Open Access Open Badges Research article

Feasibility of isometric spinal muscle training in patients with bone metastases under radiation therapy - first results of a randomized pilot trial

Harald Rief1*, Georg Omlor3, Michael Akbar3, Thomas Welzel1, Thomas Bruckner2, Stefan Rieken1, Matthias F Haefner1, Ingmar Schlampp1, Alexandros Gioules1, Daniel Habermehl1, Friedbert von Nettelbladt1 and Jürgen Debus1

Author Affiliations

1 Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany

2 Department of Medical Biometry, University Hospital of Heidelberg, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany

3 Department of Orthopaedics and Trauma Surgery, University Hospital of Heidelberg, Schlierbacherstrasse 120a, 69118 Heidelberg, Germany

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BMC Cancer 2014, 14:67  doi:10.1186/1471-2407-14-67

Published: 5 February 2014



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.


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.


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).


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.

Trial registration

Clinical trial identifier NCT01409720.

Bone metastases; Spine; Physical exercise; Stability; Isometric training