by more than half (high-certainty evidence) and probably shortened the hospital stay by about 2 days. The American Society of Clinical Oncology (ASCO) says doctors may recommend it.
UK hospital leaflets give slow deep breaths and a supported cough, shoulder and trunk exercises 2 or 3 times a day so your shoulder doesn't stiffen, and walking from the first day, building up over 6 weeks.
Hospitals advise no heavy lifting for 4 to 6 weeks or 6 to 8 weeks, or no pushing, pulling or lifting in the early weeks. Most people are back to their usual activities by 2 to 3 months. Your own team's limits come first.
The European Society for Medical Oncology (ESMO) guideline backs a handheld fan, breathing techniques, pacing and positions that ease breathing, with exercise-based rehabilitation among its strongest recommendations.
Get help for breathlessness that's new, getting worse quickly or worse than usual, coughing up blood, chest pain, or a cough, wheeze or fever during or after immunotherapy or chest radiotherapy.
Lung cancer is cancer in one or both lungs. About 50,200 people are diagnosed with it each year in the UK. About 80 to 85 in 100 have non-small cell lung cancer, and 15 to 20 in 100 small cell lung cancer, which tends to spread early.
In England in 2022, 18% of people had surgery as part of their first treatment, 24% radiotherapy and 24% chemotherapy or other drugs. Surgery removes a small part of the lung, a lobe (a lobectomy, the most common operation) or a whole lung (a pneumonectomy), by keyhole, robot-assisted or open surgery, and hospital stays are usually 3 to 5 days. Targeted drugs and immunotherapy are used mainly for advanced cancer. NICE (the National Institute for Health and Care Excellence) says your fitness for surgery may be checked with a walking test, or an exercise test that measures how your heart and lungs cope.
Some breathlessness is normal after lung surgery. Many people find it improves over the first 4 to 8 weeks, depending on how breathless they were before and how much lung was removed, and the remaining lung usually adapts. Pain along the scar can last a long time after open surgery, though for most people it eases over a couple of years.
It can come from the cancer, fluid around the lung, anaemia, infection, weak muscles, pain, a blood clot, other lung conditions such as COPD (chronic obstructive pulmonary disease), anxiety, smoking or treatment. Being breathless can lead to doing less, which weakens your muscles and makes you more breathless. Rehabilitation breaks that cycle by getting you used to being breathless while staying in control.
Chest radiotherapy can cause tiredness, and sometimes a dry cough or breathlessness from inflammation of the lungs (pneumonitis), soon after treatment or months later. Immunotherapy such as pembrolizumab can also inflame the lungs, during treatment or after it ends.
Most trials were in non-small cell lung cancer, and many people in the trials before surgery also had COPD. Trials in advanced lung cancer are small, with 20 to 111 people each.
In a Cochrane review of 10 trials (636 people), exercise before surgery cut lung complications after the operation by more than half (9 trials, 573 people; high-certainty evidence): about one fewer complication for every 5 people who exercised. It probably shortened the hospital stay by about 2 days and improved fitness (moderate certainty). The trials reported no harms.
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Programmes ran from 3 sessions a day for a week to 5 times a week for 4 weeks, and half lasted 1 or 2 weeks. All included aerobic exercise such as walking or cycling, most added breathing exercises, and some added strength training. Programmes of 2 weeks or less worked as well as longer ones, and the best prescription isn't known.
Source 4
In 151 people, 2 or 3 supervised interval sessions a week on a bike, for about 25 days, raised fitness by about 15% but didn't reduce the combined measure of complications and death.
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ASCO says doctors may recommend exercise before lung cancer surgery. NICE says smoking raises the risk of lung complications after surgery and advises stopping as soon as lung cancer is suspected, though surgery isn't delayed to allow it. Cancer Research UK says stop smoking at least 4 weeks before surgery if you can, and some hospitals run prehabilitation programmes.
Walk for 20 to 30 minutes every other day if you can, doing enough to feel mildly short of breath, and try marching on the spot, stair walking or step-ups, and raising a ball above your head, 4 or 5 times a week.
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In whatever time you have, walk or cycle most days at a pace that leaves you mildly short of breath, building towards 30 minutes. Add leg strength exercises such as sit-to-stands and step-ups 2 or 3 times a week, and practise the deep breathing you'll use after surgery. Do harder intervals only if your team agrees. In the trials, even 1 to 2 weeks counted.
Our exercises after lung surgery routine puts the exercises in order.
