I recently asked Mary-Ann Dalzell about exercise choice and bone metastasis.
Exercise Choice When You Have Bone Metastasis
I asked Mary-Ann whether or not there is a difference in the choice of exercise you would do if you have been diagnosed with advanced cancer with metastasis to the bone versus having osteoporosis.
If you are located in the United States and want to locate a Physical Therapist who specializes in cancer/oncology, please visit the online directory at the APTA. If you are in Canada, please use Google to track down a therapist in your area.
Exercise Choice and Bone Metastasis — Video Transcript
My name is Mary-Ann Dalzell. I am a physiotherapist, past clinical director of the Rehabilitation and Exercise Oncology Program, Hope and Cope Segal Cancer Center in Montreal.
The next question that I’d like to address is whether or not there’s a difference in the type of exercise that you would do if you’ve been diagnosed with an advanced cancer with metastasis to the bone versus having treatment induced osteoporosis. And the answer to that is yes, there is a difference in the type of exercises that are recommended for you if you have one versus the other.
There is a difference in the type of bone deterioration when you have osteoporosis, even cancer treatment induced osteoporosis, versus if you have a metastasis of the bone. The biggest difference is which part of the bone is affected by one versus the other. When you have osteoporosis, whether it is chemotherapy-induced or cortisone-induced or as a result of disuse, it’s the core of the bone that is most affected, that you have got less calcium, less minerals supporting generally that tubercular structure we call it of the bone.
Whereas when you have a bone metastasis, it is all parts of the bone that are affected, it is the outside core as well as the internal part, the marrow component) of your bone that is affected and the biggest difference is the degree of softening of this bone, the degree of deterioration of the bone.
When you have metastasis, the bone is eaten away by something like a peck men and creating holes in the bone and that would rarely occur even if you have treatment induced severe osteoporosis. So that the degree of damage to the bone is different if you have advanced disease, bone metastasis, versus whether you have osteoporosis, even of a severe degree.
So therefore the types of exercises that you would choose have to take that into consideration. And the other big difference actually that I forgot to mention is that when you have osteoporosis, it tends to be generalized. It’s not all that specific. It’s all the bones in your body. There may be a greater concentration in your spine and in your hips as a general consensus. But by in large, it’s all of the bones in your body that are affected.
Whereas when you have metastasis, it tends to be very specific. So it will affect one bone, it can go to the spine. Only when you are at a very advanced stage of disease, it is possible to be disseminated throughout your skeleton and that’s very rare. So when we come back to the question of can I do the same type of exercise when I have one versus the other, the answer if you have to be much more careful with the degree of impact that you have on your bone when you have bone metastasis. The bone is much weaker.
So when we talk about elements of any exercise, any exercise prescription takes into consideration, first thing is positioning. How do I position myself in order to do an exercise? If you have osteoporosis, even of a severe degree, you have to position yourself in a stable manner. But when you actually have bone metastasis, you have to protect that part that is affected. So it’s more than just stability, you actually need an outside support in order for you to be able to manage an exercise without causing any injury and further deterioration or fracture of the bone. So positioning is very, very important in one versus the other.
Another great element of any exercise prescription is going to be how much weight are you lifting or how much weight are you putting through the part. There again, because of the differences between osteoporosis and bone metastasis, you do have to grade that degree of stress going through your bones. When you have osteoporosis, it is recommended that you put high levels of stress and strain through bone. Whereas when you have bone metastasis you have to put much lower levels of stress and strain on the part that is affected by the metastasis. So there is a difference here. Your bone will not become healthier if you have metastasis and you put greater weight through it.
Another big factor is leverage. So that when I do an exercise, there is always the consideration of whether or not I can lift a weight at distance or if I can do exercises that involve leverage of something, pulling a weight using a pulley system, lifting a weight using an elastic that is at distance. And when you have osteoporosis, that’s can be managed very well. The leverage is good for the bone again. Using more strain through your muscles is always good for the health of the bone. Whereas when you have bone metastasis, your concern is that additional leverage could actually cause a fracture at the point of weakening of the bone because the bone is at greater risk. It is generally the cortex of the bone is much weaker.
So leverage is another big consideration, duration, frequency, all of these elements. How many times I do repetitions? Without question, if you have osteoporosis, you can go within the normal realm of how I would do exercises. Do so many repetitions and do so many sets of exercise very much like the exercises and the graded course of exercises that have been recommended by the MelioGuide that have been developed by Margaret Martin. And I think these guides are extremely important for you to follow.
Whereas when you have bone metastasis, the difference here, duration, frequency, how often can I do something has to be monitored carefully so that you don’t put an excessive strain and stress through those bones that are affected. Again, there’s always the consideration of the type of bone metastasis that you have. There are different types, some are proliferative. They make the bone larger than it would normally be, but it’s not necessarily stronger. And then there is another type that actually eats holes into the bone and those are very weak, so you have to be very cautious with the type of exercise that you do in that case.
So in summary, there is a difference. Early bone metastasis likely you could follow the guides that have been used and set in to place for osteoporosis very easily as long as you’re cautious about where and know where your metastasis is. But anyone who may have more advanced disease and greater bone deterioration needs professional guidance and needs to do exercise that potentially will have less impact, less stress and strain, and perhaps be working more on cardiovascular endurance or other elements of exercise that preserve your well-being and functionality.
For more information, check out my Osteoporosis Guidelines.