BACKGROUND: Exercise has proved to be beneficial for patients with advanced cancer, yet the presence of bone metastasis is commonly perceived as one of the contraindications in exercise prescription. Our objective is to determine the efficacy and safety in prescribing physical training for palliative patients with bone metastasis. METHODS: Pubmed, Embase, and Cochrane databases were searched up to 1st April 2022. Articles were screened and selected independently by two authors, based on the defined inclusion and exclusion criteria. The assessment for risk of bias of the included randomized controlled trials (RCTs) was examined by the Cochrane risk-of-bias tool for randomized trials (RoB 2). RevMan 5.4.1 was utilized for meta-analysis. RESULTS: Eight RCTs were eligible for this meta-analysis, with a sum of 234 subjects equally assigned to intervention and control groups. No statistical difference in the number of adverse events was identified between intervention and control groups (standardized mean difference (SMD) -0.05; 95% confidence interval (CI) -0.73 to 0.64; p = 0.89) with an inapplicable heterogeneity. No significant increase in bone pain was shown between groups at baseline; at the completion of radiotherapy and 6 months post-radiotherapy. Yet, significantly less pain was found in intervention groups after 3 months (SMD -0.85, 95% CI -1.55 to -0.14, p = 0.02, 3 trials), (Chi2 6.89, I2 71%, p = 0.03). Exercise did not result in significant change in quality of life and physical function. CONCLUSIONS: Guided training appeared safe in early-stage palliative cancer cases with bone metastasis. No significant change in physical function and quality of life was found in this review. In future, large-controlled investigations and structured exercise programs should be developed to look into the safety and efficacy of supervised exercise.

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