Feasibility of isometric spinal muscle training in patients with bone metastases under radiation therapy - first results of a randomized pilot trial.
BACKGROUND
Spinal bone metastases are commonly diagnosed in cancer patients. The consequences are pain both at rest and under exercise, impairment of activities of daily life (ADL), reduced clinical performance, the risk of pathological fractures, and neurological deficits. The aim of this randomized, controlled pilot trial was to investigate the feasibility of muscle-training exercises in patients with spinal bone metastases under radiotherapy. Secondary endpoints were local control, pain response and survival.


METHODS
This study was a prospective, randomized, monocentre, controlled explorative intervention trial to determine the multidimensional effects of exercises for strengthening the paravertebral muscles. On the days of radiation treatment, patients in the control group were physically treated in form of respiratory therapy. Sixty patients were randomized between September 2011 and March 2013 into one of the two groups: differentiated resistance training or physical measure with thirty patients in each group.


RESULTS
The resistance training of the paravertebral muscles was feasible in 83.3% of patients (n = 25). Five patients died during the first three months. The exercise group experienced no measurable side effects. "Chair stand test" in the intervention group was significant enhanced with additionally improved analgesic efficiency. Patients in intervention group improved in pain score (VAS, 0-10) over the course (p < .001), and was significant better between groups (p = .003) after 3 months. The overall pain response showed no significant difference between groups (p = .158) There was no significant difference in overall and bone survival (survival from first diagnosed bone metastases to death).


CONCLUSIONS
Our trial demonstrated safety and feasibility of an isometric resistance training in patients with spinal bone metastases. The results offer a rationale for future large controlled investigations to confirm these findings.
Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. harald.rief@med.uni-heidelberg.de.
Harald
H
Rief
Georg
G
Omlor
Michael
M
Akbar
Thomas
T
Welzel
Thomas
T
Bruckner
Stefan
S
Rieken
Matthias F
MF
Haefner
Ingmar
I
Schlampp
Alexandros
A
Gioules
Daniel
D
Habermehl
Friedbert
F
von Nettelbladt
Jürgen
J
Debus
D000203:Activities of Daily Living; D000368:Aged; D064131:Back Muscles / Q000503:physiopathology*; D001416:Back Pain / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control; D005240:Feasibility Studies; D005260:Female; D005858:Germany; D006801:Humans; D007537:Isometric Contraction; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010865:Pilot Projects; D011446:Prospective Studies; D055070:Resistance Training; D013125:Spinal Neoplasms / Q000401:mortality / Q000503:physiopathology / Q000532:radiotherapy* / Q000556:secondary*; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome