Bone is sculpted through mechanically-driven and adaptive processes, designed to meet the physiological and biomechanical challenges it faces in everyday life. Advances in our understanding of how forces shape bone through-out life, and how forces can exert protective or disruptive effects towards bone in response to disease-states (such as bone metastases) or in response to cancer treatments (such as hormone therapy, chemotherapy, and beyond) highlight the potential of precision exercise as a targeted therapy for people with cancer. Preclinical studies demonstrate the fascinating propensity of mechanical loading to interfere with tumour-driven processes in bone metastases and myeloma bone disease models. However, the question for exercise professionals in the clinical setting remains: How do we deliver exercise that EFFECTIVELY targets bone health outcomes in people with cancer with or without bone metastases?; and does diseased bone behave the same under loading conditions?. Professor Nicolas Hart will leverage his expertise as an exercise scientist specialising in musculoskeletal biomechanics in healthy, athletic, and clinical populations; and his experience delivering multiple Phase I to Phase III RCT’s for people with sclerotic or osteolytic bone metastases or myeloma bone disease; to discuss how and why exercise is precision therapy for bone health; what ‘rules of engagement’ govern the design and delivery of exercise when targeting bone; and why generic approaches to exercise oncology are not fit-for-purpose in this context.