Hi Drs. Baraki and Feigenbaum! I understand this might be too much for a forum, and am happy to consult if necessary. My father, who is 86, was diagnosed a few years ago with prostate cancer. It spread to the bones, but overall the cancer is currently under control. About a year and a half ago he also dealt with an aortic aneurysm, which he received a stent for.
He really enjoys lifting weights and is in pretty good shape for his age. I am writing because his oncologist had told him too avoid lifting heavy weights out of fear of a bone fracture due to the nature of the cancer having spread to his bones. His cardiothoracic surgeon was completely okay with him getting back into lifting, whereas the oncologist put out a recommendation of 20-25#.
In talking with my dad, it’s clear he’s afraid to lift anything now. He wants to get rid of his weights at home and sit and do basically nothing out of fear of breaking something. I tried to encourage him to start light, find an entry point, and go from there, adding slowly, and that the risk is likely minimal compared to the risk of being sedentary. He’s still apprehensive and asked if I would be able to get a Doctor’s opinion who is also familiar with weight training.
Is his risk of a bone fracture much higher due to the cancer? For someone of his age/ background, would you recommend lifting weights? If so, do you find the 20-25# limit to be reasonable? Thanks in advance for your time!
Hi,
A bone containing metastasis is less structurally robust than a healthy bone that does not contain metastatic cancer. However, this does not mean that he must withdraw from any form of loaded activity. There is overall not a lot of great evidence in this realm, but I have linked a few relevant resources below. It is not really possible to provide a generalized recommendation that would apply to all patients in this situation, as the assessment and advice needs to be more individualized. His age is not a factor I would be considering here, but rather things like the extent, locations, and severity of metastasis, and any history of fracture. Any absolute weight limit (like 20-25 lbs.) is completely made up.
It is important to recognize that there are significant risks to withdrawing from any loaded activity including progressive weakening of muscles, which can compromise physical independence, as well as weakening of the bones (which can be especially significant in the context of androgen deprivation therapy for prostate cancer). So while there may be a concern for fracture from excessive loading in the setting of metastasis, avoiding all loaded activity can also accelerate the loss of “healthy” bone, increasing fracture risk as well. So I would suggest that he does need some form of loaded activity, although the specifics of what this would look like are beyond what we can feasibly prescribe via the forum here. Depending on where you live and where he receives his treatment, he may have access to exercise oncology expertise. We could also do an individual consultation, although again the caveat here is that we don’t have a great body of evidence on which to base recommendations.
https://www.nature.com/articles/pcan201322
https://ascopubs.org/doi/10.1200/OP.21.00454
Thank you Dr. Baraki! I will pass this along to him.