According to GLOBOCAN 2022, lung malignancy continues to be the predominant form of cancer, having recorded 2.48 million fresh instances globally in 20,22.1 This statistic comprises 12.4 % of all malignancies identified during that year, representing the highest documented rate.1 Furthermore, the report emphasizes the significance of lung malignancy as the primary contributor to cancer-related deaths, resulting in an alarming 1.81 million fatalities, constituting 18.7 % of all cancer-induced passings worldwide.1 Non-small cell lung cancer (NSCLC), representing 85 % of all lung malignancies, is the predominant subtype.2 Surgical excision serves as the primary therapeutic approach in managing NSCLC, particularly in its early stages (I and II) and select advanced cases (stage IIIa) .3 The advent of the rapid advancement of contemporary medical technology and the extensive popularity of lung cancer screenings, coupled with the notable elevation in public health consciousness, have significantly improved the early identification of lung cancer at its preliminary stages. This positive transformation has not only enabled more patients to undergo surgical intervention in the early stages of the disease, but has also substantially improved the overall survival rate of patients, offering new hope to lung cancer patients.4 Nonetheless, as the disease progresses and treatment-related side effects emerge, lung cancer patients frequently develop a constellation of symptoms including dyspnea, reduced exercise tolerance, and weight loss, often accompanied by chronic pain.5 These physical manifestations, combined with the psychological burden of the disease, commonly lead to the development of significant psychosocial distress, which frequently progresses to clinically relevant depression and anxiety disorders.6, 7, 8 Ranging from 20 % to 43.5 % for anxiety and 42.9 % to 58 % for depression, respectively, studies have demonstrated the prevalence of these conditions in Chinese individuals suffering from lung cancer.9, 10, 11, 12 Consequently, there is an urgent need to implement comprehensive measures to enhance the overall health and emotional stability of lung cancer patients across all fronts.

Pulmonary function inevitably declines following lung cancer surgery, with the extent of reduction varying according to the surgical procedure.13 Specifically, forced expiratory volume in 1 s (FEV1) decreases by approximately 15 % after lobectomy and 35 % following total pneumonectomy.14 A prospective cohort study demonstrated significant postoperative reductions in forced vital capacity (FVC), percentage of predicted forced vital capacity (FVC%), FEV1, and percentage of predicted forced expiratory volume in 1 s (FEV1%) within two weeks after surgery. While partial recovery of pulmonary function was observed at 6 months postoperatively, lung function parameters typically stabilized at one year following surgery.13 Notably, patients with compromised pulmonary function are at higher risk of developing clinical symptoms, including persistent cough, chest tightness, dyspnea, and sleep disturbances.13

The concept of quality of life (QoL) encompasses an individual's self-perceived life status, which is evaluated through the lens of their cultural background and value orientation, while considering their objectives, anticipations, criterion and concerns.15 In lung cancer patients, surgical intervention combined with adjuvant chemotherapy or radiotherapy often results in persistent QoL impairment.16 This compromised quality of life frequently exacerbates symptom burden and predisposes patients to psychological comorbidities, particularly depression and anxiety disorders.17 Consequently, the enhancement of QoL has emerged as a primary therapeutic objective in the management of advanced lung cancer patients.18

Psychological and emotional disturbances represent significant challenges in the management of lung cancer patients.15 Individuals who have received a diagnosis related to lung cancer frequently confront heightened emotional burdens and stigma compared to those afflicted with other malignancies, contributing to poorer mental health, resulting in a higher prevalence of mental health disorders, particularly anxiety and depression.19 These psychiatric comorbidities not only adversely affect treatment adherence and clinical outcomes but also significantly impair quality of life and hinder rehabilitation processes, potentially contributing to disease progression.20

Exercise tolerance, a key indicator of cardiopulmonary fitness, is commonly assessed using the 6 min walking distance (6MWD) .15,21 A higher 6MWD is associated with improved functional capacity and physical activity levels.22 Notably, research has demonstrated that every 50-meter improvement in the 6 min walking test (6MWT) is linked to a 13 % decrease in mortality risk among individuals with metastatic NSCLC.23

