What Is Pulmonary Rehabilitation for Lung Cancer?

In This Article

Pulmonary rehabilitation can be beneficial when you have lung cancer. It's an ongoing process that encompasses multiple components, including exercises that strengthen breathing muscles and techniques for swallowing more safely. Participating in pulmonary rehabilitation at any phase during your lung cancer care and recovery can improve your ability to manage day-to-day activities and optimize healing after lung cancer surgery.

Purpose

There are many objectives of pulmonary rehabilitation when you have lung cancer, such as:

  • Easing breathing
  • Building tolerance for physical activity
  • Reducing lung cancer pain
  • Eating and drinking safely
  • Nutritional management
  • Emotional and psychological support

Physical Strengthening

Physical exercises to help you gain better control of muscles throughout your body, such as in your legs, trunk, core, and arms, can decrease the effort that you have to put into daily activities, reducing the demands on your lungs.

Conditioning your heart muscle with aerobic exercises also improves your heart's efficiency, giving you more energy.

Optimizing Lung Function

Exercises geared to strengthen your respiratory muscles are part of pulmonary rehabilitation. This can improve your lung function so you can breathe more efficiently. It also helps prevent infections and other complications of lung cancer, such as atelectasis.

In fact, pre-operative exercises have been found to reduce complications after lung cancer surgery, decrease the length of your hospital stay, and improve your quality of life.

Safety

Fatigue and lack of coordination can develop due to complications of lung cancer. These problems increase day-to-day dangers such as choking on food or physically falling while walking.

Pulmonary rehabilitation helps maintain safety with approaches such as building coordination and learning to adapt to your limitations.

Nutrition

Weight loss and malnutrition can be a consequence of cancer. Pulmonary rehabilitation involves education to help you maintain a healthy diet. This is important in recovering from lung cancer and from surgery to treat it.

Emotional Support

Counseling and therapy are also among the components of pulmonary rehabilitation. You can gain skills to help you cope with stress, sadness, and uncertainty that you might be experiencing.

Pulmonary rehabilitation is different than chest physical therapy, also called chest physiotherapy. Chest physical therapy involves techniques used to remove excess mucus from the lungs.

Risks and Contraindications

Pulmonary rehabilitation is generally safe, but there a few risks that you and your medical team need to keep in mind. Your rehabilitation may need to be adjusted, even temporarily, to avoid any adverse effects of therapy.

  • As you are recovering from surgery, it’s important that you avoid any activities that could cause your surgical incision to open or become infected.
  • And when you are undergoing treatment with chemotherapy or radiation, you could be at an increased risk of infection. You and your therapist might need to take infection control precautions.
  • It's also important to keep in mind that osteoporosis and bone metastases, both of which may occur with lung cancer, can increase the risk of bone fractures—even without an injury or with one that would have otherwise been considered negligible.
  • If you have certain heart diseases, like unstable angina, some physically demanding exercises can increase your risk of having a cardiovascular event.

Even with these issues, you can still benefit from pulmonary rehabilitation. In fact, if your health is interfering with your activities, your pulmonary rehabilitation is especially valuable. For example, if you have bone metastases that put you at risk of a fracture, learning to walk safely will reduce that risk.

Before Rehabilitation

Your medical team, which will include an oncologist, pulmonologist, and surgeon, will work with you to determine the best time for pulmonary rehabilitation. There are several factors that can play into this.

For example, your doctors may want you to have therapy before surgery so you can learn skills like breathing more deeply and coughing more effectively to improve your recovery after surgery.

On the other hand, if you've already had a thoracotomy, post-operative rehabilitation is recommended, but you might need to wait until you heal from surgery to avoid pain.

Timing

Your pulmonary rehabilitation will likely involve several sessions that take place over the course of weeks or months. The duration of these sessions may differ depending on your needs and your practitioner.

Location

Your pulmonary rehabilitation may take place at a rehabilitation facility or at the clinic or hospital where you get your lung cancer care. This may occur while are an inpatient at the hospital or in an outpatient setting with scheduled appointments.

Regardless, it's unlikely your rehab will take place in just one spot. That's because your program can involve a number of therapies—such as speech and swallow therapy, muscle strengthening, breathing exercises, and more. Each therapist will meet with you in the location where they have specialized equipment that you can work with.

What to Wear

Be sure to wear something comfortable so that you can move without limitations.

Also, if you are going to have a swallow evaluation or swallow therapy, consider wearing something that would be easy to clean in case food or drink spills on it.

Food and Drink

Be sure that you are neither hungry nor so full that you're bloated when you go in for your pulmonary rehabilitation. For physical aspects of your session, you'll need to move around and breathe deeply, so any discomfort or distraction can interfere with that.

Cost and Health Insurance

If you have insurance, it's important to check with your provider to see whether pulmonary rehabilitation will be covered by your particular plan. You can ask how many sessions are covered and if only certain aspects of the program are included.