The leaflets differ in the detail. South Tees: sit upright with your hands on the sides of your chest, breathe in slowly, hold for 1 or 2 seconds and breathe out slowly, 5 times, then huff 5 times, and cough with a small pillow over your wound if there's phlegm. Norfolk and Norwich: 3 slow deep breaths with a 3-second hold, then rest, because more can make you dizzy. St George's: 5 deep breaths every half hour, and "coughing will not damage your chest wound".
You'll usually be out of bed the first morning. Walk regularly, about every 2 hours once you can, or march on the spot or use the ward bike. Roy Castle says feeling short of breath shows you're working at the right level, but you shouldn't be gasping. One NHS (National Health Service) trust sends people home at about 5 days, once they can manage 5 minutes on the bike and a flight of stairs if they need to.
Moving the arm on your operated side early helps prevent a stiff or frozen shoulder. The leaflets use arm raises forwards and out to the side, shoulder shrugs and rolls, side bends and trunk turns with your arms crossed: 5 to 10 times, 2 or 3 times a day.
South Tees' schedule, walking outdoors where you can:
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Keep up the shoulder exercises and sit and stand tall: it's common to lean towards the painful side. St George's plan: short walks in week 1; light tasks such as cooking from week 2, avoiding pushing, pulling and lifting; gardening and light shopping at 4 to 8 weeks; and life back to normal at 8 to 12 weeks, building sport back gradually. Ask your GP (general practitioner) before competitive or contact sport.
South Tees says no heavy lifting for 4 to 6 weeks while the wound heals; Norfolk and Norwich says avoid heavy lifting for 6 to 8 weeks; St George's says avoid pushing, pulling and lifting in the early weeks; and Roy Castle says don't lift heavy pots and pans at first. None of these comes from a trial, and your own team's limits come first.
Ask your surgeon when you can swim. After a whole lung is removed, you may float differently, even if you were a strong swimmer, so go with someone and use floats at first.
In a Cochrane review of 8 trials (450 people), exercise programmes in the year after surgery added about 57 metres to a 6-minute walk (high certainty) and improved fitness and leg strength (moderate certainty), with a possible small easing of breathlessness (very low certainty). Programmes lasted 4 to 20 weeks, mostly 2 or 3 sessions a week with some supervision. Ask your team what's available.
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Ask to be referred to a breathlessness clinic. If you also have COPD, pulmonary rehabilitation (a supervised exercise and education course) can help.
From the South Tees, Norfolk and Norwich and St George's leaflets. Every half hour while you're awake in the first days, then several times a day.
See the movement on the 3D figure: Lateral breathing (Pilates breathing)
Doses from the hospital leaflets: arm raises, shoulder rolls and shrugs 5 to 10 times (South Tees); side bends and trunk turns with your arms crossed, sitting, 5 each side, 3 times a day (St George's); ankle circles 10 each way, thigh tightening 10 each leg, and knee straightening held for 5 seconds, 10 each leg (South Tees). The breathing techniques move has written steps only.
3D demoLateral breathing (Pilates breathing)Beginner · No equipment
3D demoActive cycle of breathing techniques (ACBT) with huffingBeginner · No equipment
3D demoBreath reachBeginner · No equipment
3D demoShoulder rollsBeginner · No equipment
3D demoOverhead side bendBeginner · No equipment
3D demoThoracic rotationBeginner · No equipment
3D demoSeated upper-back lift (sit tall, shoulders back)Beginner · A bench or box
3D demoAnkle circlesBeginner · No equipment
3D demoQuad set (static quads)Beginner · No equipment
3D demoSeated knee extension (chair)Beginner · A bench or box + Something with weight
3D demoStanding marchBeginner · No equipmentTreat any causes that can be reversed first. Then a handheld fan, breathing retraining with a physiotherapist, trying a walking aid, learning to pace activities and use positions that ease breathing, and exercise-based rehabilitation, including pulmonary rehabilitation for people who also have lung or heart disease. ESMO says breathlessness "is itself not dangerous".
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Macmillan suggests relaxed tummy breathing (breathing control), pursed-lip breathing during or after walking, and breathing in on 1 step and out on the next 2 when you walk. Practise them when you're not too breathless. Our COPD guide shows the same techniques step by step.
Sit upright and supported, sit leaning forward with your forearms on your thighs, stand leaning forward on a surface, or stand leaning back against a wall. Hold a handheld fan about 15 cm from your face. Relaxation for 5 to 10 minutes a day can ease anxiety and breathlessness.
