Prehabilitation and Lung Cancer: Building Reserve Before Surgery
The strongest evidence in cancer prehabilitation, fewer chest complications and shorter hospital stays
Lung resection places an exceptional demand on a respiratory system that is often already compromised by smoking history, COPD or the tumour itself. Prehabilitation, aerobic and resistance exercise, inspiratory muscle training, nutritional optimisation, smoking cessation and psychological support, uses the weeks before surgery to raise that reserve. In thoracic surgery the evidence base is among the strongest anywhere in prehabilitation.
What the research shows
• Substantially fewer chest complications. A systematic review of 16 studies and 2,096 patients undergoing surgery for non-small cell lung cancer found prehabilitation more than halved postoperative pulmonary complications (OR 0.45) and severe complications (OR 0.51).¹
• Shorter hospital stays. The same analysis reported a mean reduction in length of stay of 2.46 days.¹ A separate review of 23 studies and 2,068 participants concluded that preoperative rehabilitation reduces both pulmonary complications and length of stay, while short-term inpatient rehabilitation after surgery alone probably does not.²
• Consistent across pooled analyses. A further meta-analysis of pulmonary rehabilitation in lung resection found overall postoperative complications reduced (OR 0.62) and pulmonary complications reduced (OR 0.39), although mortality was unchanged.³
• Better fitness can change what is possible. Preoperative pulmonary rehabilitation improves postoperative quality of life and, in patients initially considered too high-risk because of poor lung function, can help make surgery a realistic option.⁴
• Mental health improves too. Meta-analysis across cancer types shows prehabilitation significantly reduces anxiety and depression alongside gains in walking capacity, relevant in a diagnosis that carries a heavy psychological burden.⁵
Why a digital programme (digital prehab) fits this pathway well
The window before lung surgery is short, so every wasted day matters. Travelling to a hospital-based class two or three times a week is difficult for someone who is breathless, and hospital-based programmes are known to lose patients to the burden of commuting.⁶ Remote, technology-supported prehabilitation has been shown to be feasible and highly acceptable in people awaiting major surgery, and can begin within days of referral rather than waiting for a gym slot.⁷
Personalisation is particularly important in this group, where baseline exercise tolerance, comorbidity and symptom burden vary enormously; reviewers repeatedly identify inadequate exercise dosing and low adherence as the main reasons prehabilitation programmes underperform.¹ A digital platform can prescribe and adjust intensity from each person’s own baseline and track it daily. But adherence is a human problem as much as a technical one, digital health research consistently shows engagement rises when a trusted coach provides feedback and supportive accountability.⁸ Programmes built on this “human-in-the-loop” model, such as QuestPrehab, deliver personalised digital prehabilitation remotely within NHS pathways, or through self referrals, while keeping a real clinician alongside the patient.
Sources
1. Evidence base for exercise prehabilitation for patients undergoing surgery for non-small cell lung cancer: a systematic review and meta-analysis. Eur J Surg Oncol 2023. https://www.sciencedirect.com/science/article/pii/S0748798323000902
2. Xu X et al. Effectiveness of pre- and post-operative rehabilitation for lung cancer: systematic review and meta-analysis. Clin Rehabil 2022;36:172–189. https://doi.org/10.1177/02692155211043267
3. The clinical value of pulmonary rehabilitation in reducing postoperative complications and mortality of lung cancer resection: a systematic review and meta-analysis. 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8503917/
4. Efficacy of preoperative pulmonary rehabilitation in lung cancer patients: systematic review and meta-analysis of RCTs. Discov Oncol 2025. https://doi.org/10.1007/s12672-025-01774-2
5. Efficacy of prehabilitation in cancer patients: an RCTs systematic review with meta-analysis. BMC Cancer 2024;24:1302. https://doi.org/10.1186/s12885-024-13023-w
6. Kleve G et al. Digital home-based multimodal prehabilitation (dHOPE): trial protocol. Front Digit Health 2025;7:1609678. https://doi.org/10.3389/fdgth.2025.1609678
7. Blumenau Pedersen M et al. Digital technologies to support home-based prehabilitation: a systematic review. The Surgeon 2023;21:e305–e315. https://doi.org/10.1016/j.surge.2023.05.006
8. Application of the supportive accountability model in digital health interventions: scoping review. J Med Internet Res 2025;27:e72639. https://doi.org/10.2196/72639