Exercise Recommendation for People With Bone Metastases: Expert Consensus for Health Care Providers and Exercise Professionals

Abstract

PURPOSE: Exercise has been underutilized in people with advanced or incurable cancer despite the potential to improve physical function and reduce psychosocial morbidity, especially for people with bone metastases because of concerns over skeletal complications. The International Bone Metastases Exercise Working Group (IBMEWG) was formed to develop best practice recommendations for exercise programming for people with bone metastases on the basis of published research, clinical experience, and expert opinion. METHODS: The IBMEWG undertook sequential steps to inform the recommendations: (1) modified Delphi survey, (2) systematic review, (3) cross-sectional survey to physicians and nurse practitioners, (4) in-person meeting of IBMEWG to review evidence from steps 1-3 to develop draft recommendations, and (5) stakeholder engagement. RESULTS: Recommendations emerged from the contributing evidence and IBMEWG discussion for pre-exercise screening, exercise testing, exercise prescription, and monitoring of exercise response. Identification of individuals who are potentially at higher risk of exercise-related skeletal complication is a complex interplay of these factors: (1) lesion-related, (2) cancer and cancer treatment–related, and (3) the person-related. Exercise assessment and prescription requires consideration of the location and presentation of bone lesion(s) and should be delivered by qualified exercise professionals with oncology education and exercise prescription experience. Emphasis on postural alignment, controlled movement, and proper technique is essential. CONCLUSION: Ultimately, the perceived risk of skeletal complications should be weighed against potential health benefits on the basis of consultation between the person, health care team, and exercise professionals. These recommendations provide an initial framework to improve the integration of exercise programming into clinical care for people with bone metastases.

Supportive Care in Oncology—From Physical Activity to Nutrition

“…Nevertheless, in patients with advanced cancer, exercise has the potential to prevent the loss of function, control symptoms, and help maintain independence [ 26 ]. Recent reviews have evaluated that exercise interventions are safe and feasible in advanced cancer patients and in those with metastatic bone disease [ 27 , 28 , 29 , 30 ]. Furthermore, recent reviews and meta-analyses also showed that exercise interventions achieve potential benefits on quality of life, fatigue, cancer-related symptoms, and functional status outcomes [ 31 , 32 ].…”

Tailoring the Evidence for Exercise Oncology within Breast Cancer Care

“…Patients may present with debilitating pain, pathologic fractures, and spinal cord compression as a consequence of boney metastasis [ 30 ]. Due to concerns regarding pathologic fractures, in the past, limited rehabilitation and exercise interventions were implemented for this population [ 31 ]. Newer evidence shows that exercise is safe, feasible, and beneficial for people living with bone metastasis, and although much more research is needed, early work in mixed metastatic cancer groups shows that exercise is important in preventing deconditioning and improving QOL [ 32 ].…”

Exercise for people with bone metastases: MASCC endorsed clinical recommendations developed by the International Bone Metastases Exercise Working Group

“…However, people with bone metastases have unique safety parameters that require consideration to ensure the health benefits of exercise medicine can be realised without the development of skeletal complications, including lesion-, cancer-, treatment-, and patient-related factors. Recognising this challenge, and a lack of resources available to healthcare providers and exercise professionals, the IBMEWG -consisting of 23 experts from across the world (i.e., Australia, Canada, Europe, UK, and USA) and clinical disciplines (i.e., exercise physiologists, physiotherapists, kinesiologists, physiatrists, medical oncologists, and radiation oncologists)was established [1].…”

“…In 2022, the International Bone Metastases Exercise Working Group (IBMEWG) released the world's first clinical exercise recommendations as a guiding framework to support healthcare providers and exercise professionals in delivering safe exercise medicine to people with bone metastases [1]. As an international and interdisciplinary organisation dedicated to quality supportive care for all people affected by cancer, the Multinational Association for Supportive Care in Cancer (MASCC) endorses the IMBEWG produced clinical exercise recommendations, supported by MASCC Exercise Oncology and MASCC Survivorship Study Groups.…”