Exercise and Bone Health in Cancer: Enemy or Ally?

Abstract

Bone health is often threatened in cancer patients. Bone metastasis and osteoporosis frequently occur in patients with cancer and may lead to different skeletal-related events, which may negatively affect patients’ quality of life and are associated with high mortality risk. Physical exercise has been recognized as a potential adjunctive strategy in the cancer setting to improve physical function as well as treatment-related side effects. Nevertheless, exercise is often not recommended to patients with bone health impairments due to safety concerns. In the current review, we aimed, through a comprehensive review of the evidence, to explore the impact of exercise in terms of safety profile, bone outcomes, and the effects on other outcomes in patients with cancer affected by bone metastasis or at high risk of losing bone. Additionally, we explored the potential mechanisms by which exercise may act on bone, particularly the impact of mechanical load on bone remodeling. Finally, considerations about exercise prescription and programming in these populations are also discussed.

Physical exercise recommendations for patients with chronic myeloid leukemia based on individual preferences identified in a large international patient survey study of the East German Study Group for Hematology and Oncology (OSHO #97)

“…As indicated by surveys of other patient cohorts alternative effective methods for PE counseling and instruction could be faceto-face or technology-based (e.g. internet, email) information exchange with a PE specialist from cancer centers (72)(73)(74)(75).…”

“…Accordingly, these comorbidities can have a negative impact on exercise behavior. Further, there are several other barriers to PE, including older age, distance from structures, lack of motivation, lack of time, lack of information, as well as physical, personal and emotional problems (73,82). Therefore, the involvement of a psychologist to implement and maintain changes in exercise behavior could be beneficial.…”

Effects on the Physical Functioning of Two Exercise Interventions in Patients with Multiple Myeloma: A Pilot Feasibility Study

“…Therefore, in addition to the quantity of life, quality of life has become an increasingly important aim of MM patients, providers, and researchers. Physical therapy (PT) and physical activity, in general, can contribute to the overall well-being of patients, especially if their skeletal systems are affected by cancer [8,9]. However, out of fear of further bone damage, MM patients are oftentimes advised not to participate in any such activities, even though many of them report a strong desire to do so [10].…”

A Feasibility Study Investigating an Exercise Program in Metastatic Cancer Based on the Patient-Preferred Delivery Mode

“… 13 Preliminary evidence deriving from these researches reported mixed findings regarding benefits in physical fitness and quality of life, which are the most studied outcomes. 6-14 In addition, another concern regards the feasibility of the intervention; although the safety profile of exercise in patients with metastasis has been reported, 15 , 16 compliance and adherence to the program are still challenging, and some studies also find a high dropout rate. 10 , 13 , 17 Different features may obstacle exercise participation, including disease specific (eg, symptoms burden and treatment toxicity) and general barriers (eg, lack of time and interest).…”