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

Kristin L Campbell¹, Prue Cormie^{2

3}, Sarah Weller^{1

4}, Shabbir M H Alibhai⁵, Kate A Bolam⁶, Anna Campbell⁷, Andrea L Cheville⁸, Mary-Ann Dalzell⁹, Nicolas H Hart^{10

11}, Celestia S Higano¹², Kirstin Lane¹³, Sami Mansfield¹⁴, Margaret L McNeely¹⁵, Robert U Newton¹⁰, Morten Quist¹⁶, Jennifer Rauw⁴, Friederike Rosenberger¹⁷, Daniel Santa Mina¹⁸, Kathryn H Schmitz¹⁹, Kerri M Winters-Stone²⁰, Joachim Wiskemann¹⁷, Jennifer Goulart²¹

Affiliations

¹ Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
² Australian Catholic University, Melbourne, Australia.
³ Peter MacCallum Cancer Centre, East Melbourne, Australia.
⁴ BC Cancer, Vancouver, British Columbia, Canada.
⁵ Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada.
⁶ Karolinska Institute, Stockholm, Sweden.
⁷ Edinburgh Napier University, Edinburgh, Scotland.
⁸ Mayo Clinic, Rochester, NY.
⁹ Oncology Division of the Canadian Physiotherapy Association, Montreal, Quebec, Canada.
¹⁰ Edith Cowan University, Joondalup, Australia.
¹¹ Queensland University of Technology, Brisbane, Australia.
¹² Vancouver Prostate Centre, Vancouver, British Columbia, Canada.
¹³ University of Victoria, Victoria, British Columbia, Canada.
¹⁴ University of Kansas Cancer Center, Kansas City, MO.
¹⁵ University of Alberta, Edmonton, Alberta, Canada.
¹⁶ University of Copenhagen, Copenhagen, Denmark.
¹⁷ National Center for Tumor Diseases, Heidelberg, Germany.
¹⁸ University of Toronto, Toronto, Ontario, Canada.
¹⁹ Penn State University, Hershey, PA.
²⁰ Oregon Health and Sciences University, Portland, OR.
²¹ BC Cancer, Victoria, British Columbia, Canada.

PMID: 34990293
PMCID: PMC9810134
DOI: 10.1200/OP.21.00454

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

Kristin L Campbell et al. JCO Oncol Pract. 2022 May.

. 2022 May;18(5):e697-e709.

doi: 10.1200/OP.21.00454. Epub 2022 Jan 6.

Authors

Affiliations

¹ Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
² Australian Catholic University, Melbourne, Australia.
³ Peter MacCallum Cancer Centre, East Melbourne, Australia.
⁴ BC Cancer, Vancouver, British Columbia, Canada.
⁵ Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada.
⁶ Karolinska Institute, Stockholm, Sweden.
⁷ Edinburgh Napier University, Edinburgh, Scotland.
⁸ Mayo Clinic, Rochester, NY.
⁹ Oncology Division of the Canadian Physiotherapy Association, Montreal, Quebec, Canada.
¹⁰ Edith Cowan University, Joondalup, Australia.
¹¹ Queensland University of Technology, Brisbane, Australia.
¹² Vancouver Prostate Centre, Vancouver, British Columbia, Canada.
¹³ University of Victoria, Victoria, British Columbia, Canada.
¹⁴ University of Kansas Cancer Center, Kansas City, MO.
¹⁵ University of Alberta, Edmonton, Alberta, Canada.
¹⁶ University of Copenhagen, Copenhagen, Denmark.
¹⁷ National Center for Tumor Diseases, Heidelberg, Germany.
¹⁸ University of Toronto, Toronto, Ontario, Canada.
¹⁹ Penn State University, Hershey, PA.
²⁰ Oregon Health and Sciences University, Portland, OR.
²¹ BC Cancer, Victoria, British Columbia, Canada.

PMID: 34990293
PMCID: PMC9810134
DOI: 10.1200/OP.21.00454

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.

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Conflict of interest statement

Kristin L. CampbellHonoraria: Astellas Pharma Prue CormieStock and Other Ownership Interests: Exercise Oncology EDU Pty LtdOther Relationship: EX-MED Cancer Ltd Sarah WellerResearch Funding: Astellas Pharma Shabbir M. H. AlibhaiStock and Other Ownership Interests: ResMedHonoraria: Astellas Scientific and Medical Affairs Inc Kate A. BolamStock and Other Ownership Interests: Novo Nordisk Celestia S. HiganoEmployment: CTI BioPharma Corp (I)Stock and Other Ownership Interests: CTI BioPharma Corp (I)Honoraria: Astellas PharmaConsulting or Advisory Role: Bayer, Ferring, Clovis Oncology, Blue Earth Diagnostics, Janssen, Hinova Pharmaceuticals, Pfizer, AstraZeneca, Carrick Therapeutics, Novartis, Merck Sharp & Dohme, Astellas Pharma, Myovant Sciences, Genentech, MenariniResearch Funding: Aragon Pharmaceuticals (Inst), AstraZeneca (Inst), Medivation (Inst), Emergent BioSolutions (Inst), Bayer (Inst), Pfizer (Inst), Roche (Inst), Astellas Pharma (Inst), Clovis Oncology (Inst), Ferring (Inst), eFFECTOR Therapeutics (Inst)Travel, Accommodations, Expenses: Pfizer, Janssen Oncology, Novartis, Merck Sharp & Dohme, Carrick Therapeutics Kirstin LaneStock and Other Ownership Interests: Moderna TherapeuticsTravel, Accommodations, Expenses: Astellas Pharma Robert U. NewtonHonoraria: GenesisCareResearch Funding: IpsenTravel, Accommodations, Expenses: Genesis Cancer Care Morten QuistEmployment: Zealand Pharmaceuticals (I)Honoraria: AstraZeneca Jennifer RauwHonoraria: AstraZenecaSpeakers' Bureau: GlaxoSmithKlineTravel, Accommodations, Expenses: AstraZeneca Friederike RosenbergerStock and Other Ownership Interests: BioNTech, Bristol Myers Squibb, AstraZenecaHonoraria: Bristol Myers Squibb, Hexal Kathryn H. SchmitzPatents, Royalties, Other Intellectual Property: Fees from the educational program I developed that are now offered through Klose Training and Consulting Joachim WiskemannHonoraria: Pfizer, Lilly, Novartis Jennifer GoulartResearch Funding: Astellas Pharma (Inst)No other potential conflicts of interest were reported.

Figures

**FIG 1.**
Information gathering and recommendation development process.

See this image and copyright information in PMC

References

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

Affiliations

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

Authors

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Abstract

Conflict of interest statement

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