Additionally, you'll want to know if you will be expected to pay for some of your therapy out of pocket. If so, the cost can vary substantially, so it's worth asking about the price in advance. Because there is such a variety of services, this type of treatment can range from hundreds to thousands of dollars if you are considering having many sessions.

If the cost is out of reach, you may want to consider entering a clinical trial that is studying the effects of pulmonary rehabilitation on people with lung cancer.

What to Bring

You should bring documentation, such as your identification, insurance card, the doctor's order for your rehabilitation treatment, and a form of payment if you are expected to pay for some or all of your treatment.

Bring along your inhalers in case you need a scheduled or urgent treatment during your session.

Be sure to bring a record of any measurements that you may have taken at home, such readings from your peak flow meter (if applicable). Similarly, if you have been asked to track your respiratory rate, your pulse rate, or how many steps you take, be sure to bring this information with you as well.

During Rehabilitation

Pulmonary rehabilitation is a coordinated approach to improving quality of life that uses the expertise of several specialties. Some of these include respiratory therapists, physical therapists, occupational therapists, nutritionists, psychologists, and exercise physiologists.

You will have an appointment with one or more specialists who will work with you to improve a specific aspect of your health that's affected by lung cancer.

Pre-Therapy

Before you begin your rehabilitation program, you may need some baseline tests. For instance, lung function tests or a six-minute walk test can establish your abilities before therapy so you and your therapist can work together to create realistic goals for improvement.

And when your therapy is focused on counseling, you might have a questionnaire or a pre-treatment interview to establish whether you have been experiencing stress, sadness, or any other issues that need to be addressed.

Throughout Therapy

The types of pulmonary therapy you receive will depend on your personal needs. Sometimes these may be combined in one appointment, other times they may be administered on their own.

Breathing Exercises

There are a number of techniques you might learn to help improve your pulmonary function and efficiency. Diaphragmatic breathing can strengthen the diaphragm and decrease the fatigue of breathing. And pursed-lip breathing may help decrease the sensation of shortness of breath.

Energy-Conservation Techniques

Your pulmonary rehabilitation specialist may provide instruction that includes tips for avoiding shortness of breath while eating or strategies for avoiding reaching and bending. They might show you how to use extension arms or grabbers for everyday tasks.

Aerobic Exercise Therapy

Aerobic exercise, such as walking on a treadmill or using an exercise bike, may improve your endurance and/or increase your lung capacity. You might also be encouraged to keep up aerobic exercise with at-home activities on the days when you aren't going in for therapy.

Weightlifting

Your therapist may show you how to lift light weights as a way to build strength throughout your body so that your daily activities won't be too exhausting.

Assistance With Medications and/or Oxygen

You might benefit from instruction in the use of your prescribed medications, such as inhalers and nebulizers. While these treatments can help you breathe more easily, it's important to learn how to use them so you can get their benefits.

Similarly, it can take time to get used to using supplemental oxygen and your respiratory therapist can help you get the hang of it.

Education About Airborne Triggers

Living well with lung disease means avoiding things that can trigger respiratory issues. You might need to figure out whether factors like pollen or animal dander are making you short of breath. Improving indoor air quality with things like houseplants known to purify indoor air can help you breathe easier.

Smoking Cessation

You might have decided that you want to stop smoking if you are a smoker. However, smoking cessation isn't easy due to its addictive nature. Pulmonary rehabilitation can support you in your efforts to quit smoking by, among other things, providing a supervised smoking cessation program.

Counseling

Counselors can be invaluable in helping you develop coping strategies as you face your cancer. A counselor can also help you recognize times when your emotions and psychological stress can affect your breathing.

Nutrition Counseling

Weight loss can be a consequence of lung cancer. And cancer cachexia, a syndrome that includes unintentional weight loss and muscle wasting, contributes to cancer deaths.

Nutritional guidance can help you maintain a healthy weight while being mindful of issues like being too tired to eat, diminished appetite, nausea, and trouble swallowing.

Post-Therapy

After your session is complete, your therapist will want to make sure that you feel OK and that you are ready to safely go home. If you feel any type of discomfort, such as pain, shortness of breath, or palpitations, be sure to mention it before you leave.

After Rehabilitation

In between your pulmonary rehabilitation sessions, you might notice an improvement in your physical abilities or breathing. You might also feel tired after your sessions.

Be sure to observe any changes in your abilities or symptoms, and try to take note of what factors seem to improve or worsen how you feel. Likewise, consider tracking your goals, whether they are steps per day or a target lung volume with your incentive spirometer.

You might consider logging this information in a diary or on your calendar so you can discuss your response to therapy and any trends you are noticing with your cancer care team in a detailed way the next time you see them.

If you feel especially sore, in pain, or short of breath, call your doctor promptly rather than waiting for your next rehabilitation session or doctor's appointment.

A Word From Verywell

Pulmonary rehabilitation can be beneficial in early- or late-stage lung cancer, whether you have surgery, chemotherapy, and/or radiation. When started before lung surgery, pulmonary rehabilitation can also help reduce some common post-surgical complications. If the idea of starting a program has not yet been introduced by your medical team, ask about how it could benefit you.

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