Clinical Indicators of Effects of Yoga Breathing Exercises on Patients With Lung Cancer After Surgical Resection

Background Cancer itself and surgery pose a heavy burden on adults with lung cancer. Yoga breathing exercises have been proposed as a form of pulmonary rehabilitation exercises to improve these patients' perioperative outcomes.To investigate the impact of yoga breathing exercises based on a problem-solving model on dyspnea, exercise capacity, anxiety, depression, and postoperative indwelling time of thoracic drainage tube and compliance in adults with lung cancer undergoing surgery.One hundred eight lung cancer patients were randomly assigned to receive problem-solving model-based yoga breathing exercises, yoga breathing exercises, or usual care. Outcomes were collected at admission, the day before surgery, and at discharge.Patients in the combined intervention group showed a significantly greater improvement in dyspnea, exercise capacity, and anxiety compared with the control group. Yoga breathing training can significantly improve patients' dyspnea and anxiety. Significant difference favoring the combined group was observed in exercise capability and compliance between the 2 intervention groups. However, there was no significant difference in depression or indwelling time of thoracic drainage tube among the 3 groups at any time point.Findings indicate that yoga breathing exercises are effective in alleviating perioperative symptoms of lung resection patients. Compared with yoga breathing exercises, applying additional problem-solving model may achieve a better effect.Yoga breathing exercises can be considered as a promising pulmonary rehabilitation strategy for lung cancer patients with surgery. The problem-solving model could be integrated into yoga breathing exercises in clinical practice to enhance the rehabilitation effect.Lung cancer is the second most common cancer worldwide, representing 11.4% of all cancer diagnoses.1 Approximately 80% of the patients diagnosed with lung cancer have non-small cell lung cancer (NSCLC).2 Surgery, including traditional thoracotomy and video-assisted thoracoscopic surgery, is the main treatment for early-stage NSCLC patients (I-IIIA stage). Patients with lung cancer are prone to experience dyspnea, fatigue, and other uncomfortable symptoms due to lung lesions and the presence of malignant tumors before surgery.3,4 The trauma of the surgery itself can also cause respiratory physiological dysfunction and decrease lung tissue, which may lead to decreased respiratory function, retention of respiratory secretions, postoperative pulmonary complications, and prolonged hospitalization.5,6 In addition, because of patients' possible fear of surgery and the uncertainty of disease prognosis, they may suffer from psychological distress including anxiety and depression during hospitalization, which has an adverse impact on their rehabilitation.7,8 Therefore, adopting strategies to improve perioperative symptoms, both physically and psychologically, is needed to achieve rapid recovery.Yoga, as a mind-body therapy, has gradually attracted the attention of researchers in the field of complementary and alternative medicine. Yoga has been shown to have positive effects on the physical and mental rehabilitation of a wide range of patients, including patients with cancer,9 cardiovascular disease,10 and diabetes.11 However, it is not easy for patients with lung cancer treated with surgery to attend conventional yoga interventions delivered over 6 to 8 weeks. Therefore, we designed mini-yoga exercises specifically for surgical resection patients. Three yoga breathing techniques were selected for this study. In recent years, yoga breathing exercises have attracted special attention of researchers without the practice or intervention of other components (ie, physical posture and meditation) in yoga.12,13 Yoga breathing exercises have no special requirements for environment and setting, and their content is typically understood with ease. People who are frail or have limited activities can practice yoga breathing exercises, making it suitable for a range of people. Yoga breathing exercises enable the practicing person to actively control and adjust the depth and frequency of breathing through various breathing exercise methods so that the main respiratory muscles can contract and relax rhythmically, and the respiratory system can play a more effective role.14,15 At the same time, it can stabilize the mood and relieve stress.16With the development of rehabilitation medicine, breathing exercises have been proposed as pulmonary rehabilitation exercises for patients undergoing lung cancer surgery. The purpose is to enhance the strength and endurance of respiratory muscles through active breathing exercise, thereby reducing the incidence of postoperative pulmonary complications and promoting recovery of patients.17 However, at present, there is no uniform standard or program of breathing exercises for patients undergoing lung cancer surgery, and diverse methods are used, such as deep breathing exercises, balloon blowing, and a respiratory trainer. Compared with balloon blowing and a respiratory trainer, yoga breathing exercises do not require special devices and are cost-effective. Compared with deep breathing exercises, yoga breathing exercises focus on both breathing mechanics and on controlling every stage of breathing. The use of breath timing in seconds is very important, which allows participants to inhale, hold their breath, and exhale in the best way in each breathing exercise.18Patients' compliance with yoga breathing exercises is an important prerequisite for achieving its full effect. Some researchers have reported that patients' compliance with rehabilitation exercises after surgery is poor. Reasons that affect the compliance include patients preferring to stay in bed after surgery, fear of wound pain, fatigue and weakness, depression, lack of medical staff supervision, and lack of social support.19,20 Solving problems encountered by patients during yoga breathing exercises, thereby improving patients' compliance with yoga breathing exercises, is key. ADOPT (Attitude, Definition, Open Mind, Planning, Try it out) model, a problem-solving model put forward by Peter et al,21 may be a feasible method to achieve this goal. This model includes 5 steps, aiming at helping participants overcome obstacles encountered in behavior change and increasing the possibility of participants changing their behavior.In this study, the ADOPT model was incorporated into the yoga breathing exercises for patients undergoing lung cancer surgery to solve problems encountered by patients during yoga breathing exercises in real time, facilitating patients to actively participate in breathing exercises and promote their rehabilitation. The aim of this study was to examine the effectiveness of yoga breathing exercises based on the problem-solving ADOPT model in alleviating perioperative symptoms among lung cancer patients undergoing surgery.Background Cancer itself and surgery pose a heavy burden on adults with lung cancer. Yoga breathing exercises have been proposed as a form of pulmonary rehabilitation exercises to improve these patients' perioperative outcomes. To investigate the impact of yoga breathing exercises based on a problem-solving model on dyspnea, exercise capacity, anxiety, depression, and postoperative indwelling time of thoracic drainage tube and compliance in adults with lung cancer undergoing surgery.One hundred eight lung cancer patients were randomly assigned to receive problem-solving model-based yoga breathing exercises, yoga breathing exercises, or usual care. Outcomes were collected at admission, the day before surgery, and at discharge.Patients in the combined intervention group showed a significantly greater improvement in dyspnea, exercise capacity, and anxiety compared with the control group. Yoga breathing training can significantly improve patients' dyspnea and anxiety. Significant difference favoring the combined group was observed in exercise capability and compliance between the 2 intervention groups. However, there was no significant difference in depression or indwelling time of thoracic drainage tube among the 3 groups at any time point.Findings indicate that yoga breathing exercises are effective in alleviating perioperative symptoms of lung resection patients. Compared with yoga breathing exercises, applying additional problem-solving model may achieve a better effect.Yoga breathing exercises can be considered as a promising pulmonary rehabilitation strategy for lung cancer patients with surgery. The problem-solving model could be integrated into yoga breathing exercises in clinical practice to enhance the rehabilitation effect.Lung cancer is the second most common cancer worldwide, representing 11.4% of all cancer diagnoses.1 Approximately 80% of the patients diagnosed with lung cancer have non-small cell lung cancer (NSCLC).2 Surgery, including traditional thoracotomy and video-assisted thoracoscopic surgery, is the main treatment for early-stage NSCLC patients (I-IIIA stage). Patients with lung cancer are prone to experience dyspnea, fatigue, and other uncomfortable symptoms due to lung lesions and the presence of malignant tumors before surgery.3,4 The trauma of the surgery itself can also cause respiratory physiological dysfunction and decrease lung tissue, which may lead to decreased respiratory function, retention of respiratory secretions, postoperative pulmonary