Design of a multinational randomized controlled trial to assess the effects of structured and individualized exercise in patients with metastatic breast cancer on fatigue and quality of life: the EFFECT study

Table 2 Adaptations to the prescribed exercise program based on location of bone metastases

Metastases site	Resistance exercise^a			Aerobic exercise		Flexibility
Metastases site	Upper	Trunk	Lower	WB	NWB	Static
Pelvis	√	√	√^c		√	√
Axial skeleton (lumbar)	√		√		√	√^d
Axial Skeleton (thoracic/ribs)	√^b		√	√	√	√^d
Proximal humerus		√^b	√	√	√	√^b
Proximal femur	√	√	√^c		√	√
All regions	√^b		√^c		√	√^d

This table is adapted from Galvão et al. (2011) [14]
^aResistance exercises that load the affected region can be either omitted according this table or can be performed using a “start low, go slow” approach, depending on patient characteristics and the experience of the involved trainer. According to this approach, participants with bone metastases should start with low weights and more repetitions and increase weights gradually over time up to 10-12 repetitions if possible. Higher intensities (i.e., 6–8 repetitions with 80–85% of h1RM) should be avoided. Weights will be reduced if participants report pain during a resistance exercise or experience an increase in pain or pain medication since the last exercise session
√ = Target exercise region
^bexclusion of shoulder flexion/extension/abduction/adduction and inclusion of elbow flexion/extension
^cexclusion of hip extension/flexion and inclusion of knee extension/flexion
^dexclusion of spine/flexion/extension/rotation
WB weight bearing (e.g., walking), NWB non-weight bearing (e.g., cycling)

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