Skip to main content

Research Repository

Advanced Search

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

Campbell, Kristin L.; Cormie, Prue; Weller, Sarah; Alibhai, Shabbir M. H.; Bolam, Kate A.; Campbell, Anna; Cheville, Andrea L.; Dalzell, Mary-Ann; Hart, Nicolas H.; Higano, Celestia S.; Lane, Kirstin; Mansfield, Sami; McNeely, Margaret L.; Newton, Robert U.; Quist, Morten; Rauw, Jennifer; Rosenberger, Friederike; Santa Mina, Daniel; Schmitz, Kathryn H.; Winters-Stone, Kerri M.; Wiskemann, Joachim; Goulart, Jennifer


Kristin L. Campbell

Prue Cormie

Sarah Weller

Shabbir M. H. Alibhai

Kate A. Bolam

Andrea L. Cheville

Mary-Ann Dalzell

Nicolas H. Hart

Celestia S. Higano

Kirstin Lane

Sami Mansfield

Margaret L. McNeely

Robert U. Newton

Morten Quist

Jennifer Rauw

Friederike Rosenberger

Daniel Santa Mina

Kathryn H. Schmitz

Kerri M. Winters-Stone

Joachim Wiskemann

Jennifer Goulart


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.

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.

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.

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.

Journal Article Type Article
Acceptance Date Nov 18, 2021
Online Publication Date Jan 6, 2022
Publication Date 2022-05
Deposit Date Jan 31, 2022
Publicly Available Date Jan 31, 2022
Journal JCO Oncology Practice
Print ISSN 1554-7477
Electronic ISSN 1935-469X
Publisher American Society of Clinical Oncology
Peer Reviewed Peer Reviewed
Volume 18
Issue 5
Pages 361-E709
Public URL


You might also like

Downloadable Citations