Older Lung Cancer Patients Struggle to Keep Exercising After Leaving Hospital

Older adults recovering from lung cancer surgery often leave the hospital with a prescription for rehabilitation exercise and little else. A new qualitative study from China suggests that what happens in the weeks after discharge depends on far more than the patients’ own determination. Interviews with thirteen postoperative patients reveal a tangle of individual fears, family dynamics, and gaps in the healthcare system that together determine whether rehabilitation exercise becomes a habit or quietly fades away.

The study, published in Frontiers in Oncology, was conducted by researchers affiliated with Lishui People’s Hospital and Wenzhou Medical University’s Lishui Hospital in Zhejiang Province, along with a colleague at Changchun Humanities and Sciences College. Led by Xuli Shang of the Department of Nursing, the team set out to understand how older patients experience rehabilitation exercise during the transition from hospital to home, a period the researchers operationally defined as running from discharge to approximately eight weeks after surgery. It is during this window that patients shift from structured hospital care to home-based self-management, adapting to postoperative symptoms, exercise routines, and changes in daily life.

To capture those experiences, the researchers used a qualitative descriptive design. They recruited thirteen older patients through purposive sampling with maximum variation, seeking diversity in age, sex, education, tumour location, and exercise pattern. All participants had pathologically confirmed primary lung cancer, had undergone surgery, were at least sixty years old, were roughly eight weeks postoperative, and had attempted or engaged in rehabilitation exercise at home. Semi-structured, face-to-face interviews lasting thirty to forty minutes were conducted in quiet private rooms at the hospital or in participants’ homes, audio-recorded with consent, and transcribed verbatim within twenty-four hours. The team analysed the transcripts using the conventional content analysis method of Graneheim and Lundman, with two researchers coding independently and deliberating until consensus was reached.

The participants, eight men and five women, had a mean age of 70.23 years with a standard deviation of 5.14. Most had adenocarcinoma, ten of the thirteen, while three had squamous cell carcinoma. Eight had stage I disease, two stage II, one stage III, and two stage IV. Their chosen exercises ranged from walking and stair climbing to Baduanjin, a traditional Chinese exercise practice, along with aerobics and respiratory training. Most exercised once or twice daily, and eight kept sessions to thirty minutes or less. Recruitment continued until data saturation: after the thirteenth interview, the researchers concluded that no new codes, themes, or interpretations were emerging.

The analysis yielded three major themes and ten subthemes organised around the Social Ecological Model, a public health framework that treats health behaviours as the product of interacting influences at individual, interpersonal, and structural levels. At the micro-system level, the individual level, participants described a heavy symptom burden. Dyspnea, incision pain, and reduced physical strength were the barriers most often cited, and these symptoms frequently intensified anxiety and eroded confidence. One participant told the interviewers that taking a deep breath by accident still left them short of breath and very uncomfortable. Another described how stretching the upper body or doing chest expansion exercises made the area around the wound feel as if it were being pulled.

Psychological distress and uncertainty formed a second individual-level subtheme. Participants reported fear of wound dehiscence, anxiety about performing movements incorrectly, and uncertainty about their recovery, all of which inhibited active participation in exercise routines. One participant who had never exercised before surgery said the doctor recommended daily practice but they had no idea where to start. Another confessed to a persistent fear that exerting even a little force would split the wound open. Yet the interviews also documented adaptation and growth. Some participants gradually learned to adjust their exercise pace and techniques to manage discomfort, and several reported meaningful benefits, including smoother breathing after daily practice, along with improved mobility and overall well-being. Over time, a number of them developed fixed routines, practising every morning until the habit took hold.

