Skip to main content
Log in

Physical activity and exercise in cancer patients with bone metastases

  • short review
  • Published:
memo - Magazine of European Medical Oncology Aims and scope Submit manuscript

Summary

Physical activity and exercise can have numerous positive effects on various disease- and therapy-related symptoms across the continuum of cancer disease. These include an improvement in quality of life, physical function, aerobic fitness, muscle strength and muscle mass, bone density and a reduction of insomnia, psychological distress, pain and fatigue. Although no higher fracture incidence could be found in several studies, exercise is still often considered contraindicated in patients with bone metastases due to concerns about skeletal-related events such as pathologic fractures, spinal cord compression, aggravating pain, increased mortality and higher health care costs. This short, narrative review reports general considerations about physical activity in patients with cancer. In particular, it focuses on principles, precautions and contraindications regarding exercise recommendations for patients with metastatic bone disease in order to implement safe and efficient exercise interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Courneya KS. Exercise interventions during cancer treatment: biopsychosocial outcomes. Exerc Sport Sci Rev. 2001;29(2):60–4.

    CAS  PubMed  Google Scholar 

  2. Courneya KS, Friedenreich CM. Physical activity and cancer control. Semin Oncol Nurs. 2007;23:242–52.

    Article  Google Scholar 

  3. Lemanne D, Cassileth B, Gubili J. The role of physical activity in cancer prevention, treatment, recovery, and survivorship. Oncology (Williston Park). 2013;27(6):580–5. PMID: 23909073.

    Google Scholar 

  4. Ibrahim EM, Al-Homaidh A. Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies. Med Oncol. 2011;28:753–65.

    Article  Google Scholar 

  5. Barbaric M, Brooks E, Moore L, Cheifetz O. Effects of physical activity on cancer survival: a systematic review. Physiother Can. 2010;62:25–34.

    Article  Google Scholar 

  6. Buffart LM, et al. Effects and moderators of exercise on quality of life and physical function in patients with cancer: an individual patient data meta-analysis of 34 RCTs. Cancer Treat Rev. 2017;52:91–104.

    Article  Google Scholar 

  7. Mustian KM, Alfano CM, Heckler C, et al. Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis. JAMA Oncol. 2017;3(7):961–8. https://doi.org/10.1001/jamaoncol.2016.6914.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Lee CE, Warden SJ, Szuck B, Lau YK. A preliminary study on the efficacy of a community-based physical activity intervention on physical function-related risk factors for falls among breast cancer survivors. Am J Phys Med Rehabil. 2016;95:561–70.

    Article  Google Scholar 

  9. Buffart LM, Kalter J, Sweegers MG, et al. Effects and moderators of exercise on quality of life and physical function in patients with cancer: an individual patient data meta-analysis of 34 RCTs. Cancer Treat Rev. 2017;52:91–104.

    Article  Google Scholar 

  10. Galvão DA, Newton RU, Gardiner RA, Girgis A, Lepore SJ, Stiller A, et al. Compliance to exercise-oncology guidelines in prostate cancer survivors and associations with psychological distress, unmet supportive care needs, and quality of life. Psychooncology. 2015;24(10):1241–9. https://doi.org/10.1002/pon.3882.

    Article  PubMed  Google Scholar 

  11. Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012;62(4):243–74. https://doi.org/10.3322/caac.21142.

    Article  PubMed  Google Scholar 

  12. Saad F. Bone-targeted therapy in prostate cancer. EJC Suppl. 2013;11(2):257–9. https://doi.org/10.1016/j.ejcsup.2013.07.038.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Courneya KS, McKenzie DC, Mackey JR, et al. Effects of exercise dose and type during breast cancer chemotherapy: multicenter randomized trial. J Natl Cancer Inst. 2013;105:1821–32.

    Article  Google Scholar 

  14. Kampshoff CS, Chinapaw MJ, Brug J, et al. Randomized controlled trial of the effects of high intensity and low-to-moderate intensity exercise on physical fitness and fatigue in cancer survivors: results of the resistance and endurance exercise after chemotherapy [REACT] study. BMC Med. 2015;13:275.

    Article  Google Scholar 

  15. Sweegers MG, Altenburg MT, Chinapaw MJ, et al. Which exercise prescriptions improve quality of life and physical function in patients with cancer during and following treatment? A systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2018;52(8):505–13.

    Article  Google Scholar 

  16. Spence RR, Heesch KC, Brown WJ. Exercise and cancer rehabilitation: a systematic review. Cancer Treat Rev. 2010;36(2):185–94.

    Article  Google Scholar 

  17. Witlox L, Velthuis MJ, Boer JH, et al. Attendance and compliance with an exercise program during localized breast cancer treatment in a randomized controlled trial: the PACT study. PLoS ONE. 2019;14(5):e215517.

    Article  Google Scholar 

  18. Holdt HK, Desomer A, Hanssens S, Vlayen J. Supportive treatment for cancer. Part 1: exercise treatment. Brussels: Belgian Health Care Knowledge Centre; 2012.

    Google Scholar 

  19. Schmitz KC, Courneya KS, Matthews C, et al. American college of sports medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010;42:1409–26.

