Last week, we talked all about how to dose exercise safely for patients with non-metastatic cancer. In this episode, we’re grabbing the bull by the horns & tackling metastatic cancer head-on. What can we even do exercise-wise when a patient has metastases?
Reminder: metastases are the cancer spreading to other places, often distant from the original cancer site. It’s not just a group of errant cells wandering around; metastatic cancer cells damage the surrounding area, which may be bone, soft tissue, & or something else. Hence, why we must adjust exercise accordingly.
So here’s a few things to consider when dosing exercise for a patient with metastases:
Where are the metastases?
You need to know exactly where the metastases are. No exceptions. We have to consider that these metastases are significantly affecting the function of the affected tissue – is that bone, lung, brain, other organ, etc.?
Jumping on mini-trampoline with lower extremity/hip metastasis is very different than jumping with an upper extremity metastasis.
What is the status of the metastases?
Metastases should always be evaluated by the medical team prior to beginning or continuing an exercise program. It’s crucial that the extent of the metastasis is evaluated. Is it stable? Is it unstable? What is the next/current step of medically managing the metastasis?
Special considerations for bony metastases:
Maltser, 2017 says:
- No manual muscle testing (MMT) in the affected limb
- No progressive resistive exercises in affected limb
- offloading affected limb with assistive device
- Avoid excessive spinal flexion, extensions, & rotation, plus clarify the need for bracing
- Monitor for increasing functional pain
While exercise can have a beneficial effect on improving bone density, metastases play a different game – the same rules DO NOT apply when it comes to bony metastases. However, exercise is still beneficial for these patients when prescribed appropriately.
Same other questions should be applied from Ep. 131:
What is the goal of the exercise?
Where is the person in their cancer journey?
What does your pre-treatment assessment tell you?
What other comorbidities/impairments does the person have?
How is the person responding to the exercise so far?