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Macmillan says physical activity may not make you more breathless, especially if you go slowly, and breathlessness usually goes in a few minutes. ESMO says that even after hard exercise, breathlessness in people with lung cancer typically settles within a few minutes.
NICE says breathlessness support based on psychosocial support, breathing control and coping strategies, from a team that may include a nurse, physiotherapist or occupational therapist, should be available in all care settings.
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Oxygen helps only if your oxygen level is low; it isn't a treatment for breathlessness itself, and ESMO doesn't recommend it when your oxygen level at rest is 90% or more. If you've been prescribed oxygen, use it as your team advises.
Treating the cause, such as draining fluid or treating anaemia or an infection, comes first. Your team can also offer medicines for breathlessness.
The pursed-lip breathing page's dose: use it whenever you're breathless, and practise 5 to 10 breaths sitting down once or twice a day until it comes naturally. For relaxation, Macmillan suggests 5 to 10 minutes a day; skip any breath holds that make you breathless.
In a Cochrane review of 6 small trials (221 people), exercise may have improved walking distance (about 63 metres further in 6 minutes) and quality of life, with no clear effect on breathlessness or tiredness, and the evidence was low quality. In 92 people whose lung cancer couldn't be operated on, 8 weeks of home exercise didn't improve walking, but quality of life and symptoms were better at 6 months. Of two newer reviews, one found better fitness, strength, tiredness and quality of life, and the other better physical function only.
Keep going little and often, resting when you need to: gentle exercise may help radiotherapy tiredness. Tell your team if you feel breathless or have a dry cough during or after chest radiotherapy, and on immunotherapy contact the hospital straight away for breathlessness, a cough that won't go away, wheezing or a fever over 37.5°C. When your white cell count is low, avoid busy gyms and pools.
Exercise hasn't been shown to improve lung function tests much: Cochrane rated the effect before surgery as little to none (low certainty), and uncertain after surgery and in advanced cancer. What it improves is fitness, leg strength and walking.
Losing your appetite and weight is common with lung cancer. If you're losing weight or muscle, exercise shouldn't leave you short of energy: a dietitian can help you eat enough, and keeping up strength exercises helps you hold on to muscle.
Roy Castle says stopping smoking is the most important thing you can do to reduce the chance of lung cancer coming back, and NICE says smoking raises the risk of lung complications after surgery. Ask your team or GP for help to stop.
Starting points for someone without warning signs. Your team's advice comes first.
Walk 20 to 30 minutes every other day or more, mildly short of breath, with marching, step-ups and arm raises 4 or 5 times a week (Roy Castle). Trial programmes ran from daily to 5 times a week, for 1 to 4 weeks. Stop smoking.
Deep breaths and huffs, with a supported cough, several times an hour at first; shoulder, trunk and leg exercises 2 or 3 times a day; walking from the first day.
Walk twice a day, building from 5 to 10 minutes to 45 minutes by week 6 (South Tees). Shoulder exercises twice a day (Norfolk and Norwich). No heavy lifting while your wound heals, for as long as your team says.
Gardening, light shopping and longer walks, with most people back to their usual activities by 2 to 3 months. Ask about a rehabilitation programme: trials ran 2 or 3 sessions a week for up to 20 weeks.
Little and often, resting when you're tired. Know the signs of inflamed lungs (pneumonitis) in the warning signs below.
Pace yourself, use positions, breathing control and pursed lips, keep a fan handy, pace your breathing to your steps on walks, and build activity up slowly.
Build up to the UK guidelines: 150 minutes of moderate activity a week, plus strength exercises on 2 days, starting with 10 to 15 minutes at a time. The international roundtable's amount for tiredness and fitness is at least 30 minutes of moderate aerobic exercise 3 times a week, plus strength exercises twice a week.
Walk or cycle most days; use paced breathing on step-ups and stairs, pausing at the top. Strength 2 or 3 times a week, 2 sets of 8 to 12 to start (our editorial starting point), breathing out as you lift. Leave rows, push-ups and other upper-body loads until your team allows: hospitals give 4 to 8 weeks for heavy lifting. Arm work can make you breathless, so go light.
