Effects of Baduanjin, bedside cycle ergometer and balloon-blowing training on pulmonary function recovery following thoracoscopic surgery for lung cancer: a randomized controlled trial

doi:10.12122/j.issn.1673-4254.2026.09.20

Abstract

Abstract:

Objective To systematically compare the effects of Baduanjin exercise, bedside cycle ergometer training, and balloon-blowing training on pulmonary function recovery in patients undergoing thoracoscopic radical resection for lung cancer. Methods This study is a prospective randomized controlled trial. From January, 2021 to June, 2022, 334 patients undergoing thoracoscopic radical resection for lung cancer were enrolled and randomly assigned to Baduanjin group (108 cases), bedside cycle ergometer training group (109 cases), and balloon-blowing training group (117 cases). All the patients received 12 weeks of assigned intervention. Systematic assessments of lung function, exercise tolerance, dyspnea level, pain intensity, immune function, aerobic capacity, quality of life, and patient engagement were conducted at postoperative day 1 (baseline), 4 weeks, 12 weeks, 6 months, and 1 year postoperatively. Results At 12 weeks postoperatively, all observed indicators in the 3 groups showed significant improvement compared to the baseline levels (P<0.05). Baduanjin exercise resulted in the most pronounced improvements in immune function indicators (CD4⁺/CD8⁺ ratio, IgA, and IgG levels), pain intensity, dyspnea score, quality of life score, and treatment engagement, outperforming the other two trainings (P<0.05). The patients in bedside cycle ergometer group showed significantly more obvious improvements in forced expiratory volume in one second (FEV1), 6-min walking distance, and peak oxygen uptake (VO₂peak) than those in balloon-blowing training group (P<0.05), but these improvements did not differ significantly from those observed in Baduanjin group (P>0.05). Balloon-blowing training resulted in only limited overall improvements of the measured indicators. Conclusion Baduanjin, bedside cycle ergometer training and balloon-blowing training are all effective rehabilitation methods after video-assisted thoracoscopic radical resection for lung cancer. Personalized rehabilitation choices can be provided for patients based on their rehabilitation needs.

Key words: lung cancer, thoracoscopy, Baduanjin, bedside cycle ergometer training, balloon-blowing training, lung function

Juanjuan ZHANG, Shuhuan YAO, Zuyuan ZHAO, Xiang SUN, Ziyin ZHU, Li LI, Haitao WEI. Effects of Baduanjin, bedside cycle ergometer and balloon-blowing training on pulmonary function recovery following thoracoscopic surgery for lung cancer: a randomized controlled trial[J]. Journal of Southern Medical University, 2026, 46(9): 2222-2229.

