The time between deciding on lung-cancer surgery and entering the operating room can feel like waiting. Increasingly, it is being studied as a treatment window: can a brief, structured program make the body more ready for surgery? The answer is becoming more interesting, especially for people at higher risk of pulmonary complications.
Evidence at a glance
- Studied population: people at elevated pulmonary risk undergoing elective lung resection.
- Intervention: two weeks of high-intensity breathing-muscle training within a broader program that included nutrition, smoking cessation and psychological support.
- Meaningful benefit: fewer postoperative pulmonary complications and a roughly two-day shorter median hospital stay in one multicenter trial.
- Negative finding: protocols vary widely, and an older meta-analysis did not show clear reductions in pneumonia, atelectasis or mortality from inspiratory training alone.
- Boundary: prehabilitation prepares someone for surgery; it is not evidence of cancer control and should not delay a time-sensitive operation.
The strongest recent signal
A 2025 multicenter randomized trial enrolled 122 patients considered high risk because cardiopulmonary testing showed inefficient ventilation. For 14 days before lung resection, the intervention combined high-intensity inspiratory and expiratory muscle training with nutrition support, smoking cessation and psychological support. Pulmonary complications occurred in 34% of the prehabilitation group and 55% with usual care. Median hospital stay fell from nine to seven days, and patient-reported quality of life improved.
That 21-percentage-point difference matters. But the package was deliberately multimodal, so the trial cannot tell us that the breathing device alone produced it. The participants were also selected as high risk; we should not assume an identical benefit for every person having a smaller operation or entering surgery with stronger cardiopulmonary reserve.
A 2026 meta-analysis of 13 studies and 761 patients found that threshold inspiratory-muscle training reduced pulmonary complications and hospital stay while improving inspiratory pressure and six-minute walking distance. Yet a prior review of six randomized trials found better walking distance and shorter stays without statistically clear reductions in pneumonia, atelectasis, prolonged ventilation or mortality. Different devices, intensities and combined exercise programs make the “dose” difficult to standardize.
What a safe program looks like
This is not simply “take deep breaths at home.” Research programs measure respiratory strength, set resistance and progress it under supervision. The practical starting point is the thoracic-surgery team or a pulmonary-rehabilitation clinician, especially with COPD, oxygen use, heart disease, dizziness or recent worsening breathlessness. Training should stop for chest pain, faintness, severe breathlessness or falling oxygen levels. Surgery timing remains a multidisciplinary decision.
Questions for the care team
- Am I at increased risk for pulmonary complications after this operation?
- Is there enough time for a supervised prehabilitation program without delaying surgery?
- Would my program include walking or cycling, strength work, nutrition and smoking support as well as breathing training?
- Who should set and monitor the resistance on an inspiratory-muscle device?
Explore the Missing Script evidence library, and follow the podcast, coming soon. This article is educational and does not replace individualized medical care.