complications, and prolonged hospitalization.5,6 In addition, because of patients' possible fear of surgery and the uncertainty of disease prognosis, they may suffer from psychological distress including anxiety and depression during hospitalization, which has an adverse impact on their rehabilitation.7,8 Therefore, adopting strategies to improve perioperative symptoms, both physically and psychologically, is needed to achieve rapid recovery.Yoga, as a mind-body therapy, has gradually attracted the attention of researchers in the field of complementary and alternative medicine. Yoga has been shown to have positive effects on the physical and mental rehabilitation of a wide range of patients, including patients with cancer,9 cardiovascular disease,10 and diabetes.11 However, it is not easy for patients with lung cancer treated with surgery to attend conventional yoga interventions delivered over 6 to 8 weeks. Therefore, we designed mini-yoga exercises specifically for surgical resection patients. Three yoga breathing techniques were selected for this study. In recent years, yoga breathing exercises have attracted special attention of researchers without the practice or intervention of other components (ie, physical posture and meditation) in yoga. 12,13 Yoga breathing exercises have no special requirements for environment and setting, and their content is typically understood with ease. People who are frail or have limited activities can practice yoga breathing exercises, making it suitable for a range of people. Yoga breathing exercises enable the practicing person to actively control and adjust the depth and frequency of breathing through various breathing exercise methods so that the main respiratory muscles can contract and relax rhythmically, and the respiratory system can play a more effective role.14,15 At the same time, it can stabilize the mood and relieve stress.16With the development of rehabilitation medicine, breathing exercises have been proposed as pulmonary rehabilitation exercises for patients undergoing lung cancer surgery. The purpose is to enhance the strength and endurance of respiratory muscles through active breathing exercise, thereby reducing the incidence of postoperative pulmonary complications and promoting recovery of patients.17 However, at present, there is no uniform standard or program of breathing exercises for patients undergoing lung cancer surgery, and diverse methods are used, such as deep breathing exercises, balloon blowing, and a respiratory trainer. Compared with balloon blowing and a respiratory trainer, yoga breathing exercises do not require special devices and are cost-effective. Compared with deep breathing exercises, yoga breathing exercises focus on both breathing mechanics and on controlling every stage of breathing. The use of breath timing in seconds is very important, which allows participants to inhale, hold their breath, and exhale in the best way in each breathing exercise.18Patients' compliance with yoga breathing exercises is an important prerequisite for achieving its full effect. Some researchers have reported that patients' compliance with rehabilitation exercises after surgery is poor. Reasons that affect the compliance include patients preferring to stay in bed after surgery, fear of wound pain, fatigue and weakness, depression, lack of medical staff supervision, and lack of social support.19,20 Solving problems encountered by patients during yoga breathing exercises, thereby improving patients' compliance with yoga breathing exercises, is key. ADOPT (Attitude, Definition, Open Mind, Planning, Try it out) model, a problem-solving model put forward by Peter et al,21 may be a feasible method to achieve this goal. This model includes 5 steps, aiming at helping participants overcome obstacles encountered in behavior change and increasing the possibility of participants changing their behavior.In this study, the ADOPT model was incorporated into the yoga breathing exercises for patients undergoing lung cancer surgery to solve problems encountered by patients during yoga breathing exercises in real time, facilitating patients to actively participate in breathing exercises and promote their rehabilitation. The aim of this study was to examine the effectiveness of yoga breathing exercises based on the problem-solving ADOPT model in alleviating perioperative symptoms among lung cancer patients undergoing surgery.Background Cancer itself and surgery pose a heavy burden on adults with lung cancer. Yoga breathing exercises have been proposed as a form of pulmonary rehabilitation exercises to improve these patients' perioperative outcomes. To investigate the impact of yoga breathing exercises based on a problem-solving model on dyspnea, exercise capacity, anxiety, depression, and postoperative indwelling time of thoracic drainage tube and compliance in adults with lung cancer undergoing surgery.One hundred eight lung cancer patients were randomly assigned to receive problem-solving model-based yoga breathing exercises, yoga breathing exercises, or usual care. Outcomes were collected at admission, the day before surgery, and at discharge.Patients in the combined intervention group showed a significantly greater improvement in dyspnea, exercise capacity, and anxiety compared with the control group. Yoga breathing training can significantly improve patients' dyspnea and anxiety. Significant difference favoring the combined group was observed in exercise capability and compliance between the 2 intervention groups. However, there was no significant difference in depression or indwelling time of thoracic drainage tube among the 3 groups at any time point.Findings indicate that yoga breathing exercises are effective in alleviating perioperative symptoms of lung resection patients. Compared with yoga breathing exercises, applying additional problem-solving model may achieve a better effect.Yoga breathing exercises can be considered as a promising pulmonary rehabilitation strategy for lung cancer patients with surgery. The problem-solving model could be integrated into yoga breathing exercises in clinical practice to enhance the rehabilitation effect.Lung cancer is the second most common cancer worldwide, representing 11.4% of all cancer diagnoses.1 Approximately 80% of the patients diagnosed with lung cancer have non-small cell lung cancer (NSCLC).2 Surgery, including traditional thoracotomy and video-assisted thoracoscopic surgery, is the main treatment for early-stage NSCLC patients (I-IIIA stage). Patients with lung cancer are prone to experience dyspnea, fatigue, and other uncomfortable symptoms due to lung lesions and the presence of malignant tumors before surgery.3,4 The trauma of the surgery itself can also cause respiratory physiological dysfunction and decrease lung tissue, which may lead to decreased respiratory function, retention of respiratory secretions, postoperative pulmonary complications, and prolonged hospitalization.5,6 In addition, because of patients' possible fear of surgery and the uncertainty of disease prognosis, they may suffer from psychological distress including anxiety and depression during hospitalization, which has an adverse impact on their rehabilitation.7,8 Therefore, adopting strategies to improve perioperative symptoms, both physically and psychologically, is needed to achieve rapid recovery.Yoga, as a mind-body therapy, has gradually attracted the attention of researchers in the field of complementary and alternative medicine. Yoga has been shown to have positive effects on the physical and mental rehabilitation of a wide range of patients, including patients with cancer,9 cardiovascular disease,10 and diabetes.11 However, it is not easy for patients with lung cancer treated with surgery to attend conventional yoga interventions delivered over 6 to 8 weeks. Therefore, we designed mini-yoga exercises specifically for surgical resection patients. Three yoga breathing techniques were selected for this study. In recent years, yoga breathing exercises have attracted special attention of researchers without the practice or intervention of other components (ie, physical posture and meditation) in yoga. 12,13 Yoga breathing exercises have no special requirements for environment and setting, and their content is typically understood with ease. People who are frail or have limited activities can practice yoga breathing exercises, making it suitable for a range of people. Yoga breathing exercises enable the practicing person to actively control and adjust the depth and frequency of breathing through various breathing exercise methods so that the main respiratory muscles can contract and relax rhythmically, and the respiratory system can play a more effective role.14,15 At the same time, it can stabilize the mood and relieve stress.16With the development of rehabilitation medicine, breathing exercises have been proposed as pulmonary rehabilitation exercises for patients undergoing lung cancer surgery. The purpose is to enhance the strength and endurance of respiratory muscles through active breathing exercise, thereby reducing the incidence of postoperative pulmonary complications and promoting recovery of patients.17 However, at present, there is no uniform standard or program of breathing exercises for patients undergoing lung cancer surgery, and diverse methods are used, such as deep breathing exercises, balloon blowing, and a respiratory trainer. Compared with balloon blowing and a respiratory trainer, yoga breathing exercises do