Figures/Tables 9

References 31

[1]	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2024, 74(3): 229-63. doi：10.3322/caac.21834
[2]	Yan TD, Black D, Bannon PG, et al. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer[J]. J Clin Oncol, 2009, 27(15): 2553-62. doi：10.1200/jco.2008.18.2733
[3]	Hong Q, Wang Y, Ma FY, et al. Patient-reported outcomes after lobectomy vs. segmentectomy for early-stage non-small cell lung cancer[J]. Surg Endosc, 2025, 39(11): 7566-75. doi：10.1007/s00464-025-12172-8
[4]	赖玉田, 王娇, 李晓鸥, 等. 肺癌围手术期肺康复训练中国专家共识[J]. 中国肺癌杂志, 2024, 27(7): 495-503.
[5]	Xu JL, Li X, Zeng J, et al. Effect of Baduanjin Qigong on postoperative pulmonary rehabilitation in patients with non-small cell lung cancer: a randomized controlled trial[J]. Support Care Cancer, 2023, 32(1): 73. doi：10.1007/s00520-023-08194-4
[6]	Oeser A, Messer S, Wagner C, et al. Cardiovascular training versus resistance training for fatigue in people with cancer[J]. Cochrane Database Syst Rev, 2024, 9(9): CD015519. doi：10.1002/14651858.cd015519.pub2
[7]	白欢, 李晶. 吹气球呼吸功能训练对肺癌患者术后康复效果及引流时间、引流量影响[J]. 医学食疗与健康, 2021, 19(10): 201-2.
[8]	Chen Y, Zhang P, Dong ZM, et al. Effect of Baduanjin exercise on health and functional status in patients with chronic obstructive pulmonary disease: a community-based, cluster-randomized controlled trial[J]. npj Prim Care Respir Med, 2024, 34: 43. doi：10.1038/s41533-024-00400-y
[9]	Ahmad AM, Abusarea SA, Fouad BZ, et al. Effect of adding early bedside cycling to inpatient cardiac rehabilitation on physical function and length of stay after heart valve surgery: a randomized controlled trial[J]. Arch Phys Med Rehabil, 2024, 105(6): 1050-7. doi：10.1016/j.apmr.2024.02.711
[10]	李景峰, 蒋天赐. 吹气球呼吸功能训练对肺癌患者术后肺功能及并发症的影响[J]. 深圳中西医结合杂志, 2023, 33(3): 119-22.
[11]	国家体育总局健身气功管理中心. 健身气功·八段锦[M]. 北京: 人民体育出版社, 2003.
[12]	Scherr J, Wolfarth B, Christle JW, et al. Associations between Borg's rating of perceived exertion and physiological measures of exercise intensity[J]. Eur J Appl Physiol, 2013, 113(1): 147-55. doi：10.1007/s00421-012-2421-x
[13]	Zink EK, Kumble S, Beier M, et al. Physiological responses to in-bed cycle ergometry treatment in intensive care unit patients with external ventricular drainage[J]. Neurocritical Care, 2021, 35(3): 707-13. doi：10.1007/s12028-021-01204-5
[14]	刘国芳. 腹式呼吸训练+吹气球在哮喘慢性持续期患者康复护理中的应用[J]. 黑龙江医学, 2022, 46(20): 2518-20.
[15]	Heinicke G, Clay R, DeCato TW. Six-minute-walk testing[J]. Am J Respir Crit Care Med, 2021, 204(3): P5-6. doi：10.1164/rccm.2043p5
[16]	Kendrick KR, Baxi SC, Smith RM. Usefulness of the modified 0-10 Borg scale in assessing the degree of dyspnea in patients with COPD and asthma[J]. J Emerg Nurs, 2000, 26(3): 216-22. doi：10.1016/s0099-1767(00)90093-x
[17]	Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain[J]. J Pain, 2003, 4(7): 407-14. doi：10.1016/s1526-5900(03)00716-8
[18]	Jones LW, Watson D, Herndon II JE, et al. Peak oxygen consumption and long-term all-cause mortality in nonsmall cell lung cancer[J]. Cancer, 2010, 116(20): 4825-32. doi：10.1002/cncr.25396
[19]	李鲁, 王红妹, 沈毅. SF-36健康调查量表中文版的研制及其性能测试[J]. 中华预防医学杂志, 2002, 36(2): 109-13. doi：10.3760/j:issn:0253-9624.2002.02.011
[20]	Ma JL, Li XY, Zhao SF, et al. Robot-assisted thoracic surgery versus video-assisted thoracic surgery for lung lobectomy or segmentectomy in patients with non-small cell lung cancer: a meta-analysis[J]. BMC Cancer, 2021, 21(1): 498. doi：10.1186/s12885-021-08241-5
[21]	Cavalheri V, Burtin C, Formico VR, et al. Exercise training undertaken by people within 12 months of lung resection for non-small cell lung cancer[J]. Cochrane Database Syst Rev, 2019, 6(6): CD009955. doi：10.1002/14651858.cd009955.pub3
[22]	Cavalheri V, Granger CL. Exercise training as part of lung cancer therapy[J]. Respirology, 2020, 25(S2): 80-7. doi：10.1111/resp.13869
[23]	Abidi Y, Fekete M, Farkas Á, et al. Effectiveness and quality of life in lung cancer, pre-, post- and perioperative rehabilitation–A review[J]. PhysInt, 2023, 110(2): 89-107. doi：10.1556/2060.2023.00237
[24]	Wu D, Li J, Dong H, et al. Effect of Baduanjin on postoperative activity tolerance, lung function and negative emotions in patients with lung cancer: a protocol for systematic review and meta-analysis[J]. BMJ Open, 2025,15(5): e093152. doi：10.1136/bmjopen-2024-093152
[25]	Plinsinga ML, Singh B, Rose GL, et al. The effect of exercise on pain in people with cancer: a systematic review with meta-analysis[J]. Sports Med, 2023, 53(9): 1737-52. doi：10.1007/s40279-023-01862-9
[26]	Wang X, Yin X, Liu P, et al. The effect of Baduanjin Qigong combined with five-elements music on anxiety and quality of sleep in asymptomatic patients with COVID-19 infection: a randomised controlled trial[J]. Heliyon, 2023, 9(8): e18962. doi：10.1016/j.heliyon.2023.e18962
[27]	Oh B, Bae K, Lamoury G, et al. The effects of Tai Chi and Qigong on immune responses: a systematic review and meta-analysis[J]. Medicines, 2020, 7(7): 39. doi：10.3390/medicines7070039
[28]	Scott JM, Thomas SM, Herndon JE 2nd, et al. Effects and tolerability of exercise therapy modality on cardiorespiratory fitness in lung cancer: a randomized controlled trial[J]. J Cachexia Sarcopenia Muscle, 2021, 12(6): 1456-65. doi：10.1002/jcsm.12828
[29]	Sturzenegger N, Schneider SR, Furian M, et al. The effect of eccentric cycling on cerebral and muscle tissue oxygenation in patients with pulmonary hypertension and healthy individuals: a randomized controlled crossover trial[J]. J Clin Med, 2025, 14(16): 5751. doi：10.3390/jcm14165751
[30]	Ulrich S, Kammerlander A, Schneider SR, et al. Effect of eccentric cycling on oxygen uptake and hemodynamics in patients with chronic obstructive pulmonary disease: a randomized controlled crossover trial[J]. Respiration, 2025, 104(9): 637-47. doi：10.1159/000545787
[31]	Zisi D, Chryssanthopoulos C, Nanas S, et al. The effectiveness of the active cycle of breathing technique in patients with chronic respiratory diseases: a systematic review[J]. Heart Lung, 2022, 53: 89-98. doi：10.1016/j.hrtlng.2022.02.006

