Thread by @KLCampbellPhD

*THREAD* 1/17 People with #bonemets should be supported & encouraged to engage in regular physical activity to manage side effects from cancer & treatments. Recommendations to guide practice in @JCOOP_ASCO ascopubs.org/doi/pdf/10.120…

2/17 Method: International Bone Metastases Exercise Working Group: Multidisciplinary, international panel of physicians, PTs, exercise physiologists & researchers, formed to develop best practice recommendations based on published research, clinical experience & expert opinion.

3/17 Healthcare provider survey found practitioners were uncertain of correct risk management approach. 75% of physicians & NPs agreed patients look to them for guidance, but 86% not comfortable making recommendation #oncology #clinonc #medonc #exonc
link.springer.com/article/10.100…

4/17 Systematic Review of RCT literature specific to exercise for people living with bone metastases led by @_sarahweller, @Katebolam, @DrNicolasHart found exercise is safe, feasible & beneficial. sciencedirect.com/science/articl… #medonc #radonc #exerciseoncology

5/17 Modified Delphi survey done to better understand the views of experts in exercise, rehabilitation & oncology specific to bone metastases & generated consensus statements for screening, testing, exercise prescription & communication. Full results: ascopubs.org/doi/pdf/10.120…

6/17 After summarizing the findings of the healthcare professional survey, systematic review & modified Delphi survey, the working group had a roundtable meeting to discuss and develop 5 key recommendations, stakeholder engagement/development, finalization of key recommendations

7/17 Recommendation 1: Before exercise testing or training, perform a risk assessment to inform likelihood of a skeletal complication from exercise ascopubs.org/doi/pdf/10.120…

8/17 Recommendation 2: Consultation with medical team strongly encouraged before an exercise professional provides structured exercise, to obtain key medical information & establish bidirectional communication for initial assessment & exercise training throughout care. #clinonc

9/17 Recommendation 3: Exercise professionals best suited to prescribe exercise to people with bone metastases are physical therapists & clinical exercise physiologists (or equivalent in your jurisdiction), with additional cancer exercise training & experience in oncology #exonc

10/17 Recommendation 4: Professional judgment should be used to consider if exercise testing at baseline & follow-up is necessary by weighing the risks & benefits of including the test or if the testing protocols may need to be modified.

11/17 Recommendation 5: Exercise prescription should follow standard #ACSM exercise guidelines for Cancer Survivors (2019) with more emphasis on postural alignment, controlled movement & proper technique. journals.lww.com/acsm-msse/Full…

12/17 Exercise prescription should also include formal monitoring of exercise response & adjustment of exercise prescription that is ongoing.

13/17 Regular exercise has the potential to maintain or improve physical function & health-related quality of life in people with #bonemets, and the perceived risk of skeletal complication should be weighed against the potential health benefits. #cancerexercise #medonc #radonc

14/17 These recommendations provide framework & starting point for exercise professionals & members of the health care team to improved integration of physical activity into the care of individuals with #bonemets & will continue to evolve as more literature is available. #exonc

15/17 Limitations incl: lack of definitive data on standardized approaches to safety screening, exercise testing & prescription; safety reporting of complications with exercise; individuals that may be at increased risk of fracture with exercise (ie, elderly & multiple myeloma).

16/17 Thanks: Stakeholders with bone metastases, survey & Delphi participants, peers who provided feedback (Alysa Fairchild, @DMLangelierMD, @sheillg, Martijn Stuiver, Shelley Kay), endorsing partners @PhysioCan, @CSEPdotCA, @IPTHOPE, & funders (Astellas Pharma Canada Inc).

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@KLCampbellPhD
@pruecormie
@_sarahweller
@Katebolam
@CanRehab
@DrNicolasHart
@Tiahigano
@kirstin_lane
@bewellwithsami
@MargieMcNeely
@ProfRobNewton
@QuistMorten
@DR_SantaMina
@fitaftercancer
@winters_stone
@exoncolgermany