Preparing for CRS/HIPEC: Could Breathing Exercises Improve Recovery?
Sand, O., Arakelian, E., Semenas, E. et al. Preoperative inspiratory muscle training for patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a randomized feasibility study. Pilot Feasibility Stud 12, 152 (2026). https://doi.org/10.1186/s40814-026-01946-z
New Research Explores the Benefits of Strengthening Breathing Muscles Before Major Abdominal Cancer Surgery
For patients preparing for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), recovery can be challenging. These extensive procedures, used to treat certain cancers that have spread within the abdominal cavity, can place significant stress on the body, including the lungs.
A new study published in Pilot and Feasibility Studies suggests that targeted breathing exercises before surgery may help strengthen respiratory muscles and support recovery afterward.
Why Breathing Exercises Matter
Following CRS/HIPEC, patients can experience respiratory complications, including difficulty breathing, pneumonia, and reduced lung capacity. These complications can prolong recovery and affect overall health.
Researchers in Sweden explored whether inspiratory muscle training (IMT), a type of exercise designed to strengthen the muscles used to breathe in, could help patients better prepare for surgery.
The training is part of a broader approach called prehabilitation, which focuses on improving a patient's physical and overall health before treatment to support recovery afterward.
What Did the Study Involve?
Researchers at Uppsala University Hospital in Sweden conducted a small randomized feasibility study involving 30 patients scheduled for CRS/HIPEC.
Participants were assigned to one of two groups:
Breathing Muscle Training Group: Patients used a handheld device that provided resistance while inhaling, helping strengthen the muscles responsible for breathing.
Comparison Group: Patients performed a different type of breathing exercise using a positive expiratory pressure device.
Both groups were instructed to practice their assigned exercises twice daily for at least two weeks before surgery.
Researchers evaluated whether patients could successfully complete the exercises and monitored breathing muscle strength, lung function, and respiratory complications following surgery.
What Did Researchers Find?
Although the study was small, several findings were encouraging.
1. Improved breathing muscle strength
Patients who completed inspiratory muscle training demonstrated greater improvements in breathing muscle strength before surgery compared with those in the comparison group.
2. Faster early recovery of lung capacity
Following surgery, patients in the breathing muscle training group showed faster improvement in vital capacity, a measure of how much air a person can breathe out after taking a deep breath.
3. Fewer reported lung-related complications
Researchers recorded 6 postoperative pulmonary complications in the breathing muscle training group compared with 12 in the comparison group.
While this difference is promising, the study was not large enough to determine whether breathing muscle training actually reduces the risk of complications.
4. Most patients tolerated the exercises well
The training was generally well received, although some participants experienced discomfort, including coughing. Researchers also identified challenges with recruiting participants and ensuring that patients had enough time to complete the training before surgery.
What Does This Mean for Patients?
For patients preparing for CRS/HIPEC, this study highlights the potential importance of preparing the body for surgery, not just recovering afterward.
Breathing muscle training may eventually become another useful part of prehabilitation programs, alongside physical activity, nutritional support, and other measures designed to improve surgical readiness.
However, this was a small feasibility study, not a definitive clinical trial. Many participants withdrew or were excluded, and the researchers could not establish whether the breathing exercises directly prevented complications or improved long-term outcomes.
Larger studies are needed before specific breathing muscle training programs can be routinely recommended based on these findings.
The Alliance's Perspective
At the Abdominal Cancers Alliance, we believe patients should have access to information that helps them prepare for treatment and participate in informed decisions about their care.
For patients considering CRS/HIPEC, this research reinforces the value of discussing prehabilitation with their surgical team.
Patients may wish to ask:
Would a prehabilitation program be appropriate before my surgery?
Could breathing exercises or respiratory physical therapy help me prepare?
What steps can I safely take now to support my recovery?
Every patient's circumstances are different. Breathing exercises, particularly those involving resistance devices, should be discussed with the care team to ensure they are appropriate for the patient's health and treatment plan.
The Bottom Line: Preparing for major abdominal cancer surgery may involve more than physical fitness and nutrition. Early research suggests that strengthening breathing muscles before CRS/HIPEC could support lung function and postoperative recovery. While more evidence is needed, these findings offer another promising direction for improving the surgical experience and outcomes for patients with peritoneal cancers.
