Investigation of the Effects of Tele-Yoga Training in Individuals With Lung Cancer Undergoing Lung Resection Surgery

Lung carcinoma, also referred to as pulmonary carcinoma, is a malignant tumor characterized by uncontrolled cell proliferation in the lung tissue, originating from epithelial cells. It is the most commonly diagnosed cancer type globally. Histopathologically, lung cancer is classified into two main categories: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). NSCLC constitutes approximately 85% of all lung cancer cases and is associated with high morbidity and mortality. According to the Tumor-Node-Metastasis (TNM) staging system developed by the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC), NSCLC is staged from I to IV. While SCLC has a lower prognostic value within the TNM system and is rarely operable, NSCLC is typically treated surgically in early stages.

Surgical treatment for early state of lung cancer includes lobectomy, pneumonectomy, segmentectomy, or wedge resection, depending on tumor location, lung function, and disease stage. The most commonly employed surgical approaches are thoracotomy, video-assisted thoracoscopic surgery (VATS), and robot-assisted thoracoscopic surgery (RATS). Although techniques such as VATS are associated with less postoperative pain, faster recovery, and better preservation of pulmonary function compared to thoracotomy, surgery still significantly reduces exercise capacity and contributes to long-term physical and psychological limitations.

Following lung resection, patients often experience a decline in exercise capacity, attributed to loss of lung parenchyma, ventilatory limitations, increased cardiac workload, thoracic pain, and muscle weakness. Dyspnea is prevalent in up to 60% of postoperative patients, many of whom did not experience dyspnea prior to surgery. Additionally, adjuvant chemotherapy and/or radiotherapy may cause pulmonary inflammation and fibrosis, further reducing lung function and quality of life. Sleep disturbances and psychological disorders such as anxiety and depression are also common during this period.

Exercise training is a non-pharmacological intervention that improves immune function and quality of life in cancer patients; however, traditional pulmonary rehabilitation programs are often underutilized postoperatively. There is increasing interest in mind-body exercise (MBE) modalities such as yoga, tai chi, and qigong, which integrate physical postures, breath control, and meditation. Among these, yoga has shown potential to improve exercise capacity, pulmonary function, muscle strength, fatigue, anxiety, depression, and sleep quality. Despite promising findings, there is a lack of evidence regarding the efficacy of structured yoga interventions specifically tailored for lung cancer patients post-surgery.

Furthermore, the transition from hospital to home poses challenges in ensuring the continuity and accessibility of rehabilitation services. Telehealth, defined as the provision of healthcare services via digital communication technologies, has emerged as a feasible platform for delivering home-based interventions. Tele-yoga, a form of remote supervised yoga practice, has shown benefits in various populations, including those with chronic obstructive pulmonary disease (COPD), heart failure, sleep apnea, and ankylosing spondylitis. However, no study has yet examined its application in post-surgical lung cancer patients.

Based on this gap in the literature, the present study aims to investigate the effects of an 8-week synchronized tele-yoga intervention on exercise capacity, pulmonary function, respiratory and peripheral muscle strength, physical activity level, dyspnea, fatigue, sleep quality, anxiety, depression, and health-related quality of life in patients who have undergone lung resection surgery for lung cancer. This will be the first randomized controlled trial to assess a comprehensive yoga-based telerehabilitation approach in this population. The findings may provide a cost-effective and practical home-based rehabilitation strategy to enhance physical and psychological recovery in lung cancer survivors.

• Incremental Shuttle Walk Test (ISWT) [Time frame: Change from Baseline at 8 weeks]
• 6-Minute Pegboard and Ring Test (6PBRT) [Time frame: Change from Baseline at 8 weeks]
• Pulmonary Function Tests (PFT) [Time frame: Change from Baseline at 8 weeks]
• Respiratory Muscle Strength Test (MIP/MEP) [Time frame: Change from Baseline at 8 weeks]
• Peripheral Muscle Strength (Handgrip Strength Test) [Time frame: Change from Baseline at 8 weeks]
• Physical Activity Level (IPAQ-SF) [Time frame: Change from Baseline at 8 weeks]
• Dyspnea Assessment (Cancer Dyspnea Scale - CDS) [Time frame: Change from Baseline at 8 weeks]
• Fatigue Assessment (Fatigue Severity Scale - FSS) [Time frame: Change from Baseline at 8 weeks]
• Sleep Quality (Pittsburgh Sleep Quality Index - PSQI) [Time frame: Change from Baseline at 8 weeks]
• Anxiety and Depression (Hospital Anxiety and Depression Scale - HADS) [Time frame: Change from Baseline at 8 weeks]
• Quality of Life (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30): [Time frame: Change from Baseline at 8 weeks]
• Verbal Feedback [Time frame: Post-intervention (Week 8)]