Pulmonary rehabilitation is a personalized, multidisciplinary program that starts with a detailed patient assessment and includes exercise, education, and behavior modification. Its goal is to enhance physical and mental health in chronic respiratory disease patients and encouraging sustained engagement in health-promoting activities.24 Exercise training serves as the core component of pulmonary rehabilitation.24 Previous studies on exercise training in chronic obstructive pulmonary disease (COPD) have demonstrated its significant benefits, including improvements in pulmonary function, QoL, exercise capacity, and reductions in anxiety and depression.25, 26, 27 However, the potential benefits of exercise for lung cancer patients remain underexplored, and evidence-based exercise guidelines specifically tailored to this population are notably lacking.15 Low adherence and high attrition rates are common challenges in exercise training.28, 29, 30, 31, 32 Excessive training intensity may induce patient fatigue and discomfort, thereby compromising long-term adherence. In contrast, moderate-intensity training has gained wider acceptance due to its better tolerability and sustainability.33 Additionally, a lack of interest and motivation has been identified as a key factor contributing to exercise discontinuation.28, 29, 30, 31, 32, 33 Furthermore, the requirement for specialized equipment and multidisciplinary team support in pulmonary rehabilitation limits its accessibility, particularly in resource-limited settings.33 As a moderate intensity mind-body exercise, Baduanjin features simple and easy-to-learn movements, requires no specialized equipment or dedicated space, and can be performed in various settings. These characteristics enable Baduanjin to effectively address the limitations of traditional pulmonary rehabilitation, offering lung cancer patients a highly accessible and adherence-friendly rehabilitation option.34

Baduanjin exercise, also known as "Eight Section Brocade", has gained increasing recognition as a valuable complementary therapy for chronic disease management. It originated from the philosophical principles of the I Ching (Book of Changes), emphasizing the balance between Yin and Yang.35 Unlike other traditional Chinese mind-body exercises such as Tai Chi, Baduanjin is characterized by its focus on controlled breathing, meditation, and mindful relaxation. Historical records indicate that similar exercises were documented in Chinese literature as early as the 3rd century. By the 12th century, Baduanjin had gained widespread popularity and was formally integrated into military training as a routine fitness practice. In recent years, the movements of Baduanjin have been standardized and promoted by the General Administration of Sport of China, further enhancing its accessibility and popularity[35]. This holistic practice consists of eight meticulously designed movement sequences that integrate bodily flexions, extensions, torsions, and pitch variations with modulated respiration and focused mindfulness.36 The specific movements include lifting both hands upward, stretching arms sideways in a bow-drawing motion, alternating arm lifts, gentle head and upper body rotations, side-to-side movements, forward bends to touch the feet, alternate forward punching with focused gaze, and heel lifts with toe bouncing. The therapeutic efficacy of Baduanjin lies in its unique combination of physical, respiratory, and mental components. During practice, emphasis is placed on maintaining precise postures, physical coordination, and balance, which collectively enhance muscular strength and flexibility while promoting mental clarity. The exercise's gentle and continuous movements, often accompanied by subtle musical accompaniment, contribute to both internal and external cultivation, making it particularly suitable for patients with chronic conditions. Clinical applications have demonstrated Baduanjin's significant role in pulmonary rehabilitation, particularly for COPD patients, where it has been shown to support recovery and enhance pulmonary function.37 As a highly esteemed complementary and alternative medicinal therapy, Baduanjin is increasingly integrated into treatment protocols, offering patients an effective approach to better disease management and improved quality of life beyond traditional medical interventions.

Previous meta-analyses have demonstrated notable outcomes from the practice of Baduanjin exercise, including substantial improvement in the QoL among breast cancer patients,38 alleviation of cancer-induced fatigue for those with digestive system tumors,39 as well as enhancement of exercise tolerance in individuals with compromised cardiac function,40 and advancement of balance and motor function in stroke survivors.41 However, within the realm of NSCLC treatment, the research on Baduanjin exercise is sparse. Although initial studies suggest its therapeutic potential and beneficial effects, the evidence base to fully evaluate its clinical efficacy remains underdeveloped. The meta-analysis aims to appraise the role that Baduanjin exercise plays in enhancing the postoperative rehabilitation of NSCLC patients, with a focus on key outcomes including pulmonary function, QoL, mental health status, and exercise tolerance.