Abstract Background Understanding the barriers and facilitators of prehabilitation in elderly patients with early-stage lung cancer is of significant importance. This study aimed to elucidate these barriers and facilitators from the perspectives of different clinical professionals. Methods A qualitative descriptive study was undertaken. Semi-structured interviews with clinical professionals, using purposive sampling and content analysis were conducted in March to May 2023 to summarize and refine the key themes. Results From the perspective of clinical professionals, the facilitators of prehabilitation have been categorized into five major themes. These include the recognized importance of prehabilitation, the positive attitude of clinical professionals, the support of leadership, the willingness of the majority of patients to accept prehabilitation, and the initial implementation of an enhanced recovery after surgery - multidisciplinary team (ERAS-MDT) approach. Conversely, clinical professionals identify several barriers to prehabilitation, which are grouped into seven themes. These impediments encompass a lack of knowledge regarding clinical practice, insufficient preoperative preparation time, the absence of an aging-friendly clinical practice scheme, an immature multidisciplinary cooperation mechanism, a lack of explicit regulations, inadequate emergency safeguards, and a shortage of specialized professionals. Practice strategies for promoting prehabilitation in elderly patients with early lung cancer include development of evidence summaries, develop healthcare training materials, develop patient health education brochures, clarify the division of labor of ERAS-MDT, improve patient safety and monitoring measures, optimize practice flow and obtain funding support. Conclusion To enhance the feasibility and clinical relevance of prehabilitation, clinical professionals should consider establishing a multidisciplinary information consulting team, developing a comprehensive prehabilitation program, and reinforcing the support system prior to surgery.