Accelerated Pulmonary Rehabilitation in the Preoperative Period

Inclusion Criteria: * Age 18 years or older * Lung nodule that is deemed highly suspicious for lung cancer based on: nodule characteristics, risk factors, CT-PET avidity, previous biopsy results, and assessment by physicians specializing in lung cancers * Eligible for treatment * Current cigarette smoking ≥5 cigarettes per day * Willing to attempt smoking cessation during prehab period * Willing to take nicotine replacement therapy (NRT) and varenicline * Able to attend PR at UVMMC for 2, one-hour sequential sessions for a total of 16 sessions over 8 days during treatment * Willing and able to provide informed consent; ability determined by study physician and/or LMDC treatment physicians Exclusion Criteria: * Unable to safely participate in PR due to unstable cardiac disease, unstable peripheral vascular disease, musculoskeletal disease that would prevent exercise, significant psychiatric or neurocognitive disease that would limit ability to exercise safely in a group setting as determined by the study physician and/or treatment physicians * Inability to consistently attend PR during treatment * Pregnancy, per patient self-report * Active or recent participation in another clinical trial that, in the opinion of the investigator would impact outcomes measured in this study * Any other condition in the opinion of the investigator/study physician and or treatment physicians that would jeopardize patient safety or integrity of research results