Can Digital Exercise Benefit Patients With Multiple Myeloma?

In recent years, much attention has been paid to more holistic treatment for patients with cancer. Focusing on nutrition, spiritual care, and maintenance of overall health while receiving treatment has been shown to have both physical and quality of life benefits.

But multiple myeloma (MM) can present special challenges, since the disease presents a risk of lytic lesions; in turn these can lead to pain, bone fractures, and other deformities. Tailoring a digital exercise program to benefit patients with MM without increasing physical risks was the subject of a pilot study, with results appearing in the journal Digital Health.

As the authors noted, in addition to a lack of evidence about the effectiveness of exercise for patients with MM, “Individuals may be hesitant to exercise, due to a psychological fear of exercise triggering a fracture.”

For the pilot, participants with MM completed a 12-week exercise program that was supported virtually, with remotely supervised group workouts, independent workouts, and aerobic exercise. Patients were at least 18 years old and had a MM diagnosis in 1 of 3 categories: (1) 14% were transplant ineligible, first-line treatment; (2) 29% were transplant eligible, 3 months post transplant; and (3) 57% had relapsed/recurrent MM with 1 prior line of treatment.

Participants used the HEAL-Me eHealth app, which is an online, noncommercial application developed at the University of Alberta to create individually tailored home exercise programs. The exercise consisted of the following components:

Resistance exercise. Participants took part in 60 minute virtually supervised group workouts as well as independent workouts using the app; the sessions consisted of a warmup, 2 rounds of a 8-exercise circuit and a cool down stretch. Muscle groups likely to be affected by MM were given attention over others groups, including proximal limbs, core, and back. The programs focused on proper alignment, technique, and tempo, encouraging participants in the principles of avoiding falls. Participants had varied start points based on their level of fitness and were able to progress.

Aerobic activity. Participants worked from their baseline to up to 90 minutes per week of moderate intensity aerobic exercise; they were given the option of walking, cycling, or elliptical training. Participants were monitored to ensure that they were breathing harder but still capable of talking.

Results. Of the 29 participants who consented, 26 completed follow-up testing (90%). Adherence was tracked directly through the app. Adherence to the exercise plan was 90% for group resistance sessions, 83% for independent resistance sessions, and 90% for aerobic sessions. Significant improvements were found for both physical fitness and quality of life:

• 96% of participants found the program beneficial
• 93% found it enjoyable
• 89% were satisfied or very satisfied with the program delivery through the HEAL-Me app
• 48% reported that the eHealth program helped manage cancer-related side effects and symptoms

The authors also reported secondary outcomes that the authors said may be worthy of investigation in larger studies. For example, they wrote, the mean change in leg strength “was above the established minimally importance difference (MID)” for older adults and clinical populations, which supported previous findings in MM and with eHealth interventions in other cancer populations, a noteworthy outcome given the challenges of MM.

Although no MID has been established in core endurance, “the observed mean difference in pre- versus post-intervention plank duration of 41.6 [seconds] is promising.” Improved core strength could help patients with MM improve balance, prevent vertebral fractures in osteoporosis, reduce back pain, and improve posture.

In quality of life measurements, the mean change of the emotional subscale of the Functional Assessment of Cancer Therapy—Multiple Myeloma (FACT-MM) did show improvement from established MID of 2 to 3.69. “Total symptom burden did not improve in this study, but the program did not exacerbate symptoms. This is important because the control/maintenance of symptoms is a key exercise goal amongst those with advanced cancer,” the authors wrote.

The major limitation cited was the lack of a control group, which the authors said could be addressed in a larger study. “Programming should be individually tailored, and include supervision, active support, and well-trained personnel in order to manage the possibility of both serious and nonserious adverse events. A randomized controlled trial, with quality of life as a primary outcome, is warranted to determine the effects of the current exercise program.”

Reference

Purdy GM, Venner CP, Tandon P, McNeely ML. Feasibility of a tailored and virtually supported home exercise program for people with multiple myeloma using a novel eHealth application. Digital Health. 2022;8:1-17. doi: 10.1177/20552076221129066