Improving Breathing After Lobectomy

Patients with non-small cell lung cancer who undergo surgical removal of a pulmonary lobe must exercise to avoid such complications as collapse of the unaffected lung and the pooling of secretions that may obstruct air passages if not cleared by coughing due to postoperative pain.

Light exercises, which can be done at home, may also be beneficial for patients who require additional therapy like chemotherapy or radiation because exercise helps reduce the toxicities that can occur with these treatments.

To learn more about these exercises, CURE® spoke with Dr. Scott L. Shofer, a pulmonologist at Duke Cancer Center in North Carolina and Durham Veterans Affairs Medical Center, and Susan Blackwell, a physician assistant in the thoracic oncology program at Duke Cancer Center. Both suggest that patients speak with their cancer team before starting to exercise.

Chair Exercises

Patients can work on movements from sitting to standing, which allows them to move in a controlled manner.

“(For a patient who is) early post-op, (if they) want to start moving a little bit but (they’re) not quite ready to get into a (rehabilitation) program, things we often do are things like sit to stand (exercises), working from the chair,” Shofer said.

Walking

Patients can walk outdoors on flat ground (tracking how much they walk with a pedometer) or on a treadmill. A pulse oximeter, which measures blood oxygen saturation and estimates heart rate, can allow patients to gauge how much more they can exercise.

“(Patients) can probably think about working in a level of intensity that’s maybe 20% above their baseline heart rate,” Shofer said. “If their normal heart rate is in the 80s or 90s, and they’re exercising up to the 110s or 120s, that’s a reasonable level of exercise for people to start with.”

Blackwell added, “I tell patients to start out slow so they don’t get overwhelmed and they don’t quit. ... I do not want them to get discouraged and stop exercising.”

Resistance Bands

These elastic bands, which come in different levels of resistance, can be used to do arm curls, leg lifts and other exercises.

“Start with (a band) that allows you to complete eight to 10 repetitions of a particular exercise, and aim for three sets of eight to 10 repetitions,” Shofer said. “Increase band resistance as you become more accustomed to the exercise.”

Breathing Exercises

An incentive spirometer is often given to patients at the hospital, which can be taken home for further use.

“It has a volume measurement ... (that shows) how big the breath is on inhalation,” Shofer explained. “(Patients) can continue to work on getting (the volume) higher and higher to a defined target level.”

Advice

• Stay adherent to respiratory medications to help clear secretions, open airways and lead to more effective breathing.
• Patients may be pushing themselves too hard if they feel lightheaded, sweaty or clammy, or if they feel like they can’t catch their breath. If a patient experiences these feelings, find a place to sit and rest until these symptoms resolve. If they don’t go away after several minutes, consult with a doctor or get emergency attention before restarting an exercise program.