not require special devices and are cost-effective. Compared with deep breathing exercises, yoga breathing exercises focus on both breathing mechanics and on controlling every stage of breathing. The use of breath timing in seconds is very important, which allows participants to inhale, hold their breath, and exhale in the best way in each breathing exercise.18Patients' compliance with yoga breathing exercises is an important prerequisite for achieving its full effect. Some researchers have reported that patients' compliance with rehabilitation exercises after surgery is poor. Reasons that affect the compliance include patients preferring to stay in bed after surgery, fear of wound pain, fatigue and weakness, depression, lack of medical staff supervision, and lack of social support.19,20 Solving problems encountered by patients during yoga breathing exercises, thereby improving patients' compliance with yoga breathing exercises, is key. ADOPT (Attitude, Definition, Open Mind, Planning, Try it out) model, a problem-solving model put forward by Peter et al,21 may be a feasible method to achieve this goal. This model includes 5 steps, aiming at helping participants overcome obstacles encountered in behavior change and increasing the possibility of participants changing their behavior.In this study, the ADOPT model was incorporated into the yoga breathing exercises for patients undergoing lung cancer surgery to solve problems encountered by patients during yoga breathing exercises in real time, facilitating patients to actively participate in breathing exercises and promote their rehabilitation. The aim of this study was to examine the effectiveness of yoga breathing exercises based on the problem-solving ADOPT model in alleviating perioperative symptoms among lung cancer patients undergoing surgery.Background Cancer itself and surgery pose a heavy burden on adults with lung cancer. Yoga breathing exercises have been proposed as a form of pulmonary rehabilitation exercises to improve these patients' perioperative outcomes. To investigate the impact of yoga breathing exercises based on a problem-solving model on dyspnea, exercise capacity, anxiety, depression, and postoperative indwelling time of thoracic drainage tube and compliance in adults with lung cancer undergoing surgery.One hundred eight lung cancer patients were randomly assigned to receive problem-solving model-based yoga breathing exercises, yoga breathing exercises, or usual care. Outcomes were collected at admission, the day before surgery, and at discharge.Patients in the combined intervention group showed a significantly greater improvement in dyspnea, exercise capacity, and anxiety compared with the control group. Yoga breathing training can significantly improve patients' dyspnea and anxiety. Significant difference favoring the combined group was observed in exercise capability and compliance between the 2 intervention groups. However, there was no significant difference in depression or indwelling time of thoracic drainage tube among the 3 groups at any time point.Findings indicate that yoga breathing exercises are effective in alleviating perioperative symptoms of lung resection patients. Compared with yoga breathing exercises, applying additional problem-solving model may achieve a better effect.Yoga breathing exercises can be considered as a promising pulmonary rehabilitation strategy for lung cancer patients with surgery. The problem-solving model could be integrated into yoga breathing exercises in clinical practice to enhance the rehabilitation effect.Lung cancer is the second most common cancer worldwide, representing 11.4% of all cancer diagnoses.1 Approximately 80% of the patients diagnosed with lung cancer have non-small cell lung cancer (NSCLC).2 Surgery, including traditional thoracotomy and video-assisted thoracoscopic surgery, is the main treatment for early-stage NSCLC patients (I-IIIA stage). Patients with lung cancer are prone to experience dyspnea, fatigue, and other uncomfortable symptoms due to lung lesions and the presence of malignant tumors before surgery.3,4 The trauma of the surgery itself can also cause respiratory physiological dysfunction and decrease lung tissue, which may lead to decreased respiratory function, retention of respiratory secretions, postoperative pulmonary complications, and prolonged hospitalization.5,6 In addition, because of patients' possible fear of surgery and the uncertainty of disease prognosis, they may suffer from psychological distress including anxiety and depression during hospitalization, which has an adverse impact on their rehabilitation.7,8 Therefore, adopting strategies to improve perioperative symptoms, both physically and psychologically, is needed to achieve rapid recovery.Yoga, as a mind-body therapy, has gradually attracted the attention of researchers in the field of complementary and alternative medicine. Yoga has been shown to have positive effects on the physical and mental rehabilitation of a wide range of patients, including patients with cancer,9 cardiovascular disease,10 and diabetes.11 However, it is not easy for patients with lung cancer treated with surgery to attend conventional yoga interventions delivered over 6 to 8 weeks. Therefore, we designed mini-yoga exercises specifically for surgical resection patients. Three yoga breathing techniques were selected for this study. In recent years, yoga breathing exercises have attracted special attention of researchers without the practice or intervention of other components (ie, physical posture and meditation) in yoga. 12,13 Yoga breathing exercises have no special requirements for environment and setting, and their content is typically understood with ease. People who are frail or have limited activities can practice yoga breathing exercises, making it suitable for a range of people. Yoga breathing exercises enable the practicing person to actively control and adjust the depth and frequency of breathing through various breathing exercise methods so that the main respiratory muscles can contract and relax rhythmically, and the respiratory system can play a more effective role.14,15 At the same time, it can stabilize the mood and relieve stress.16With the development of rehabilitation medicine, breathing exercises have been proposed as pulmonary rehabilitation exercises for patients undergoing lung cancer surgery. The purpose is to enhance the strength and endurance of respiratory muscles through active breathing exercise, thereby reducing the incidence of postoperative pulmonary complications and promoting recovery of patients.17 However, at present, there is no uniform standard or program of breathing exercises for patients undergoing lung cancer surgery, and diverse methods are used, such as deep breathing exercises, balloon blowing, and a respiratory trainer. Compared with balloon blowing and a respiratory trainer, yoga breathing exercises do not require special devices and are cost-effective. Compared with deep breathing exercises, yoga breathing exercises focus on both breathing mechanics and on controlling every stage of breathing. The use of breath timing in seconds is very important, which allows participants to inhale, hold their breath, and exhale in the best way in each breathing exercise.18Patients' compliance with yoga breathing exercises is an important prerequisite for achieving its full effect. Some researchers have reported that patients' compliance with rehabilitation exercises after surgery is poor. Reasons that affect the compliance include patients preferring to stay in bed after surgery, fear of wound pain, fatigue and weakness, depression, lack of medical staff supervision, and lack of social support.19,20 Solving problems encountered by patients during yoga breathing exercises, thereby improving patients' compliance with yoga breathing exercises, is key. ADOPT (Attitude, Definition, Open Mind, Planning, Try it out) model, a problem-solving model put forward by Peter et al,21 may be a feasible method to achieve this goal. This model includes 5 steps, aiming at helping participants overcome obstacles encountered in behavior change and increasing the possibility of participants changing their behavior.In this study, the ADOPT model was incorporated into the yoga breathing exercises for patients undergoing lung cancer surgery to solve problems encountered by patients during yoga breathing exercises in real time, facilitating patients to actively participate in breathing exercises and promote their rehabilitation. The aim of this study was to examine the effectiveness of yoga breathing exercises based on the problem-solving ADOPT model in alleviating perioperative symptoms among lung cancer patients undergoing surgery.Background Cancer itself and surgery pose a heavy burden on adults with lung cancer. Yoga breathing exercises have been proposed as a form of pulmonary rehabilitation exercises to improve these patients' perioperative outcomes. To investigate the impact of yoga breathing exercises based on a problem-solving model on dyspnea, exercise capacity, anxiety, depression, and postoperative indwelling time of thoracic drainage tube and compliance in adults with lung cancer undergoing surgery.One hundred eight lung cancer patients were randomly assigned to receive problem-solving model-based yoga breathing exercises, yoga breathing exercises, or usual care. Outcomes were collected at admission, the day before surgery, and at discharge.Patients in the combined intervention group showed a significantly