A/Prof Prue Cormie
Bone metastases should not automatically exclude patients with cancer from exercise assessment and prescription and the potential benefits on physical functioning and health-related quality of life.
The International Bone Metastases Exercise Working Group (IBMEWG) has worked through a rigorous process including a modified Delphi survey, systematic review, professional and patient engagement to develop its best practice recommendations published in JCO Oncology Practice.
The Working Group found most survey respondents (82%) agreed that exercise for people with bone metastases was safe, however the IBMEWG recommended a risk assessment before exercise testing or training to inform the likelihood of exercise-related skeletal complications.
“To provide additional expert guidance, the recommendation is to focus on the goal of exercise testing and to follow the testing guidance in the International Exercise Guidelines for Cancer Survivors until further evidence is available to update this approach,” it said.
Two-way communication between medical and exercise professionals was strongly recommended to obtain key medical information such as bone scan results, assess the risk-benefit of exercise in individual patients and to guide exercise prescription.
The multidisciplinary Working Group said previously published approaches to exercise prescription were conservative, while evidence regarding safety continued to emerge.
It recommended greater emphasis on postural alignment, controlled movement, and proper technique.
“The Delphi shows a 91% consensus that education and advice on safe movement patterns for activities of daily living is important for all people with bone metastases,” it said.
“Specific to prescribing an exercise that could directly place stress on the lesion site, most respondents agreed that the correct approach was to use caution.”
This approach included starting with no or low loads on the affected bone region and progressing slowly “provided there is no exacerbation of pain or adverse symptoms”.
It said the recommendations were a starting point only and further research was required to determine standardised approaches to screening and risk stratification, exercise testing and prescription, the impact of new imaging modalities on detection of bone metastases, and the impact of cancer therapy and bone-modifying agents in bone remodelling.
The IBMEWG included Professor Robert Newton (deputy director of the Exercise Medicine Research Unit at Edith Cowan University), Associate Professor Prue Cormie (Peter MacCallum Cancer Centre), and Dr Nicholas Hart (Edith Cowan University).