Sheill G1, Guinan E2, Peat N3, Hussey J4
1Trinity College Dublin, Discipline of Physiotherapy, Dublin, Ireland, 2Trinity College Dublin, School of Medicine, Dublin, Ireland, 3Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom, 4Trinity College Dublin, Dublin, Ireland

Background: Exercise is often perceived as a contraindication in the presence of bone metastases due to concerns about aggravating skeletal related events. However there is enormous potential for exercise to enhance function, ameliorate the side-effects of treatment and to act as an adjunct to modern anti-cancer treatments.

Purpose: The purpose of this narrative review was to comprehensively synthesize evidence on the involvement of patients with bone metastases in exercise trials, including the efficacy and safety outcomes.

Methods: Papers were identified through a search of the following databases: CINHAL, EMBASE, Medline, PubMed, SCOPUS and Web of Science. The search terms used included combinations of physical activity or exercise and key words related to bone metastases. Studies which involved patients with metastatic disease, in particular bone metastases, as a result of solid primary tumors, participating in supervised exercise interventions were eligible for inclusion.

Results: Eleven studies, described in 18 papers, relating to exercise prescription in patients with bone metastases were considered eligible for inclusion. Aerobic and/or resistance exercise training was prescribed by all studies. Studies report high levels of patient tolerance, acceptability and adherence. The need to individualize exercise prescription and adapt exercises to patient ability were reinforced in all papers reviewed. Studies reviewed reporting adverse events did not find a high fracture incidence with exercise in comparison with control participants, or an association between exercise and fracture risk. Statistically significant and clinically meaningful improvements in exercise behavior, muscle strength, aerobic fitness, walking speed and muscle mass were observed with several different exercise training modalities. These benefits occurred without aggravating symptoms such as fatigue and bone pain.

Conclusion(s): Physical exercise programs tailored to the individual patient appear safe, efficacious and feasible in populations living with bone metastases.

Implications: Patients with metastatic cancer require exercise prescription from exercise specialists trained in cancer rehabilitation who are able to complete complex assessments and evaluations of patient response to exercise.

Keywords: Oncology, Exercise, Bone metastases

Funding acknowledgements: A researcher on this study (G.S.) was supported by funding from the World Cancer Research Fund

Topic: Oncology, HIV & palliative care; Disability & rehabilitation

Ethics approval required: No
Institution: Trinity College Dublin
Ethics committee: Trinity College Health Sciences REC
Reason not required: Narrative review of existing literature

All authors, affiliations and abstracts have been published as submitted.

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