Background: To investigate the influence of preoperative physical training combining aerobic and breathing exercises on surgical lung cancer patients with impaired lung function. Methods: A total of 68 patients with predicted postoperative FEV1% <60% were equally and randomly assigned into one-week physical training combining aerobic and breathing exercises (intervened group: IG) or routine preoperative preparation (control group: CG). Then, 6-min walking distance (6-MWD), in-hospital length of stay (LOS), and other clinical variables were included and recorded. Results: An increase of 22.6 +/- 27.0 m of 6-MWD was observed in IG, compared to 2.7 +/- 27.6 m in CG (between-group difference: 19.9 m, 95% CI: 6.7 to 33.2, P=0.004), but no difference was found in lung function. The emotional function of EORTC-QLQ-30 was significantly improved in IG after the training regimen, compared to CG. Meanwhile, the intervened patients (IG) had significantly lower postoperative pulmonary complication (PPC) rate (11.8%, 4/34 vs. 35.3%, 12/34, P=0.022), shorter postoperative LOS [median: 5.0 interquartile (4.0-7.0) vs. 8.0 (7.0-10.0) days, P<0.001] and lower costs, including total cost [48,588.7 (44,999.1-52,693.3) vs. 52,445.3 (49,002.9-61,994.0) (sic), P=0.016], material cost [23,350.8 (18,300.6-26,421.9) vs. 25,730.0 (21,328.7-29,250.2) (sic), P=0.048] and drug cost [7,230.0 (6,661.9-8,347.4) vs. 11,388.6 (7,963.0-16,314.3) (sic), P<0.001]. Conclusions: The preoperative physical training combining aerobic and breathing exercises can improve exercise capacity, decrease the occurrence of PPCs, and shorten LOS with lower in-hospital cost; it thus shows potential to be an effective preparation strategy for surgical lung cancer patients with limited lung function.