3D demoTreadmill walkingBeginner · Cardio machine
3D demoStationary cyclingBeginner · Cardio machine
3D demoLow step-upBeginner · A step
3D demoStair climbingIntermediate · A step
3D demoSit to stand from a chairBeginner · A bench or box
3D demoStep-upBeginner · A step
3D demoSlow calf raiseBeginner · A wall
3D demoBand rowBeginner · A band + An anchor point
3D demoWall push-upBeginner · A wall
3D demoSeated dumbbell lateral raiseBeginner · A dumbbell + A bench or boxFollow the exercises after lung surgery routine for the first 6 weeks, then move on to the easy cardio workout and a strength routine. The COPD workout suits breathlessness at home; its inhaler, oxygen and flare-up tips apply only if you also have COPD. Do the build-up interval walk before surgery only if your team agrees, and skip any breath holds in the relaxing breathing routine that make you breathless.
A gentle 15-minute routine for the first 6 weeks after lung surgery: deep breaths and a supported cough, shoulder and trunk moves, leg exercises and a walk.
15 minBeginner12 movesA bench or box, Something with weightA 25-minute home session for COPD: marching and light strength work, with pursed-lip and paced breathing and rests in a recovery position when you need them.
25 minBeginner12 movesA bench or box, A wallA 20-minute seated workout for older adults who cannot stand for long: marching, leg and arm strength, posture, and sit-to-stands that lead back to standing.
20 minBeginner11 movesA bench or box, Something with weightA 10-minute session for low-energy days: marching, sit-to-stands, wall push-ups, step-ups and bridges, then a short walk. Doing a little counts.
10 minBeginner7 movesA bench or box, A wallA steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.
40 minBeginner3 movesCardio machine, A wallA 25-minute walk with short faster bouts: notice your heart and breathing speed up, then settle. A gentle way to get used to the feelings of effort.
25 minBeginner5 movesCardio machine, A wallA full-body resistance band workout: squats, rows, push-ups, presses, pull-aparts, band walks, good mornings and flyes.
30 minBeginner9 movesA band, An anchor pointA 40-minute strength and balance session for over-65s, built from the Otago home programme and NHS exercises, using a chair, a counter and a step.
40 minBeginner18 movesA bench or box, Something with weightA 6-minute breathing routine: slow breathing, crocodile breathing, alternate nostril breathing, box breathing and 4-7-8 breathing.
6 minBeginner5 movesNo equipmentThe walking plan builds to 150 minutes a week over 8 weeks: a good next step once the 6-week walking schedule is done.
This is general information, not a diagnosis: your cancer team knows your treatment, so use the numbers they gave you. A&E means accident and emergency. In the US, call 911 where this page says 999.
Call 999 (911 in the US) if any of these happen, and don't drive yourself to A&E:
Call 999 or go to A&E if you're coughing up more than just a few spots or streaks of blood, or coughing up blood with difficulty breathing, a very fast heartbeat or pain in your chest or upper back. For a few small spots, flecks or streaks of blood, or blood in your phlegm, ask for an urgent GP appointment or get help from NHS 111, and tell your lung cancer team. Stop exercising if it happens while you're active (our suggestion).
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During treatment, a minor infection can quickly become serious. Call 999 if you have:
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If you have:
Source 9
Contact your doctor straight away if breathlessness is new, painful when you breathe, or getting worse quickly. If you can't speak to them and it keeps getting worse, go to A&E.
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Use the number your hospital gave you, or NHS 111 if you can't reach your care team, if you have:
Macmillan says stop and speak to a doctor straight away if you get:
Source 31
A lung cancer diagnosis and breathlessness can both make you anxious, which can make breathing harder. If you're thinking about suicide or can't keep yourself safe, call 999 or go to A&E. For urgent help, call Samaritans free on 116 123, any time, or in England call 111 and select the mental health option. In the US, call or text 988. Roy Castle Lung Cancer Foundation's helpline is 0800 358 7200, and Macmillan's support line is free on 0808 808 0000, 8am to 8pm, 7 days a week.
ESMO says breathlessness "is itself not dangerous" and settles within minutes, even after hard exercise. Macmillan says activity may not make you more breathless, especially if you go slowly, and Roy Castle says feeling short of breath shows you're working at the right level, though you shouldn't be gasping.
Roy Castle says many people wrongly presume this. Exercise before surgery cut lung complications by more than half, exercise after surgery improved walking and strength, and ESMO recommends exercise-based rehabilitation for breathlessness.
Cochrane rated the effect of exercise on lung function tests as little to none before surgery, uncertain after it, and unclear in advanced cancer. The gains come from fitter muscles, heart and circulation, which make the same lungs go further.