greater improvement in dyspnea, exercise capacity, and anxiety compared with the control group. Yoga breathing training can significantly improve patients' dyspnea and anxiety. Significant difference favoring the combined group was observed in exercise capability and compliance between the 2 intervention groups. However, there was no significant difference in depression or indwelling time of thoracic drainage tube among the 3 groups at any time point.Findings indicate that yoga breathing exercises are effective in alleviating perioperative symptoms of lung resection patients. Compared with yoga breathing exercises, applying additional problem-solving model may achieve a better effect.Yoga breathing exercises can be considered as a promising pulmonary rehabilitation strategy for lung cancer patients with surgery. The problem-solving model could be integrated into yoga breathing exercises in clinical practice to enhance the rehabilitation effect.Lung cancer is the second most common cancer worldwide, representing 11.4% of all cancer diagnoses.1 Approximately 80% of the patients diagnosed with lung cancer have non-small cell lung cancer (NSCLC).2 Surgery, including traditional thoracotomy and video-assisted thoracoscopic surgery, is the main treatment for early-stage NSCLC patients (I-IIIA stage). Patients with lung cancer are prone to experience dyspnea, fatigue, and other uncomfortable symptoms due to lung lesions and the presence of malignant tumors before surgery.3,4 The trauma of the surgery itself can also cause respiratory physiological dysfunction and decrease lung tissue, which may lead to decreased respiratory function, retention of respiratory secretions, postoperative pulmonary complications, and prolonged hospitalization.5,6 In addition, because of patients' possible fear of surgery and the uncertainty of disease prognosis, they may suffer from psychological distress including anxiety and depression during hospitalization, which has an adverse impact on their rehabilitation.7,8 Therefore, adopting strategies to improve perioperative symptoms, both physically and psychologically, is needed to achieve rapid recovery.Yoga, as a mind-body therapy, has gradually attracted the attention of researchers in the field of complementary and alternative medicine. Yoga has been shown to have positive effects on the physical and mental rehabilitation of a wide range of patients, including patients with cancer,9 cardiovascular disease,10 and diabetes.11 However, it is not easy for patients with lung cancer treated with surgery to attend conventional yoga interventions delivered over 6 to 8 weeks. Therefore, we designed mini-yoga exercises specifically for surgical resection patients. Three yoga breathing techniques were selected for this study. In recent years, yoga breathing exercises have attracted special attention of researchers without the practice or intervention of other components (ie, physical posture and meditation) in yoga. 12,13 Yoga breathing exercises have no special requirements for environment and setting, and their content is typically understood with ease. People who are frail or have limited activities can practice yoga breathing exercises, making it suitable for a range of people. Yoga breathing exercises enable the practicing person to actively control and adjust the depth and frequency of breathing through various breathing exercise methods so that the main respiratory muscles can contract and relax rhythmically, and the respiratory system can play a more effective role.14,15 At the same time, it can stabilize the mood and relieve stress.16With the development of rehabilitation medicine, breathing exercises have been proposed as pulmonary rehabilitation exercises for patients undergoing lung cancer surgery. The purpose is to enhance the strength and endurance of respiratory muscles through active breathing exercise, thereby reducing the incidence of postoperative pulmonary complications and promoting recovery of patients.17 However, at present, there is no uniform standard or program of breathing exercises for patients undergoing lung cancer surgery, and diverse methods are used, such as deep breathing exercises, balloon blowing, and a respiratory trainer. Compared with balloon blowing and a respiratory trainer, yoga breathing exercises do not require special devices and are cost-effective. Compared with deep breathing exercises, yoga breathing exercises focus on both breathing mechanics and on controlling every stage of breathing. The use of breath timing in seconds is very important, which allows participants to inhale, hold their breath, and exhale in the best way in each breathing exercise.18Patients' compliance with yoga breathing exercises is an important prerequisite for achieving its full effect. Some researchers have reported that patients' compliance with rehabilitation exercises after surgery is poor. Reasons that affect the compliance include patients preferring to stay in bed after surgery, fear of wound pain, fatigue and weakness, depression, lack of medical staff supervision, and lack of social support.19,20 Solving problems encountered by patients during yoga breathing exercises, thereby improving patients' compliance with yoga breathing exercises, is key. ADOPT (Attitude, Definition, Open Mind, Planning, Try it out) model, a problem-solving model put forward by Peter et al,21 may be a feasible method to achieve this goal. This model includes 5 steps, aiming at helping participants overcome obstacles encountered in behavior change and increasing the possibility of participants changing their behavior.In this study, the ADOPT model was incorporated into the yoga breathing exercises for patients undergoing lung cancer surgery to solve problems encountered by patients during yoga breathing exercises in real time, facilitating patients to actively participate in breathing exercises and promote their rehabilitation. The aim of this study was to examine the effectiveness of yoga breathing exercises based on the problem-solving ADOPT model in alleviating perioperative symptoms among lung cancer patients undergoing surgery.Background Cancer itself and surgery pose a heavy burden on adults with lung cancer. Yoga breathing exercises have been proposed as a form of pulmonary rehabilitation exercises to improve these patients' perioperative outcomes. To investigate the impact of yoga breathing exercises based on a problem-solving model on dyspnea, exercise capacity, anxiety, depression, and postoperative indwelling time of thoracic drainage tube and compliance in adults with lung cancer undergoing surgery.One hundred eight lung cancer patients were randomly assigned to receive problem-solving model-based yoga breathing exercises, yoga breathing exercises, or usual care. Outcomes were collected at admission, the day before surgery, and at discharge.Patients in the combined intervention group showed a significantly greater improvement in dyspnea, exercise capacity, and anxiety compared with the control group. Yoga breathing training can significantly improve patients' dyspnea and anxiety. Significant difference favoring the combined group was observed in exercise capability and compliance between the 2 intervention groups. However, there was no significant difference in depression or indwelling time of thoracic drainage tube among the 3 groups at any time point.Findings indicate that yoga breathing exercises are effective in alleviating perioperative symptoms of lung resection patients. Compared with yoga breathing exercises, applying additional problem-solving model may achieve a better effect.Yoga breathing exercises can be considered as a promising pulmonary rehabilitation strategy for lung cancer patients with surgery. The problem-solving model could be integrated into yoga breathing exercises in clinical practice to enhance the rehabilitation effect.Lung cancer is the second most common cancer worldwide, representing 11.4% of all cancer diagnoses.1 Approximately 80% of the patients diagnosed with lung cancer have non-small cell lung cancer (NSCLC).2 Surgery, including traditional thoracotomy and video-assisted thoracoscopic surgery, is the main treatment for early-stage NSCLC patients (I-IIIA stage). Patients with lung cancer are prone to experience dyspnea, fatigue, and other uncomfortable symptoms due to lung lesions and the presence of malignant tumors before surgery.3,4 The trauma of the surgery itself can also cause respiratory physiological dysfunction and decrease lung tissue, which may lead to decreased respiratory function, retention of respiratory secretions, postoperative pulmonary complications, and prolonged hospitalization.5,6 In addition, because of patients' possible fear of surgery and the uncertainty of disease prognosis, they may suffer from psychological distress including anxiety and depression during hospitalization, which has an adverse impact on their rehabilitation.7,8 Therefore, adopting strategies to improve perioperative symptoms, both physically and psychologically, is needed to achieve rapid recovery.Yoga, as a mind-body therapy, has gradually attracted the attention of researchers in the field of complementary and alternative medicine. Yoga has been shown to have positive effects on the physical and mental rehabilitation of a wide range of patients, including patients with cancer,9 cardiovascular disease,10 and diabetes.11 However, it is not easy for patients with lung cancer treated with surgery to attend conventional yoga interventions delivered over 