Exercise therapy indications in metastatic bone patients

INTRODUCTION: In recent years, the exercise prescription has given unequivocal benefits in cancer patients. The purpose of this review is to analyze indications of exercise therapy in the patient with bone metastases, analyzing the benefits, limits and appropriate indications of physical activity according to the individual clinical situation of the patient. EVIDENCEACQUISITION: The present systematic review was conducted using a thorough database search of PubMed, EMBASE and SCOPUS. Authors independently screened all articles identified concerning exercise therapy in metastatic bone patients, to assess their suitability to the research focus. EVIDENCESYNTHESIS: Authors included 12 articles as full-text in 19 papers, dated from 2000 to 2018. Among these, 8 were randomized controlled trials, 3 single-arm studies and 1 multi-arm interventional study. Aerobic and/or resistance exercise training was prescribed in all the studies analyzed. The mean follow-up was 10.7±11.2 (range 1-36) months. Significant benefits were reported in fatigue, pain and physical function with no increasing incidence of pathologic fractures. CONCLUSIONS: Exercise therapy in patients with bone metastases is useful in tackling bone loss, showing anticancer effects and increasing patient's quality of life with very low adverse effects rate (2,2%). The prescription of exercises in this kind of patients can be complex for the possible increasing risk of pathological fractures and pain levels. It is therefore strictly necessary to personalize the exercises according to patient's abilities, skeletal site and type of metastatic lesion.