Variable	Baduanjin group (n=108)	Bedside cycle ergometer training group (n=109)	Balloon-blowing training group (n=117)	χ²/F	P
Age (year)	63.20±8.14	62.71±7.86	63.84±7.51	0.643	0.526
Gender (n)				0.331	0.847
Male	61	59	68
Female	47	50	49
BMI	23.40±3.03	23.08±2.82	23.55±3.05	0.712	0.491
Education level				1.926	0.382
High school or below	65	70	76
Junior college or above	43	39	41
Disease characteristics
Disease course (years)	5.21±2.12	4.92±2.25	5.40±2.05	1.245	0.289
Pathological type				0.894	0.925
Squamous cell carcinoma	31	29	35
Adenocarcinoma	72	75	77
Other	5	5	5
Clinical stage				1.557	0.817
I	71	74	75
II	31	29	35
IIIa	6	6	7
Comorbidities
Hypertension	39	35	45	1.025	0.599
Diabetes mellitus	19	16	22	0.752	0.686
Coronary heart disease	11	9	13	0.522	0.770
Smoking history				0.385	0.825
Yes	57	62	63
No	51	47	54
Surgery-related indicators
Surgical method				0.288	0.866
Lobectomy	90	92	99
Segmentectomy	18	17	18
Operation time (min)	89.83±5.22	88.50±6.06	90.11±4.99	0.412	0.663
Intraoperative blood loss (mL)	41.76±8.71	40.20±9.27	42.57±8.11	1.283	0.278
Postoperative 24-hour drainage volume (mL)	35.20±9.11	33.82±8.72	33.80±8.74	1.967	0.142
Chest tube duration (days)	1.56±0.53	1.57±0.64	1.77±0.40	1.445	0.237
Postoperative hospital stay (days)	3.61±1.15	3.52±1.16	3.83±0.99	2.342	0.098

Variable	Baduanjin group (n=108)	Bedside cycle ergometer training group (n=109)	Balloon-blowing training group (n=117)	χ²/F	P
Age (year)	63.20±8.14	62.71±7.86	63.84±7.51	0.643	0.526
Gender (n)				0.331	0.847
Male	61	59	68
Female	47	50	49
BMI	23.40±3.03	23.08±2.82	23.55±3.05	0.712	0.491
Education level				1.926	0.382
High school or below	65	70	76
Junior college or above	43	39	41
Disease characteristics
Disease course (years)	5.21±2.12	4.92±2.25	5.40±2.05	1.245	0.289
Pathological type				0.894	0.925
Squamous cell carcinoma	31	29	35
Adenocarcinoma	72	75	77
Other	5	5	5
Clinical stage				1.557	0.817
I	71	74	75
II	31	29	35
IIIa	6	6	7
Comorbidities
Hypertension	39	35	45	1.025	0.599
Diabetes mellitus	19	16	22	0.752	0.686
Coronary heart disease	11	9	13	0.522	0.770
Smoking history				0.385	0.825
Yes	57	62	63
No	51	47	54
Surgery-related indicators
Surgical method				0.288	0.866
Lobectomy	90	92	99
Segmentectomy	18	17	18
Operation time (min)	89.83±5.22	88.50±6.06	90.11±4.99	0.412	0.663
Intraoperative blood loss (mL)	41.76±8.71	40.20±9.27	42.57±8.11	1.283	0.278
Postoperative 24-hour drainage volume (mL)	35.20±9.11	33.82±8.72	33.80±8.74	1.967	0.142
Chest tube duration (days)	1.56±0.53	1.57±0.64	1.77±0.40	1.445	0.237
Postoperative hospital stay (days)	3.61±1.15	3.52±1.16	3.83±0.99	2.342	0.098