6 to 8 weeks. Therefore, we designed mini-yoga exercises specifically for surgical resection patients. Three yoga breathing techniques were selected for this study. In recent years, yoga breathing exercises have attracted special attention of researchers without the practice or intervention of other components (ie, physical posture and meditation) in yoga. 12,13 Yoga breathing exercises have no special requirements for environment and setting, and their content is typically understood with ease. People who are frail or have limited activities can practice yoga breathing exercises, making it suitable for a range of people. Yoga breathing exercises enable the practicing person to actively control and adjust the depth and frequency of breathing through various breathing exercise methods so that the main respiratory muscles can contract and relax rhythmically, and the respiratory system can play a more effective role.14,15 At the same time, it can stabilize the mood and relieve stress.16With the development of rehabilitation medicine, breathing exercises have been proposed as pulmonary rehabilitation exercises for patients undergoing lung cancer surgery. The purpose is to enhance the strength and endurance of respiratory muscles through active breathing exercise, thereby reducing the incidence of postoperative pulmonary complications and promoting recovery of patients.17 However, at present, there is no uniform standard or program of breathing exercises for patients undergoing lung cancer surgery, and diverse methods are used, such as deep breathing exercises, balloon blowing, and a respiratory trainer. Compared with balloon blowing and a respiratory trainer, yoga breathing exercises do not require special devices and are cost-effective. Compared with deep breathing exercises, yoga breathing exercises focus on both breathing mechanics and on controlling every stage of breathing. The use of breath timing in seconds is very important, which allows participants to inhale, hold their breath, and exhale in the best way in each breathing exercise.18Patients' compliance with yoga breathing exercises is an important prerequisite for achieving its full effect. Some researchers have reported that patients' compliance with rehabilitation exercises after surgery is poor. Reasons that affect the compliance include patients preferring to stay in bed after surgery, fear of wound pain, fatigue and weakness, depression, lack of medical staff supervision, and lack of social support.19,20 Solving problems encountered by patients during yoga breathing exercises, thereby improving patients' compliance with yoga breathing exercises, is key. ADOPT (Attitude, Definition, Open Mind, Planning, Try it out) model, a problem-solving model put forward by Peter et al,21 may be a feasible method to achieve this goal. This model includes 5 steps, aiming at helping participants overcome obstacles encountered in behavior change and increasing the possibility of participants changing their behavior.In this study, the ADOPT model was incorporated into the yoga breathing exercises for patients undergoing lung cancer surgery to solve problems encountered by patients during yoga breathing exercises in real time, facilitating patients to actively participate in breathing exercises and promote their rehabilitation. The aim of this study was to examine the effectiveness of yoga breathing exercises based on the problem-solving ADOPT model in alleviating perioperative symptoms among lung cancer patients undergoing surgery.Background Cancer itself and surgery pose a heavy burden on adults with lung cancer. Yoga breathing exercises have been proposed as a form of pulmonary rehabilitation exercises to improve these patients' perioperative outcomes. To investigate the impact of yoga breathing exercises based on a problem-solving model on dyspnea, exercise capacity, anxiety, depression, and postoperative indwelling time of thoracic drainage tube and compliance in adults with lung cancer undergoing surgery.One hundred eight lung cancer patients were randomly assigned to receive problem-solving model-based yoga breathing exercises, yoga breathing exercises, or usual care. Outcomes were collected at admission, the day before surgery, and at discharge.Patients in the combined intervention group showed a significantly greater improvement in dyspnea, exercise capacity, and anxiety compared with the control group. Yoga breathing training can significantly improve patients' dyspnea and anxiety. Significant difference favoring the combined group was observed in exercise capability and compliance between the 2 intervention groups. However, there was no significant difference in depression or indwelling time of thoracic drainage tube among the 3 groups at any time point.Findings indicate that yoga breathing exercises are effective in alleviating perioperative symptoms of lung resection patients. Compared with yoga breathing exercises, applying additional problem-solving model may achieve a better effect.Yoga breathing exercises can be considered as a promising pulmonary rehabilitation strategy for lung cancer patients with surgery. The problem-solving model could be integrated into yoga breathing exercises in clinical practice to enhance the rehabilitation effect.Lung cancer is the second most common cancer worldwide, representing 11.4% of all cancer diagnoses.1 Approximately 80% of the patients diagnosed with lung cancer have non-small cell lung cancer (NSCLC).2 Surgery, including traditional thoracotomy and video-assisted thoracoscopic surgery, is the main treatment for early-stage NSCLC patients (I-IIIA stage). Patients with lung cancer are prone to experience dyspnea, fatigue, and other uncomfortable symptoms due to lung lesions and the presence of malignant tumors before surgery.3,4 The trauma of the surgery itself can also cause respiratory physiological dysfunction and decrease lung tissue, which may lead to decreased respiratory function, retention of respiratory secretions, postoperative pulmonary complications, and prolonged hospitalization.5,6 In addition, because of patients' possible fear of surgery and the uncertainty of disease prognosis, they may suffer from psychological distress including anxiety and depression during hospitalization, which has an adverse impact on their rehabilitation.7,8 Therefore, adopting strategies to improve perioperative symptoms, both physically and psychologically, is needed to achieve rapid recovery.Yoga, as a mind-body therapy, has gradually attracted the attention of researchers in the field of complementary and alternative medicine. Yoga has been shown to have positive effects on the physical and mental rehabilitation of a wide range of patients, including patients with cancer,9 cardiovascular disease,10 and diabetes.11 However, it is not easy for patients with lung cancer treated with surgery to attend conventional yoga interventions delivered over 6 to 8 weeks. Therefore, we designed mini-yoga exercises specifically for surgical resection patients. Three yoga breathing techniques were selected for this study. In recent years, yoga breathing exercises have attracted special attention of researchers without the practice or intervention of other components (ie, physical posture and meditation) in yoga. 12,13 Yoga breathing exercises have no special requirements for environment and setting, and their content is typically understood with ease. People who are frail or have limited activities can practice yoga breathing exercises, making it suitable for a range of people. Yoga breathing exercises enable the practicing person to actively control and adjust the depth and frequency of breathing through various breathing exercise methods so that the main respiratory muscles can contract and relax rhythmically, and the respiratory system can play a more effective role.14,15 At the same time, it can stabilize the mood and relieve stress.16With the development of rehabilitation medicine, breathing exercises have been proposed as pulmonary rehabilitation exercises for patients undergoing lung cancer surgery. The purpose is to enhance the strength and endurance of respiratory muscles through active breathing exercise, thereby reducing the incidence of postoperative pulmonary complications and promoting recovery of patients.17 However, at present, there is no uniform standard or program of breathing exercises for patients undergoing lung cancer surgery, and diverse methods are used, such as deep breathing exercises, balloon blowing, and a respiratory trainer. Compared with balloon blowing and a respiratory trainer, yoga breathing exercises do not require special devices and are cost-effective. Compared with deep breathing exercises, yoga breathing exercises focus on both breathing mechanics and on controlling every stage of breathing. The use of breath timing in seconds is very important, which allows participants to inhale, hold their breath, and exhale in the best way in each breathing exercise.18Patients' compliance with yoga breathing exercises is an important prerequisite for achieving its full effect. Some researchers have reported that patients' compliance with rehabilitation exercises after surgery is poor. Reasons that affect the compliance include patients preferring to stay in bed after surgery, fear of wound pain, fatigue and weakness, depression, lack of medical staff supervision, and lack of social support.19,20 Solving problems encountered by patients during yoga breathing exercises, thereby improving patients' compliance