Trial programmes lasted 1 to 4 weeks, and those of 2 weeks or less worked as well as longer ones. Some hospitals run prehabilitation programmes: ask yours.
Oxygen is for low oxygen levels, not for breathlessness itself, and ESMO doesn't recommend it when your oxygen level at rest is 90% or more. If you've been prescribed oxygen, use it as your team advised.
The remaining lung usually adapts, and breathing should improve over time with exercise. Some people stay more breathless and can be referred to a breathlessness clinic, and swimming needs care after a whole lung is removed.
St George's says "coughing will not damage your chest wound". Support it with a small pillow, and ask for pain relief if pain stops you coughing or breathing deeply.
Yes. Exercise is safe and recommended at every stage, from before surgery to advanced lung cancer, and it helps fitness, strength and how you cope with breathlessness. Start gently and build up, and check with your team first if you've just had surgery or have heart or lung problems.
Getting a bit out of breath when you're active isn't dangerous, and it usually settles within a few minutes of resting. Going slowly, pacing yourself and using breathing techniques make activity easier, and getting fitter can make everyday tasks feel less breathless. Contact your doctor straight away if breathlessness is new, getting worse quickly, or painful.
Relaxed tummy breathing (breathing control), pursed-lip breathing during or after activity, and pacing your breaths to your steps, such as in on 1 step and out on the next 2. A handheld fan, leaning forward and relaxation help too. Practise when you're not too breathless; our COPD guide shows the same techniques step by step.
Yes, if you can. In a Cochrane review, exercise before surgery cut lung complications afterwards by more than half and probably shortened the hospital stay by about 2 days, and programmes of 2 weeks or less worked as well as longer ones. Walk or cycle most days until you're mildly short of breath, add leg strength exercises, practise deep breathing, and stop smoking.
Deep breaths and huffs, with a supported cough if there's phlegm, several times an hour at first; shoulder and trunk movements 2 or 3 times a day so your shoulder doesn't stiffen; leg exercises; and walking from the first day. At home, walk twice a day and build up: one NHS trust goes from 5 to 10 minutes in week 1 to 45 minutes by week 6. Our exercises after lung surgery routine puts it in order.
UK hospitals advise avoiding heavy lifting, pushing and pulling for 4 to 8 weeks while the wound heals, and most people are back to their usual activities by 2 to 3 months. Build gym work back gradually, and ask your GP or team before competitive or contact sport. Your own team's advice comes first.
People tend to hold the arm still and lean towards the operated side, and the shoulder can stiffen; pain along the scar can also last a long time after open surgery. Moving the arm on your operated side from the first day helps prevent a stiff or frozen shoulder. If the movement isn't coming back, ask your GP about physiotherapy.
Some breathlessness is normal at first, and for many people it improves over the first 4 to 8 weeks as the remaining lung adapts, even after a whole lung is removed. Some people stay more breathless, especially if they were before surgery; a breathlessness clinic or a rehabilitation programme can help. Tell your team if it's getting worse rather than better.
Yes, adjusting to how you feel and resting when you need to; gentle exercise may help radiotherapy tiredness. Tell your team about breathlessness or a dry cough after chest radiotherapy, and on immunotherapy contact the hospital straight away for breathlessness, a cough that won't go away, wheezing or a fever over 37.5°C. Avoid busy gyms when your white cells are low.
Not much, as far as trials show: exercise made little or no difference to lung function tests. What it does improve is fitness, leg strength and walking distance, which make everyday activities easier with the same lungs.
If you're breathless and also have a lung condition such as COPD, or heart disease, the European Society for Medical Oncology recommends exercise-based rehabilitation, including pulmonary rehab; our COPD guide explains what it involves. After lung cancer surgery, rehabilitation programmes of 2 or 3 sessions a week improved walking and fitness. Ask your team what's available near you.
Yes, at a level that suits you: small trials suggest exercise may improve walking, fitness and quality of life, though the evidence is limited. Short walks, chair exercises and light strength work, fitted around treatment and tiredness, are a good start. If the cancer has spread to your bones, read our cancer guide's advice first.
Exercise education, not a diagnosis or treatment plan, and clinical review of these guides is pending. Stop and get advice for chest pain, unusual breathlessness, dizziness or fainting, or new pain, and check with your doctor or midwife first if they have told you to limit activity. Health disclaimer.
