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Supervised Exercise Safe for People With Bone Metastases

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People diagnosed with metastatic cancer that has spread to the bones can safely participate in supervised exercise programs, according to a review of 17 studies.

The research was published online on Aug. 3, 2021, by the journal Critical Reviews in Oncology/Hematology. Read “Exercise for individuals with bone metastases: A systematic review.”

Metastatic cancer is cancer that has spread away from the original site to other parts of the body. So metastatic breast cancer is cancer that has spread to parts of the body away from the breast, such as the bones, liver, or brain.

Exercise and breast cancer
About the study
What this means for you

Exercise and breast cancer

Regular exercise is an important part of being as healthy as you can be. More and more research shows that exercise can reduce the risk of breast cancer coming back (recurrence) if you’ve been diagnosed, as well as the risk of developing breast cancer if you’ve never been diagnosed.

For people living with cancer, regular exercise also has been shown to:

  • improve physical function
  • reduce anxiety
  • ease depression
  • lessen fatigue
  • improve quality of life

There are three basic types of exercise:

  • Aerobic exercise uses the large muscles in your body in rhythmic, repetitive motions; examples are walking, running, bike riding, and dancing.
  • Flexibility exercise stretches your muscles to keep them elastic and to keep your joints moving freely; examples are yoga, Tai Chi, foam rolling, and stretching.
  • Resistance exercise uses weight or resistance to make your muscles work harder; examples are weight lifting, resistance band exercises, pull-ups, and push-ups.

A number of organizations, including the American Cancer Society (ACS) and the American College of Sports Medicine (ACSM), have published exercise recommendations for people living with and beyond cancer. Still, most people who have been diagnosed with cancer don’t exercise regularly.

In many cases, people with cancer — especially advanced-stage cancer — don’t exercise because they, along with their doctors, are concerned that exercise may not be safe for them. This is especially true for people with cancer that has spread to the bones. Because bone metastases can weaken the bones, some doctors worry that exercise may cause a broken bone, spinal cord compression, or other bone-related problems.

The researchers who did this study wanted to see if exercise was safe, possible, and effective for people with cancer that had spread to the bones.

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About the study

This study was a meta-analysis. A meta-analysis combines and analyzes the results of many earlier studies. In this case, the researchers reviewed 17 studies involving 1,489 people looking at how aerobic exercise, resistance exercise, or soccer affected people diagnosed with cancer. Four of the studies included only people with bone metastases. Overall, 645 people (43%) in the studies had bone metastases.

It’s unclear how many people in the studies had metastatic breast cancer that had spread to the bones.

All the studies were controlled, which means there was a control group for comparison. For these studies, one group of people with cancer did the prescribed exercise and the other group didn’t. Sixteen of the 17 studies were randomized, which means the people in the studies were randomly assigned to either the exercise or the non-exercise group.

The studies looked at different combinations of exercise:

  • 8 studies prescribed resistance exercise only
  • 6 studies prescribed resistance and aerobic exercise
  • 2 studies prescribed only aerobic exercise
  • 2 studies prescribed soccer

The number of studies adds up to 18 because one study looked at aerobic exercise versus resistance exercise.

All but one of the studies included at least one session of supervised exercise. In most cases, the supervisor was a qualified exercise professional, such as a physical therapist, physiotherapist, clinical exercise physiologist, or another university-trained exercise professional.

While all but one of the studies reported serious side effects, only four serious side effects were because of exercise. All these serious side effects, which included a broken leg and an Achilles tendon rupture, were because of soccer injuries and not related to anyone having bone metastases.

In the four studies looking only at people with bone metastases, there were no serious side effects.

The researchers noted that about half the trials excluded people with specific bone metastasis issues, including unstable bone metastases and painful bone metastases.

All the studies measured results in different ways:

  • 7 studies found exercise improved physical function
  • 3 studies found exercise eased fatigue
  • 4 studies found exercise improved quality of life
  • 6 studies found exercise improved body composition
  • 6 studies found exercise improved muscle strength
  • 2 trials found exercise lessened pain

In the four studies looking only at people with bone metastases:

  • 3 studies found exercise improved physical function
  • 2 studies found exercise improved muscle strength
  • 1 study found exercise lessened pain
  • 3 studies found exercise had no effect on pain

“Exercise appears safe and feasible for individuals with bone metastases when it includes an element of supervised exercise instruction,” the researchers concluded. “Soccer participation was associated with a small number of [serious side effects] related to exercise, however, none of these were related to the presence of bone metastases. Mixed efficacy results were found, with no negative effects of exercise reported.”

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What this means for you

If you’re receiving treatment for metastatic breast cancer that has spread to the bones, this study offers some reassuring news: Supervised exercise is safe, possible, and likely to be beneficial for you.

Still, almost all treatments for metastatic breast cancer have side effects, including fatigue, nausea, and pain. These side effects can make exercise the last thing you feel like doing.

But as this study shows, exercise may ease some of these side effects, making you feel better overall and boosting your outlook. So it may be worth your while to make exercise a priority.

Because cancer treatments can change how you move and function, it makes sense to talk to your doctor before you start a new exercise program and ask if there are certain things you shouldn’t do.

It also makes sense to start slowly, especially if you’ve never exercised before. You might start by walking for 15 to 20 minutes a day and gradually increasing the time you walk. Slow bike riding or gentle stretching is also a good way to start.

Read more about Exercise for tips on how to find the right exercise for you, exercise safely, and stick to an exercise routine.

To talk with others about the benefits of exercise, share exercise tips, and get encouragement, join the Discussion Board forum Working on Your Fitness.

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Written by: Jamie DePolo, senior editor

Reviewed by: Brian Wojciechowski, M.D., medical adviser

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