with yoga breathing exercises, is key. ADOPT (Attitude, Definition, Open Mind, Planning, Try it out) model, a problem-solving model put forward by Peter et al,21 may be a feasible method to achieve this goal. This model includes 5 steps, aiming at helping participants overcome obstacles encountered in behavior change and increasing the possibility of participants changing their behavior.In this study, the ADOPT model was incorporated into the yoga breathing exercises for patients undergoing lung cancer surgery to solve problems encountered by patients during yoga breathing exercises in real time, facilitating patients to actively participate in breathing exercises and promote their rehabilitation. The aim of this study was to examine the effectiveness of yoga breathing exercises based on the problem-solving ADOPT model in alleviating perioperative symptoms among lung cancer patients undergoing surgery.Background Cancer itself and surgery pose a heavy burden on adults with lung cancer. Yoga breathing exercises have been proposed as a form of pulmonary rehabilitation exercises to improve these patients' perioperative outcomes. To investigate the impact of yoga breathing exercises based on a problem-solving model on dyspnea, exercise capacity, anxiety, depression, and postoperative indwelling time of thoracic drainage tube and compliance in adults with lung cancer undergoing surgery.One hundred eight lung cancer patients were randomly assigned to receive problem-solving model-based yoga breathing exercises, yoga breathing exercises, or usual care. Outcomes were collected at admission, the day before surgery, and at discharge.Patients in the combined intervention group showed a significantly greater improvement in dyspnea, exercise capacity, and anxiety compared with the control group. Yoga breathing training can significantly improve patients' dyspnea and anxiety. Significant difference favoring the combined group was observed in exercise capability and compliance between the 2 intervention groups. However, there was no significant difference in depression or indwelling time of thoracic drainage tube among the 3 groups at any time point.Findings indicate that yoga breathing exercises are effective in alleviating perioperative symptoms of lung resection patients. Compared with yoga breathing exercises, applying additional problem-solving model may achieve a better effect.Yoga breathing exercises can be considered as a promising pulmonary rehabilitation strategy for lung cancer patients with surgery. The problem-solving model could be integrated into yoga breathing exercises in clinical practice to enhance the rehabilitation effect.Lung cancer is the second most common cancer worldwide, representing 11.4% of all cancer diagnoses.1 Approximately 80% of the patients diagnosed with lung cancer have non-small cell lung cancer (NSCLC).2 Surgery, including traditional thoracotomy and video-assisted thoracoscopic surgery, is the main treatment for early-stage NSCLC patients (I-IIIA stage). Patients with lung cancer are prone to experience dyspnea, fatigue, and other uncomfortable symptoms due to lung lesions and the presence of malignant tumors before surgery.3,4 The trauma of the surgery itself can also cause respiratory physiological dysfunction and decrease lung tissue, which may lead to decreased respiratory function, retention of respiratory secretions, postoperative pulmonary complications, and prolonged hospitalization.5,6 In addition, because of patients' possible fear of surgery and the uncertainty of disease prognosis, they may suffer from psychological distress including anxiety and depression during hospitalization, which has an adverse impact on their rehabilitation.7,8 Therefore, adopting strategies to improve perioperative symptoms, both physically and psychologically, is needed to achieve rapid recovery.Yoga, as a mind-body therapy, has gradually attracted the attention of researchers in the field of complementary and alternative medicine. Yoga has been shown to have positive effects on the physical and mental rehabilitation of a wide range of patients, including patients with cancer,9 cardiovascular disease,10 and diabetes.11 However, it is not easy for patients with lung cancer treated with surgery to attend conventional yoga interventions delivered over 6 to 8 weeks. Therefore, we designed mini-yoga exercises specifically for surgical resection patients. Three yoga breathing techniques were selected for this study. In recent years, yoga breathing exercises have attracted special attention of researchers without the practice or intervention of other components (ie, physical posture and meditation) in yoga. 12,13 Yoga breathing exercises have no special requirements for environment and setting, and their content is typically understood with ease. People who are frail or have limited activities can practice yoga breathing exercises, making it suitable for a range of people. Yoga breathing exercises enable the practicing person to actively control and adjust the depth and frequency of breathing through various breathing exercise methods so that the main respiratory muscles can contract and relax rhythmically, and the respiratory system can play a more effective role.14,15 At the same time, it can stabilize the mood and relieve stress.16With the development of rehabilitation medicine, breathing exercises have been proposed as pulmonary rehabilitation exercises for patients undergoing lung cancer surgery. The purpose is to enhance the strength and endurance of respiratory muscles through active breathing exercise, thereby reducing the incidence of postoperative pulmonary complications and promoting recovery of patients.17 However, at present, there is no uniform standard or program of breathing exercises for patients undergoing lung cancer surgery, and diverse methods are used, such as deep breathing exercises, balloon blowing, and a respiratory trainer. Compared with balloon blowing and a respiratory trainer, yoga breathing exercises do not require special devices and are cost-effective. Compared with deep breathing exercises, yoga breathing exercises focus on both breathing mechanics and on controlling every stage of breathing. The use of breath timing in seconds is very important, which allows participants to inhale, hold their breath, and exhale in the best way in each breathing exercise.18Patients' compliance with yoga breathing exercises is an important prerequisite for achieving its full effect. Some researchers have reported that patients' compliance with rehabilitation exercises after surgery is poor. Reasons that affect the compliance include patients preferring to stay in bed after surgery, fear of wound pain, fatigue and weakness, depression, lack of medical staff supervision, and lack of social support.19,20 Solving problems encountered by patients during yoga breathing exercises, thereby improving patients' compliance with yoga breathing exercises, is key. ADOPT (Attitude, Definition, Open Mind, Planning, Try it out) model, a problem-solving model put forward by Peter et al,21 may be a feasible method to achieve this goal. This model includes 5 steps, aiming at helping participants overcome obstacles encountered in behavior change and increasing the possibility of participants changing their behavior.In this study, the ADOPT model was incorporated into the yoga breathing exercises for patients undergoing lung cancer surgery to solve problems encountered by patients during yoga breathing exercises in real time, facilitating patients to actively participate in breathing exercises and promote their rehabilitation. The aim of this study was to examine the effectiveness of yoga breathing exercises based on the problem-solving ADOPT model in alleviating perioperative symptoms among lung cancer patients undergoing surgery.Background Cancer itself and surgery pose a heavy burden on adults with lung cancer. Yoga breathing exercises have been proposed as a form of pulmonary rehabilitation exercises to improve these patients' perioperative outcomes. To investigate the impact of yoga breathing exercises based on a problem-solving model on dyspnea, exercise capacity, anxiety, depression, and postoperative indwelling time of thoracic drainage tube and compliance in adults with lung cancer undergoing surgery.One hundred eight lung cancer patients were randomly assigned to receive problem-solving model-based yoga breathing exercises, yoga breathing exercises, or usual care. Outcomes were collected at admission, the day before surgery, and at discharge.Patients in the combined intervention group showed a significantly greater improvement in dyspnea, exercise capacity, and anxiety compared with the control group. Yoga breathing training can significantly improve patients' dyspnea and anxiety. Significant difference favoring the combined group was observed in exercise capability and compliance between the 2 intervention groups. However, there was no significant difference in depression or indwelling time of thoracic drainage tube among the 3 groups at any time point.Findings indicate that yoga breathing exercises are effective in alleviating perioperative symptoms of lung resection patients. Compared with yoga breathing exercises, applying additional problem-solving model may achieve a better effect.Yoga breathing exercises can be considered as a promising pulmonary rehabilitation strategy for lung cancer patients with surgery. The problem-solving model could be integrated into yoga breathing exercises in clinical