Metastatic disease is a frequent complication of advanced cancer, with bone representing one of the most common sites of metastatic occurrence. Patients with bone metastases receive long-term systemic treatments that have a significant attritional impact on muscle strength, fatigue, and physical functioning. Physical rehabilitation involving exercise and physical activity prescription has a considerable role in counteracting these changes; however, exercise is often perceived as a contraindication in the presence of bone metastases due to concerns about aggravating skeletal related events. This article examines the physical sequelae of bone metastases and outlines the factors for consideration with exercise prescription in metastatic bone disease, including bone health, pain levels, and oncologic treatment. This article includes a comprehensive review of the evidence from trials of exercise prescription in this population, including the efficacy and safety outcomes of exercise interventions. Exercise interventions for patients with bone metastases are associated with positive physical and self-reported outcomes. Studies reviewed reporting adverse events did not find a high fracture incidence with exercise in comparison with control participants, or an association between exercise and fracture risk. The need to individualize exercise prescription and adapt exercises to patient ability were reinforced in all papers reviewed. Exercise prescription to patients with bone metastases does involve complex decision making; however, a number of tools are available that may inform both the assessment of patients and the prescription of exercise.
Level of evidence: NA.
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