April 11, 2025
Survival to Strength Bone Mets, Lytic Lesions & Strength Training
BY: Clare Poulose, RN, MSN, ACSM-Cancer Exercise Specialist, PAL (Physical Activity & Lymphedema)
Survival to Strength : BONE METASTASES, LYTIC LESIONS AND STRENGTH TRAINING
Primary cancers such as breast or prostate cancer can metastasize (spread) to the bone. This is called "metastatic cancer to the bone," or "bone mets."
Primary cancers such as multiple myeloma and osteosarcoma might start in the bone marrow or bone.
In either case, bone mets might be osteolytic (lytic - less dense) or osteroblastic (sclerotic - more dense) or both.
And in either case, there is an increased risk for fractures. Even after the cancer is gone, a person might have weak spots in his or her bones at those sites.
So how do I get stronger if I have bone mets? Or lytic lesions?
Resistance (strength) training can help strengthen your muscles, ligaments and tendons to support your bones, while also strengthening your bones. In addition, it can improve the immune system, independence, mood, sleep, and decrease pain and fatigue.
Safety Steps before you start strength training.
- Get a Team Approach Assessment. You are part of your team! Your team includes medical doctors/providers, nurses, physical therapists, physiotherapists, and oncology personal trainers.
Your team will look at:
- Are there health reasons that prevent strength training at this time?
- General health factors such as diabetes and fall risk.
- Symptoms/side effects of cancer or treatment such as high calcium level.
- Characteristics of your bone mets (location, pain, stability, swelling).
2. Get an Individual Exercise Plan from Your Team : including:
- Medical Clearance- Your team's assessment of your health.
- Weightlifting or movement restrictions to avoid overloading a weak spot on a bone.
- Foundation: Strength training requires breathing, posture, balance, and core foundation before completing classic exercises such as squats or bicep curls.
- Your preference and goals.
3. Monitor your response to physical activity. Your therapist or trainer will monitor how you are doing, but your feedback is vital information.
- How do you feel? Let your team know.
Tips for strength training with bone mets or lytic lesions:
- Even if you cannot complete an overall body workout, often you can complete strength work for a part of your body. It doesn't have to be all or nothing!
- Try not to be discouraged if you are using little or no weight. Any movement helps your muscles, ligaments, tendons and bones become stronger.
- Proper form improves overall strength and reduces risk of injury. Your physical therapist, physiotherapist, and oncology personal trainer can give individual instruction for you.
Remember: Resistance (strength) training has many benefits, including stronger ligaments, tendons, and muscles which support your bones. Strength training helps make your bones stronger. Tell your team that you want a plan to get stronger!
References
Campbell, K.L., Cormie, P., Weller, S.,...Goulart, J. (2022) Exercise Recommendations for People with Bone Metastases: Expert Consensus for Health Care Providers and Exercise Professionals. American Society of Clinical Oncology, Journal of Clinical Oncology Practice,18(5) e697 https://ascopubs.org/doi/10.1200/OP.21.00454
Canadian Cancer Society, 2024, 32439-1-NO, Bone Metastases and Exercise Hub
Hillengass, M, Joseph, J., McCarthy, J., Hillengass, J. (2023) Physical Activity in Multiple Myeloma: A Review of the Current Literature. Journal of Advanced Practitioner, Oncology; 14(2):153-158
Miceli, T.S. , Colson, K.C., Faiman, B.M., …Tariman.J.D., (2011) Maintaining Bone Health in Patients with Multiple Myeloma. Clinical Journal of Oncology Nursing, Supplement to Volume 15, (4), 9-23
National Comprehensive Cancer Network Guidelines Version 2.2024, Survivorship: Physical Activity, Considerations for Specific Populations
