Advancing exercise recommendations for people with bone metastases: a collaborative approach to knowledge mobilization using experience-based co-design.
Bland K, Neil-Sztramko S, et al. • Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer • 2026
Using experience-based co-design with 29 Canadian knowledge users, the authors developed a health information form, a patient education handout, a patient education webinar, and a dissemination plan (hosted on the Bone Metastases and Exercise Hub) to support adoption of the IBMEWG exercise recommendations for people with bone metastases.
Key Findings
Results
Twenty-nine knowledge users across Canada took part in the experience-based co-design process, drawn from three groups.
The groups were n = 10 people with bone metastases or caregivers, n = 9 oncology healthcare providers, and n = 10 community-based exercise professionals.
Healthcare providers included physicians, nurses, and allied health; exercise professionals included physiotherapists, clinical exercise physiologists, and kinesiologists.
Participants co-developed knowledge products and a dissemination strategy through facilitated meetings.
Results
Knowledge users prioritized three knowledge products for co-design: a health information form, a patient education handout, and a patient education webinar.
The products were intended to support adoption of the International Bone Metastases Exercise Working Group (IBMEWG) recommendations in clinical practice.
Prioritization came from the facilitated co-design meetings with the three knowledge-user groups.
Results
The Bone Metastases and Exercise Hub was created as a platform to share the co-designed knowledge products.
The hub is hosted at https://cancerexercise.med.ubc.ca/bmehub/.
It is intended to make the products available to patients, healthcare providers, and exercise professionals.
Results
International survey participants rated the design, format, and content of the patient handout and health information form favourably.
External survey feedback was collected from international participants before the knowledge products were launched.
The favourable ratings covered the patient handout and the health information form.
Results
All knowledge users who provided feedback on the co-design process were satisfied with their participation.
Satisfaction was assessed with the Public and Patient Engagement Evaluation Tool.
Only knowledge users who provided feedback are reflected in this finding.
Results
A co-designed dissemination plan was developed that uses multiple communication channels and partnerships with Canadian and international organizations.
The plan was developed with the same knowledge-user groups through facilitated meetings.
It aims to extend the reach of the IBMEWG-based products beyond the study participants.
Conclusions
The authors conclude that the co-designed products aim to support people with bone metastases to exercise safely and may improve provider confidence, and that meaningful collaboration may enhance the relevance, utility, and acceptability of materials.
People with bone metastases have historically been advised to limit exercise due to concerns about skeletal complications, despite IBMEWG evidence on the benefits of regular exercise.
The claim that co-design improves materials relative to researcher-designed materials is stated as a possibility ("may enhance"), not directly tested against researcher-designed materials.
What This Means
People with cancer that has spread to the bones have often been told to avoid exercise because of fears of fractures or other bone problems. Newer expert recommendations from an international working group say regular exercise is beneficial. This study looked at how to get those recommendations into everyday practice by involving the people who would actually use the information.
The research team worked with 29 people in Canada: 10 patients or caregivers, 9 healthcare providers, and 10 exercise professionals. Together, in facilitated meetings, they designed three tools: a health information form, a patient education handout, and an educational webinar. They also built a website, the Bone Metastases and Exercise Hub, to share these tools, and made a plan to spread them through Canadian and international organizations. International survey respondents rated the handout and form favourably, and everyone who gave feedback on the process said they were satisfied with taking part.
This research suggests that involving patients, healthcare providers, and exercise professionals in creating materials can produce resources that people find useful and acceptable. The tools aim to help people with bone metastases exercise safely and to give healthcare and exercise professionals more confidence in offering guidance. The study did not test whether the tools change exercise behaviour or whether they work better than materials designed only by researchers, so those questions remain open.
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Bland K, Neil-Sztramko S, Nadler M, Chalmers A, Dinardo R, Alibhai S, et al.. (2026). Advancing exercise recommendations for people with bone metastases: a collaborative approach to knowledge mobilization using experience-based co-design.. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. https://doi.org/10.1007/s00520-026-11386-3