Traditionally the recommendation for cancer patients with bone metastases has been to avoid physical activity and in particular exercise which involves high intensity aerobic, resistance training or impacts. The rationale has been that these patients are often to cachectic, deconditioned and functionally impaired such that they are unable to exercise effectively, no benefit would be realised, or that exercise might exacerbate their disease. However, the greatest concern raised has been the possibility fracture at the sites of metastatic lesions due to bone fragility. Despite these proposed issues, national and international guidelines state that all cancer patients should avoid inactivity regardless of their disease stage or while undergoing difficult treatments. From extensive research in other patient populations including those with terminal disease it is well established that a rest strategy will only hasten decline and reduce survival. Our team has completed randomised controlled trials in breast and prostate metastatic cancer. We designed a modular multimodal exercise program in which resistance and aerobic exercise prescription is tailored to avoid loading skeletal sites of bone metastases while maintaining high quality training stimulus to the other body segments and systems. This research demonstrates no adverse events, no increase in bone pain, high tolerance, acceptance and adherence to the exercise program. With regard to adaptation, we report statistically significant and clinically meaningful improvements in quality of life, neuromuscular strength, aerobic fitness, walking speed and increased muscle mass. Further we have reported that these benefits remain six months after completion of such an exercise intervention. We conclude that it is critical for patients with bone metastatic cancer to undertake a tailored exercise program involving both resistance and aerobic training so as to retard decline in structure and function. Well supervised and appropriate exercise programs are safe and efficacious for this patient population.