practice to enhance the rehabilitation effect.Lung cancer is the second most common cancer worldwide, representing 11.4% of all cancer diagnoses.1 Approximately 80% of the patients diagnosed with lung cancer have non-small cell lung cancer (NSCLC).2 Surgery, including traditional thoracotomy and video-assisted thoracoscopic surgery, is the main treatment for early-stage NSCLC patients (I-IIIA stage). Patients with lung cancer are prone to experience dyspnea, fatigue, and other uncomfortable symptoms due to lung lesions and the presence of malignant tumors before surgery.3,4 The trauma of the surgery itself can also cause respiratory physiological dysfunction and decrease lung tissue, which may lead to decreased respiratory function, retention of respiratory secretions, postoperative pulmonary complications, and prolonged hospitalization.5,6 In addition, because of patients' possible fear of surgery and the uncertainty of disease prognosis, they may suffer from psychological distress including anxiety and depression during hospitalization, which has an adverse impact on their rehabilitation.7,8 Therefore, adopting strategies to improve perioperative symptoms, both physically and psychologically, is needed to achieve rapid recovery.Yoga, as a mind-body therapy, has gradually attracted the attention of researchers in the field of complementary and alternative medicine. Yoga has been shown to have positive effects on the physical and mental rehabilitation of a wide range of patients, including patients with cancer,9 cardiovascular disease,10 and diabetes.11 However, it is not easy for patients with lung cancer treated with surgery to attend conventional yoga interventions delivered over 6 to 8 weeks. Therefore, we designed mini-yoga exercises specifically for surgical resection patients. Three yoga breathing techniques were selected for this study. In recent years, yoga breathing exercises have attracted special attention of researchers without the practice or intervention of other components (ie, physical posture and meditation) in yoga. 12,13 Yoga breathing exercises have no special requirements for environment and setting, and their content is typically understood with ease. People who are frail or have limited activities can practice yoga breathing exercises, making it suitable for a range of people. Yoga breathing exercises enable the practicing person to actively control and adjust the depth and frequency of breathing through various breathing exercise methods so that the main respiratory muscles can contract and relax rhythmically, and the respiratory system can play a more effective role.14,15 At the same time, it can stabilize the mood and relieve stress.16With the development of rehabilitation medicine, breathing exercises have been proposed as pulmonary rehabilitation exercises for patients undergoing lung cancer surgery. The purpose is to enhance the strength and endurance of respiratory muscles through active breathing exercise, thereby reducing the incidence of postoperative pulmonary complications and promoting recovery of patients.17 However, at present, there is no uniform standard or program of breathing exercises for patients undergoing lung cancer surgery, and diverse methods are used, such as deep breathing exercises, balloon blowing, and a respiratory trainer. Compared with balloon blowing and a respiratory trainer, yoga breathing exercises do not require special devices and are cost-effective. Compared with deep breathing exercises, yoga breathing exercises focus on both breathing mechanics and on controlling every stage of breathing. The use of breath timing in seconds is very important, which allows participants to inhale, hold their breath, and exhale in the best way in each breathing exercise.18Patients' compliance with yoga breathing exercises is an important prerequisite for achieving its full effect. Some researchers have reported that patients' compliance with rehabilitation exercises after surgery is poor. Reasons that affect the compliance include patients preferring to stay in bed after surgery, fear of wound pain, fatigue and weakness, depression, lack of medical staff supervision, and lack of social support.19,20 Solving problems encountered by patients during yoga breathing exercises, thereby improving patients' compliance with yoga breathing exercises, is key. ADOPT (Attitude, Definition, Open Mind, Planning, Try it out) model, a problem-solving model put forward by Peter et al,21 may be a feasible method to achieve this goal. This model includes 5 steps, aiming at helping participants overcome obstacles encountered in behavior change and increasing the possibility of participants changing their behavior.In this study, the ADOPT model was incorporated into the yoga breathing exercises for patients undergoing lung cancer surgery to solve problems encountered by patients during yoga breathing exercises in real time, facilitating patients to actively participate in breathing exercises and promote their rehabilitation. The aim of this study was to examine the effectiveness of yoga breathing exercises based on the problem-solving ADOPT model in alleviating perioperative symptoms among lung cancer patients undergoing surgery.Background Cancer itself and surgery pose a heavy burden on adults with lung cancer. Yoga breathing exercises have been proposed as a form of pulmonary rehabilitation exercises to improve these patients' perioperative outcomes. To investigate the impact of yoga breathing exercises based on a problem-solving model on dyspnea, exercise capacity, anxiety, depression, and postoperative indwelling time of thoracic drainage tube and compliance in adults with lung cancer undergoing surgery.One hundred eight lung cancer patients were randomly assigned to receive problem-solving model-based yoga breathing exercises, yoga breathing exercises, or usual care. Outcomes were collected at admission, the day before surgery, and at discharge.Patients in the combined intervention group showed a significantly greater improvement in dyspnea, exercise capacity, and anxiety compared with the control group. Yoga breathing training can significantly improve patients' dyspnea and anxiety. Significant difference favoring the combined group was observed in exercise capability and compliance between the 2 intervention groups. However, there was no significant difference in depression or indwelling time of thoracic drainage tube among the 3 groups at any time point.Findings indicate that yoga breathing exercises are effective in alleviating perioperative symptoms of lung resection patients. Compared with yoga breathing exercises, applying additional problem-solving model may achieve a better effect.Yoga breathing exercises can be considered as a promising pulmonary rehabilitation strategy for lung cancer patients with surgery. The problem-solving model could be integrated into yoga breathing exercises in clinical practice to enhance the rehabilitation effect.Lung cancer is the second most common cancer worldwide, representing 11.4% of all cancer diagnoses.1 Approximately 80% of the patients diagnosed with lung cancer have non-small cell lung cancer (NSCLC).2 Surgery, including traditional thoracotomy and video-assisted thoracoscopic surgery, is the main treatment for early-stage NSCLC patients (I-IIIA stage). Patients with lung cancer are prone to experience dyspnea, fatigue, and other uncomfortable symptoms due to lung lesions and the presence of malignant tumors before surgery.3,4 The trauma of the surgery itself can also cause respiratory physiological dysfunction and decrease lung tissue, which may lead to decreased respiratory function, retention of respiratory secretions, postoperative pulmonary complications, and prolonged hospitalization.5,6 In addition, because of patients' possible fear of surgery and the uncertainty of disease prognosis, they may suffer from psychological distress including anxiety and depression during hospitalization, which has an adverse impact on their rehabilitation.7,8 Therefore, adopting strategies to improve perioperative symptoms, both physically and psychologically, is needed to achieve rapid recovery.Yoga, as a mind-body therapy, has gradually attracted the attention of researchers in the field of complementary and alternative medicine. Yoga has been shown to have positive effects on the physical and mental rehabilitation of a wide range of patients, including patients with cancer,9 cardiovascular disease,10 and diabetes.11 However, it is not easy for patients with lung cancer treated with surgery to attend conventional yoga interventions delivered over 6 to 8 weeks. Therefore, we designed mini-yoga exercises specifically for surgical resection patients. Three yoga breathing techniques were selected for this study. In recent years, yoga breathing exercises have attracted special attention of researchers without the practice or intervention of other components (ie, physical posture and meditation) in yoga. 12,13 Yoga breathing exercises have no special requirements for environment and setting, and their content is typically understood with ease. People who are frail or have limited activities can practice yoga breathing exercises, making it suitable for a range of people. Yoga breathing exercises enable the practicing person to actively control and adjust the depth and frequency of breathing through various breathing exercise methods so that the main respiratory muscles can contract and relax rhythmically, and the respiratory system can play a more