The PRIMROSE Trial

Inclusion Criteria: Adults with lung cancer with surgically resectable disease who are referred for pre-treatment optimization with Prehab, from the lung cancer Multi-Disciplinary Teams (MDTs). The referral criteria for Prehab is below: * ≥1 Medical Research Council (MRC) dyspnoea score * ≥1 World Health Organization (WHO) performance status (PS) * Age ≥ 70 years * Frailty index \>3 * Borderline or poor pulmonary function (forced expiratory volume in one second (FEV1) \< 50% or diffusion capacity for carbon monoxide (DLCO) \<50%) * Sedentary people despite having adequate FEV1 or DLCO * People who are eligible for surgical procedures, including endobronchial excision of tumour, or lobectomy, segmental resection, pneumonectomy or wedge resection, either via a minimally invasive approach or a standard thoracotomy approach Additionally: * Participants will be included in the trial if they are capable of providing verbal and written consent for Prehab, and written consent for undergoing a surgical procedure for lung cancer * People over 18 years of age * All people will be considered regardless of their baseline respiratory muscle strength Exclusion Criteria: Inclusion criteria not met * People diagnosed with other cancers namely, metastatic lung cancer, mesothelioma, sarcoma, mediastinal tumours, or benign diseases * People who decline Prehab * People who do not consent to Prehab, and do not attend Prehab. People who do not consent to surgery * People with a high cardiovascular risk for Prehab and awaiting investigations or interventions (including unstable angina and syncope) * People with a serious concomitant disorder that would compromise safety during Prehab * People with an abdominal hernia or recent abdominal surgery * People with a history of spontaneous pneumothorax and/or evidence of large bullae on radiological imaging * People with an inability to understand written and/or spoken English (only if carers are able to translate) * People with a perforated ear drum * People with worsening heart failure signs and symptoms after IMT * People with pulmonary hypertension * People who have suffered from or likely to suffer from costochondritis * If a participant was involved in a similar study, with potential to cause bias or conflict of interest then they will be excluded