    Article  Google Scholar 

  20. Hsiang-Hsuan MY, Ya-Yu T, Hoffe SE. Overview of the diagnosis and management of metastatic disease to bone. Cancer Control. 2012;19(2):84–91.

    Article  Google Scholar 

  21. Errani C, Mavrogenis AF, Cevolani L, et al. Treatment for long bone metastases based on a systematic literature review. Eur J Orthop Surg Traumatol. 2017;27:205–11.

    Article  Google Scholar 

  22. Cecchini MG, Wetterwald A, van der Pluijm G, Thalmann GN. Molecular and biological mechanisms of bone metastasis. EAU Update Series. 2005;3(4):214–26. https://doi.org/10.1016/j.euus.2005.09.006.

    Article  Google Scholar 

  23. Lipton A, Uzzo R, Amato RJ, et al. The science and practice of bone health in oncology: Managing bone loss and metastasis in patients with solid tumors. J Natl Compr Cancer Netw 2009;7(Suppl 7):S1–S29.

    Article  Google Scholar 

  24. Coleman R, Body JJ, Aapro M, et al. Bone health in cancer patients: ESMO clinical practice guidelines. Ann Oncol. 2014;25(3):iii124–iii37.

    Article  Google Scholar 

  25. Gralow JR, Biermann JS, Farooki A, Fornier MN, Gagel RF, Kumar R, et al. NCCN task force report: bone health in cancer care. J Natl Compr Canc Netw. 2013;11(3):S1–50. https://doi.org/10.6004/jnccn.2013.0215. quiz S51.

    Article  PubMed  Google Scholar 

  26. Ashford RU, Randall RL. Bone metastases: epidemiology and societal effect. Metastatic bone disease. New York: Springer; 2016.

    Google Scholar 

  27. Clohisy D, Mantyh P. Bone cancer pain. Cancer. 2003;97:866.

    Article  Google Scholar 

  28. Selvaggi G, Scagliotti GV. Management of bone metastases in cancer: a review. Crit Rev Oncol Hematol. 2005;56(3):365–78. https://doi.org/10.1016/j.critrevonc.2005.03.011.

    Article  PubMed  Google Scholar 

  29. Tharmalingam S, Chow E, Harris K, et al. Quality of life measurement in bone metastases: a literature review. J Pain Res. 2008;1:49–58.

    PubMed  PubMed Central  Google Scholar 

  30. Heindel W, Gübitz R, Vieth V, et al. The diagnostic imaging of bone metastases. Dtsch Arztebl Int. 2014;111:741–7.

    PubMed  PubMed Central  Google Scholar 

  31. Macedo F, Ladeira K, Pinho F, et al. Bone metastases: an overview. Oncol Rev. 2017;11(1):321.

    PubMed  PubMed Central  Google Scholar 

  32. Sutcliffe P, Connock M, Shyangdan D, Court R, Kandala NB, Clarke A. A systematic review of evidence on malignant spinal metastases: natural history and technologies for identifying patients at high risk of vertebral fracture and spinal cord compression. Health Technol Assess. 2013;17(42):1–274. https://doi.org/10.3310/hta17420.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Jawad MU, Scully SP. Classifications in brief: Mirels’ classification: metastatic disease in long bones and impending pathologic fracture. Clin Orthop Relat Res. 2010;468:2825–7.

    Article  Google Scholar 

  34. Fourney DR, Frangou EM, Ryken TC, et al. Spinal instability neoplastic score: analysis of reliability and validity from the spine oncology study group. J Clin Oncol. 2011;29(22):3072–7.

    Article  Google Scholar 

  35. Bunting R, Lamont-Havers W, Schweon D, Kliman A. Pathologic fracture risk in rehabilitation of patients with bony metastases. Clin Orthop Relat Res. 1985;192:222–7.

    Google Scholar 

  36. Cormie P, Newton RU, Spry N, Joseph D, Taaffe DR, Galvão DA. Safety and efficacy of resistance exercise in prostate cancer patients with bone metastases. Prostate Cancer Prostatic Dis. 2015;18:196.

    Article  CAS  Google Scholar 

  37. Sheill G, Guinan EM, Peat N, Hussey J. Considerations for exercise prescription in patients with bone metastases: a comprehensive narrative review. PM R. 2018;10(8):843–64.

    Article  Google Scholar 

  38. Litterini AJ, Fieler VK, Cavanaugh JT, Lee JQ. Differential effects of cardiovascular and resistance exercise on functional mobility in individuals with advanced cancer: a randomized trial. Arch Phys Med Rehabil. 2013;94:2329–35.

    Article  Google Scholar 

  39. Cormie P, Atkinson M, Bucci L, et al. Clinical oncology society of Australia position statement on exercise in cancer care. 2018. https://www.cancer.be/sites/default/files/cosa.pdf. Accessed 10 Sept 2020

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Winfried Habelsberger MSc.

Ethics declarations

Conflict of interest

W. Habelsberger declares that he has no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Habelsberger, W. Physical activity and exercise in cancer patients with bone metastases. memo 14, 29–33 (2021). https://doi.org/10.1007/s12254-020-00664-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12254-020-00664-3

Keywords

Navigation