effective role.14,15 At the same time, it can stabilize the mood and relieve stress.16With the development of rehabilitation medicine, breathing exercises have been proposed as pulmonary rehabilitation exercises for patients undergoing lung cancer surgery. The purpose is to enhance the strength and endurance of respiratory muscles through active breathing exercise, thereby reducing the incidence of postoperative pulmonary complications and promoting recovery of patients.17 However, at present, there is no uniform standard or program of breathing exercises for patients undergoing lung cancer surgery, and diverse methods are used, such as deep breathing exercises, balloon blowing, and a respiratory trainer. Compared with balloon blowing and a respiratory trainer, yoga breathing exercises do not require special devices and are cost-effective. Compared with deep breathing exercises, yoga breathing exercises focus on both breathing mechanics and on controlling every stage of breathing. The use of breath timing in seconds is very important, which allows participants to inhale, hold their breath, and exhale in the best way in each breathing exercise.18Patients' compliance with yoga breathing exercises is an important prerequisite for achieving its full effect. Some researchers have reported that patients' compliance with rehabilitation exercises after surgery is poor. Reasons that affect the compliance include patients preferring to stay in bed after surgery, fear of wound pain, fatigue and weakness, depression, lack of medical staff supervision, and lack of social support.19,20 Solving problems encountered by patients during yoga breathing exercises, thereby improving patients' compliance with yoga breathing exercises, is key. ADOPT (Attitude, Definition, Open Mind, Planning, Try it out) model, a problem-solving model put forward by Peter et al,21 may be a feasible method to achieve this goal. This model includes 5 steps, aiming at helping participants overcome obstacles encountered in behavior change and increasing the possibility of participants changing their behavior.In this study, the ADOPT model was incorporated into the yoga breathing exercises for patients undergoing lung cancer surgery to solve problems encountered by patients during yoga breathing exercises in real time, facilitating patients to actively participate in breathing exercises and promote their rehabilitation. The aim of this study was to examine the effectiveness of yoga breathing exercises based on the problem-solving ADOPT model in alleviating perioperative symptoms among lung cancer patients undergoing surgery.Background Cancer itself and surgery pose a heavy burden on adults with lung cancer. Yoga breathing exercises have been proposed as a form of pulmonary rehabilitation exercises to improve these patients' perioperative outcomes. To investigate the impact of yoga breathing exercises based on a problem-solving model on dyspnea, exercise capacity, anxiety, depression, and postoperative indwelling time of thoracic drainage tube and compliance in adults with lung cancer undergoing surgery.One hundred eight lung cancer patients were randomly assigned to receive problem-solving model-based yoga breathing exercises, yoga breathing exercises, or usual care. Outcomes were collected at admission, the day before surgery, and at discharge.Patients in the combined intervention group showed a significantly greater improvement in dyspnea, exercise capacity, and anxiety compared with the control group. Yoga breathing training can significantly improve patients' dyspnea and anxiety. Significant difference favoring the combined group was observed in exercise capability and compliance between the 2 intervention groups. However, there was no significant difference in depression or indwelling time of thoracic drainage tube among the 3 groups at any time point.Findings indicate that yoga breathing exercises are effective in alleviating perioperative symptoms of lung resection patients. Compared with yoga breathing exercises, applying additional problem-solving model may achieve a better effect.Yoga breathing exercises can be considered as a promising pulmonary rehabilitation strategy for lung cancer patients with surgery. The problem-solving model could be integrated into yoga breathing exercises in clinical practice to enhance the rehabilitation effect.Lung cancer is the second most common cancer worldwide, representing 11.4% of all cancer diagnoses.1 Approximately 80% of the patients diagnosed with lung cancer have non-small cell lung cancer (NSCLC).2 Surgery, including traditional thoracotomy and video-assisted thoracoscopic surgery, is the main treatment for early-stage NSCLC patients (I-IIIA stage). Patients with lung cancer are prone to experience dyspnea, fatigue, and other uncomfortable symptoms due to lung lesions and the presence of malignant tumors before surgery.3,4 The trauma of the surgery itself can also cause respiratory physiological dysfunction and decrease lung tissue, which may lead to decreased respiratory function, retention of respiratory secretions, postoperative pulmonary complications, and prolonged hospitalization.5,6 In addition, because of patients' possible fear of surgery and the uncertainty of disease prognosis, they may suffer from psychological distress including anxiety and depression during hospitalization, which has an adverse impact on their rehabilitation.7,8 Therefore, adopting strategies to improve perioperative symptoms, both physically and psychologically, is needed to achieve rapid recovery.Yoga, as a mind-body therapy, has gradually attracted the attention of researchers in the field of complementary and alternative medicine. Yoga has been shown to have positive effects on the physical and mental rehabilitation of a wide range of patients, including patients with cancer,9 cardiovascular disease,10 and diabetes.11 However, it is not easy for patients with lung cancer treated with surgery to attend conventional yoga interventions delivered over 6 to 8 weeks. Therefore, we designed mini-yoga exercises specifically for surgical resection patients. Three yoga breathing techniques were selected for this study. In recent years, yoga breathing exercises have attracted special attention of researchers without the practice or intervention of other components (ie, physical posture and meditation) in yoga. 12,13 Yoga breathing exercises have no special requirements for environment and setting, and their content is typically understood with ease. People who are frail or have limited activities can practice yoga breathing exercises, making it suitable for a range of people. Yoga breathing exercises enable the practicing person to actively control and adjust the depth and frequency of breathing through various breathing exercise methods so that the main respiratory muscles can contract and relax rhythmically, and the respiratory system can play a more effective role.14,15 At the same time, it can stabilize the mood and relieve stress.16With the development of rehabilitation medicine, breathing exercises have been proposed as pulmonary rehabilitation exercises for patients undergoing lung cancer surgery. The purpose is to enhance the strength and endurance of respiratory muscles through active breathing exercise, thereby reducing the incidence of postoperative pulmonary complications and promoting recovery of patients.17 However, at present, there is no uniform standard or program of breathing exercises for patients undergoing lung cancer surgery, and diverse methods are used, such as deep breathing exercises, balloon blowing, and a respiratory trainer. Compared with balloon blowing and a respiratory trainer, yoga breathing exercises do not require special devices and are cost-effective. Compared with deep breathing exercises, yoga breathing exercises focus on both breathing mechanics and on controlling every stage of breathing. The use of breath timing in seconds is very important, which allows participants to inhale, hold their breath, and exhale in the best way in each breathing exercise.18Patients' compliance with yoga breathing exercises is an important prerequisite for achieving its full effect. Some researchers have reported that patients' compliance with rehabilitation exercises after surgery is poor. Reasons that affect the compliance include patients preferring to stay in bed after surgery, fear of wound pain, fatigue and weakness, depression, lack of medical staff supervision, and lack of social support.19,20 Solving problems encountered by patients during yoga breathing exercises, thereby improving patients' compliance with yoga breathing exercises, is key. ADOPT (Attitude, Definition, Open Mind, Planning, Try it out) model, a problem-solving model put forward by Peter et al,21 may be a feasible method to achieve this goal. This model includes 5 steps, aiming at helping participants overcome obstacles encountered in behavior change and increasing the possibility of participants changing their behavior.In this study, the ADOPT model was incorporated into the yoga breathing exercises for patients undergoing lung cancer surgery to solve problems encountered by patients during yoga breathing exercises in real time, facilitating patients to actively participate in breathing exercises and promote their rehabilitation. The aim of this study was to examine the effectiveness of yoga breathing exercises based on the problem-solving ADOPT model in alleviating perioperative symptoms among lung cancer patients undergoing surgery.