title: The effect of resistance training during radiotherapy on spinal bone metastases in cancer patients - a randomized trial.
abstract: OBJECTIVE
  To compare the effects of resistance training versus passive physical therapy on bone density in the metastatic bone during radiation therapy (RT) as combined treatment in patients with spinal bone metastases. Secondly, to quantify pathological fractures after combined treatment.
  
  
  METHODS
  In this randomized trial, 60 patients were allocated from September 2011 until March 2013 into one of the two groups: resistance training (group A) or passive physical therapy (group B) with thirty patients in each group during RT. Bone density in metastatic and non-metastatic vertebral bone was assessed at baseline, 3 and 6 months after RT.
  
  
  RESULTS
  Bone density in all metastases increased significantly by 28.3% (IQR 11.4-139.0) and 80.3% (IQR 32.6-250.6) after 3 and 6 months in group A (both p < 0.01). The bone density in group A was significantly increased compared to control group after 3 and 6months (both p < 0.01, median 59.7; IQR 21.1-98.3 and median 62.9; IQR -9.7 to 161.7). The bone density data in group B showed no significant increase over the course of time (p = 0.289, median 5.5, IQR 0.0-62.2 and p = 0.057, median 52.1, IQR 0.0-162.7). 23.3% of the patients in group A and 30.0% of the patients in group B had pathological fractures, no fracture was assigned to intervention, and no difference between groups after 3 and 6 months was observed (p = 0.592 and p = 0.604).
  
  
  CONCLUSIONS
  Our trial demonstrated that resistance training concomitant to RT can improve bone density in spinal bone metastases. This combined treatment is effective, practicable, and without side effects for patients. Importantly, the pathological fracture rate in the intervention group was not increased. The results offer a rationale for future large controlled investigations to confirm these findings.
  
  
  BACKGROUND
  Clinical trial identifier NCT01409720.
authors.affiliation: Department of Radiation Oncology, University Hospital of Heidelberg, Germany. Electronic address: harald.rief@med.uni-heidelberg.de.
authors.forename: Harald
authors.initials: H
authors.lastname: Rief
authors.affiliation: Department of Radiation Oncology, University Hospital of Heidelberg, Germany. Electronic address: lina.petersen89@googlemail.com.
authors.forename: Lina C
authors.initials: LC
authors.lastname: Petersen
authors.affiliation: Department of Orthopaedics and Trauma Surgery, University Hospital of Heidelberg, Germany. Electronic address: georg.omlor@med.uni-heidelberg.de.
authors.forename: Georg
authors.initials: G
authors.lastname: Omlor
authors.affiliation: Department of Orthopaedics and Trauma Surgery, University Hospital of Heidelberg, Germany. Electronic address: michael.akbar@med.uni-heidelberg.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Akbar
authors.affiliation: Department of Medical Biometry, University Hospital of Heidelberg, Germany. Electronic address: bruckner@imbi.uni-heidelberg.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bruckner
authors.affiliation: Department of Radiation Oncology, University Hospital of Heidelberg, Germany. Electronic address: stefan.rieken@med.uni-heidelberg.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Rieken
authors.affiliation: Department of Radiation Oncology, University Hospital of Heidelberg, Germany. Electronic address: matthias.haefner@med.uni-heidelberg.de.
authors.forename: Matthias F
authors.initials: MF
authors.lastname: Haefner
authors.affiliation: Department of Radiation Oncology, University Hospital of Heidelberg, Germany. Electronic address: ingmar.schlampp@med.uni-heidelberg.de.
authors.forename: Ingmar
authors.initials: I
authors.lastname: Schlampp
authors.affiliation: Department of Radiation Oncology, University Hospital of Heidelberg, Germany. Electronic address: robert.foerster@med.uni-heidelberg.de.
authors.forename: Robert
authors.initials: R
authors.lastname: Förster
authors.affiliation: Department of Radiation Oncology, University Hospital of Heidelberg, Germany. Electronic address: juergen.debus@med.uni-heidelberg.de.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Debus
authors.affiliation: Department of Radiation Oncology, University Hospital of Heidelberg, Germany. Electronic address: thomas.welzel@med.uni-heidelberg.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Welzel
mesh_terms: D000368:Aged; D015519:Bone Density; D001943:Breast Neoplasms / Q000473:pathology; D002277:Carcinoma / Q000532:radiotherapy / Q000534:rehabilitation* / Q000556:secondary; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D008545:Melanoma / Q000532:radiotherapy / Q000534:rehabilitation* / Q000556:secondary; D008875:Middle Aged; D009369:Neoplasms / Q000473:pathology*; D010166:Palliative Care; D026741:Physical Therapy Modalities; D011471:Prostatic Neoplasms / Q000473:pathology; D055070:Resistance Training / Q000379:methods*; D012878:Skin Neoplasms / Q000473:pathology; D013125:Spinal Neoplasms / Q000532:radiotherapy / Q000534:rehabilitation* / Q000556:secondary
keywords: Bone density; Bone metastases; Palliative radiotherapy; Resistance training; Spine