Spinal Stabilization Exercises for Cancer Patients with Spinal Metastases of High Fracture Risk: Feasibility of the DISPO-II Training Program
1
Working Group Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
2
Department of Health Science, German University of Applied Sciences for Prevention and Health Management, 66123 Saarbrücken, Germany
3
Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
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Department of Radiation Oncology, University Hospital of Freiburg, 79106 Freiburg, Germany
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Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ), and National Center for Tumor Diseases, 69120 Heidelberg, Germany
6
Radiooncological Practice Bad Godesberg, 53177 Bonn, Germany
*
Author to whom correspondence should be addressed.
Cancers 2021, 13(2), 201; https://doi.org/10.3390/cancers13020201
Received: 20 November 2020
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Revised: 27 December 2020
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Accepted: 4 January 2021
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Published: 8 January 2021
(This article belongs to the Section Cancer Therapy)
Simple Summary
Previous research indicates that the outcomes of irradiation of spinal metastases can be improved through exercise. After this was demonstrated for metastases of low fracture risk, we conducted the first study in patients with spinal metastases of high fracture risk to investigate exercise feasibility. An exercise group performed four spinal stabilization exercises daily over two weeks of radiotherapy, while a control group received relaxation. Patients in the exercise group attended 90% of training sessions, compared to 80% in the control group. No injuries occurred. However, about half of the patients could not perform two out of the four exercises due to pain, weakness or immobility. Nevertheless, they increased exercise time and training-specific strength. Altogether, exercise is well accepted and enhances muscle strength in these patients, but frequent individual adaptations of the training program are needed. This knowledge is a prerequisite for larger studies addressing exercise effects on health.
Exercise concomitant to radiotherapy for stable spinal metastases was demonstrated to increase bone density and reduce pain. In the DISPO-II study, the feasibility of exercise concomitant to radiotherapy for unstable spinal metastases was investigated. Here, a detailed analysis of the training program is presented. Cancer patients with spinal metastases (Taneichi score ≥ D) were randomly assigned to an intervention group (INT, n = 27, 62 ± 9 years) or control group (CON, n = 29, 61 ± 9 years). INT performed spinal stabilization exercises (“all fours”/“plank”/“swimmer”/“band exercise”), and CON received relaxation, daily concomitant to radiotherapy. Exercise attendance rate was 90% in INT and 80% in CON (p = 0.126). Within INT, exercise dose increased significantly (p < 0.001). 54% of patients could not perform “swimmer” in some or all sessions. 42% could not perform “plank” in some or all sessions. 13 and 25% could not perform “all fours” and “band exercise” in some sessions. “Plank” holding time increased in INT and remained unchanged in CON with different development between groups (p = 0.022). Handgrip strength did not develop differently between groups (p = 0.397). The exercise intervention demonstrated high acceptability but required frequent modifications due to pain, weakness and immobility to be feasible for the majority of participants. It enhanced specific muscle strength. Larger trials should now investigate exercise effects on health.
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Keywords:
advanced cancer; radiotherapy; bone metastases; skeletal metastases; osseous metastases; exercise; training; muscle; strength
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MDPI and ACS Style
Rosenberger, F.; Sprave, T.; Clauss, D.; Hoffmann, P.; Welzel, T.; Debus, J.; Rief, H.; Wiskemann, J. Spinal Stabilization Exercises for Cancer Patients with Spinal Metastases of High Fracture Risk: Feasibility of the DISPO-II Training Program. Cancers 2021, 13, 201. https://doi.org/10.3390/cancers13020201
AMA Style
Rosenberger F, Sprave T, Clauss D, Hoffmann P, Welzel T, Debus J, Rief H, Wiskemann J. Spinal Stabilization Exercises for Cancer Patients with Spinal Metastases of High Fracture Risk: Feasibility of the DISPO-II Training Program. Cancers. 2021; 13(2):201. https://doi.org/10.3390/cancers13020201
Chicago/Turabian StyleRosenberger, Friederike, Tanja Sprave, Dorothea Clauss, Paula Hoffmann, Thomas Welzel, Jürgen Debus, Harald Rief, and Joachim Wiskemann. 2021. "Spinal Stabilization Exercises for Cancer Patients with Spinal Metastases of High Fracture Risk: Feasibility of the DISPO-II Training Program" Cancers 13, no. 2: 201. https://doi.org/10.3390/cancers13020201
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