Practical recommendations for exercise and nutrition in patients with lung cancer

Abstract Lung cancer (LC) is the leading cause of cancer mortality worldwide. Beyond pharmacological advances, lifestyle interventions such as exercise and nutrition have emerged as valuable adjuvant strategies. Preclinical and translational studies suggest that exercise may modulate molecular and immune pathways relevant to tumor biology, whereas clinical studies support benefits in functional capacity, symptom burden, and quality of life in selected patients with LC. In surgical candidates, prehabilitation focusing on exercise and nutritional optimization improves postoperative outcomes; in unresectable or advanced stages, exercise maintains functionality and mitigates symptoms. Nutritional intervention is critical because malnutrition and sarcopenia are common and negatively affect prognosis. Early screening with tools followed by structured nutritional support, including oral nutritional supplements or, when clinically indicated, enteral nutrition, is recommended. Mediterranean dietary patterns have been associated with a lower risk of cancer, including LC, whereas evidence for improved clinical outcomes after an LC diagnosis remains limited. This narrative review summarizes the physiological rationale, clinical evidence, and practical application of exercise and nutritional interventions across the lung cancer care pathway, while distinguishing direct clinical evidence from preclinical and indirect evidence.