Time point/Variable	Baduanjin group (n=108)	Bedside cycle ergometer training group (n=109)	Balloon-blowing training group (n=117)	F	P
Postoperative day 1
FEV1 (L)	1.52±0.31	1.49±0.33	1.51±0.32	0.21	0.812
FVC (L)	2.18±0.41	2.15±0.43	2.17±0.42	0.15	0.861
FEV1/FVC (%)	69.81±5.20	69.33±5.52	69.60±5.29	0.24	0.787
Postoperative 4 weeks
FEV1 (L)	1.78±0.33	1.85±0.35*	1.71±0.32	4.12	0.017
FVC (L)	2.52±0.45	2.58±0.47	2.48±0.44	1.45	0.236
FEV1/FVC (%)	70.62±4.81	71.70±5.11*	68.94±4.92	3.78	0.024
Postoperative 12 weeks
FEV1 (L)	2.05±0.38*	2.15±0.40*	1.92±0.36	9.85	<0.001
FVC (L)	2.85±0.50	2.91±0.52	2.79±0.49	1.92	0.148
FEV1/FVC (%)	71.90±4.51*	73.79±4.70*	68.84±4.62	12.34	<0.001
Postoperative six months
FEV1 (L)	2.11±0.39*	2.21±0.41*	1.98±0.37	8.15	<0.001
FVC (L)	2.90±0.51	2.96±0.53	2.85±0.50	1.79	0.168
FEV1/FVC (%)	72.82±4.41*	74.50±4.63*	69.52±4.48	12.28	<0.001
Postoperative one year
FEV1 (L)	2.14±0.40*	2.24±0.42*	1.97±0.38	8.91	<0.001
FVC (L)	2.93±0.52	3.00±0.54	2.86±0.51	1.96	0.142
FEV1/FVC (%)	73.02±4.31*	74.73±4.51*	68.91±4.42	14.01	<0.001

Time point/Variable	Baduanjin group (n=108)	Bedside cycle ergometer training group (n=109)	Balloon-blowing training group (n=117)	F	P
Postoperative day 1
FEV1 (L)	1.52±0.31	1.49±0.33	1.51±0.32	0.21	0.812
FVC (L)	2.18±0.41	2.15±0.43	2.17±0.42	0.15	0.861
FEV1/FVC (%)	69.81±5.20	69.33±5.52	69.60±5.29	0.24	0.787
Postoperative 4 weeks
FEV1 (L)	1.78±0.33	1.85±0.35*	1.71±0.32	4.12	0.017
FVC (L)	2.52±0.45	2.58±0.47	2.48±0.44	1.45	0.236
FEV1/FVC (%)	70.62±4.81	71.70±5.11*	68.94±4.92	3.78	0.024
Postoperative 12 weeks
FEV1 (L)	2.05±0.38*	2.15±0.40*	1.92±0.36	9.85	<0.001
FVC (L)	2.85±0.50	2.91±0.52	2.79±0.49	1.92	0.148
FEV1/FVC (%)	71.90±4.51*	73.79±4.70*	68.84±4.62	12.34	<0.001
Postoperative six months
FEV1 (L)	2.11±0.39*	2.21±0.41*	1.98±0.37	8.15	<0.001
FVC (L)	2.90±0.51	2.96±0.53	2.85±0.50	1.79	0.168
FEV1/FVC (%)	72.82±4.41*	74.50±4.63*	69.52±4.48	12.28	<0.001
Postoperative one year
FEV1 (L)	2.14±0.40*	2.24±0.42*	1.97±0.38	8.91	<0.001
FVC (L)	2.93±0.52	3.00±0.54	2.86±0.51	1.96	0.142
FEV1/FVC (%)	73.02±4.31*	74.73±4.51*	68.91±4.42	14.01	<0.001

Time point	Baduanjin group (n=108)	Bedside cycle ergometer training group (n=109)	Balloon-blowing training group (n=117)	F	P
Postoperative day 1	352.62±42.50	348.91±43.23	350.80±41.85	0.18	0.837
Postoperative 4 weeks	408.50±46.31	418.17±47.82*	397.14±45.51	3.42	0.034
Postoperative 12 weeks	452.63±49.14*	468.42±50.69*	442.32±48.24	4.86	0.008
Postoperative 6 months	457.20±49.31*	470.82±50.90*	445.13±48.72	5.31	0.005
Postoperative 1 year	460.53±48.81*	476.79±50.51*	448.90±47.63	5.12	0.006