At the meso-system level, family support emerged as a powerful facilitator. Emotional encouragement from relatives helped alleviate fear and uncertainty, with one participant noting that their family kept encouraging them until they gradually tried. Companionship mattered as well: exercising alongside a spouse reduced feelings of isolation and increased willingness to engage, as one participant described after their spouse suggested practising together. Family members also provided informational support, searching for rehabilitation exercise videos, manuals, or professional guidance. One participant’s son bought rehabilitation books online and taught them step by step, while another’s family found a video teaching breathing and exercise methods. The researchers argue that these findings suggest future guideline updates could consider caregiver education and involvement in rehabilitation exercise guidance and emotional support, noting that the current lung cancer rehabilitation guideline explicitly includes caregiver participation only in its recommendation for dyadic yoga.

The macro-system level revealed the most structural frustrations. Participants reported insufficient continuity of medical guidance after discharge. Although initial in-hospital guidance helped build confidence, the absence of personalised follow-up left patients confused about exercise techniques and intensity. One participant said the doctor told them to keep it moderate but they still did not know what their limits were; another reported that once discharged, no one followed up and they did not know how to continue. Community rehabilitation resources were also found wanting, with participants reporting that local facilities and group activities were unsuitable for postoperative patients and lacked programmes tailored to lung cancer recovery. One said the exercise intensity in the community was too high and they worried it would damage their lungs. Financial barriers compounded the problem: low reimbursement for rehabilitation therapies created burdens that discouraged long-term adherence, with participants reporting that breathing training and physical therapy came out of their own pockets and that medical insurance did not cover these services after discharge.

The authors situate their findings within a broader context in which lung cancer remains the most frequently diagnosed cancer and the leading cause of cancer death worldwide, accounting for approximately 2.48 million new cases and 1.82 million deaths in 2022 according to GLOBOCAN. In China, an estimated 1,060,600 new cases and 733,300 deaths occurred that year. Surgical resection is the preferred curative treatment for early-stage non-small-cell lung cancer, but it is associated with subsequent reductions in pulmonary function, exercise capacity, and quality of life, and older adults are particularly prone to postoperative physiological decline. Previous research cited by the authors indicates that roughly two-thirds of elderly patients who have undergone lung cancer surgery do not attain recommended levels of physical activity postoperatively, with fatigue, pain, and respiratory difficulties among the prevalent impediments.

The study’s limitations deserve emphasis. The sample was drawn from a single hospital in one geographic region, which may restrict transferability of the findings. The data rely on participants’ self-reported experiences and are therefore susceptible to recall bias and social desirability bias. The authors also note that although data saturation was achieved, larger-scale, multisite qualitative investigations or mixed-methods research would likely yield more comprehensive insights. Because this is a qualitative descriptive study of thirteen patients’ subjective accounts, it documents experiences and perceived barriers rather than measuring the effects of any intervention. The authors are careful to frame their conclusions accordingly: rehabilitation exercise during the hospital-to-home transition was influenced by individual, family, and healthcare-related factors, and the findings may inform individualised exercise guidance, caregiver involvement, and continuity of professional follow-up after discharge. They recommend that future studies evaluate the feasibility and effects of such multilevel support in different healthcare settings, leaving open the question of whether addressing these barriers will translate into better long-term outcomes for older patients recovering from lung cancer surgery.

Subject of Research: A qualitative study of older lung cancer surgery patients' rehabilitation exercise experiences during the hospital-to-home transition, analysed with the Social Ecological Model.

Article Title: Experiences of rehabilitation exercise during the transition from hospital to home among older patients following lung cancer surgery: a qualitative study guided by the social ecological model

Article References: Dong, L., Chen, Y., Shang, Y., Gao, Y., Fu, J., Gu, Y., Jin, L., & Shang, X. (2026). Experiences of rehabilitation exercise during the transition from hospital to home among older patients following lung cancer surgery: a qualitative study guided by the social ecological model. Frontiers in Oncology, 16, Article 1763751. https://doi.org/10.3389/fonc.2026.1763751

Image Credits: AI Generated

DOI: 10.3389/fonc.2026.1763751

Keywords: lung cancer, rehabilitation exercise, older patients, qualitative study, social ecological model, hospital-to-home transition, postoperative recovery, family support, content analysis, patient interviews, Zhejiang China, discharge follow-up