Exercise Safe, Feasible in Older Patients With Newly Diagnosed Multiple Myeloma

Although previous study results show the benefits of exercise in patients with hematological cancers, they have focused mainly on younger, fit patients, with initial assessments taken weeks after the start of induction or high-dose chemotherapy with stem cell support.

Citing a lack of similar data in multiple myeloma (MM) for older patients and from an earlier time point, particularly diagnosis, the investigators of a study in Pilot and Feasibility Studies tested the feasibility and safety of their exercise program in this patient group as part of an ongoing randomized controlled study. Because bone involvement is a characteristic sign of MM, affecting 80% or more of patients at diagnosis and as the disease progresses, it was periodically assessed for its effects on patient physical ability.

The median age of patients in this study was 69 years (range, 38-90), and 67% had bone disease. The control group received usual care (information on the value of exercise), and the intervention group received usual care and exercise over 10 weeks. To ensure the safety of the exercise intervention, adjustments were made to account for patient pain and degree of bone disease involvement if necessary.

Each week, the exercise intervention program consisted of both supervised and unsupervised sessions 3 days a week, with self-exercise on the remaining 4 days, and participants were asked to track their progress in a journal. There were 4 data collections points: (1) diagnosis, which was used to determine eligibility for the study; (2) baseline (before the exercise program began); (3) during the 10-week program; and (4) follow-up between 11 and 13 week post intervention.

Eighty-six percent of patients were able to take part in the entire exercise intervention program, and most (92%) attended all supervised sessions, with an overall adherence rate of 99%. No patient injuries were reported. For the exercise sessions completed on their own, the adherence rate was 89%.

According to the authors, “Our main finding was that the exercise intervention and physical test procedures were feasible and safe.” They believe that the supervised and self-monitored combined exercise program was an important strength for their study.

However, the authors also caution about possible skewed results regarding attendance (“Our more favorable attendance rate may be because we strive to plan the sessions on the same days as the medical visits to the hospital, contrary to exercise in a physiotherapy practice”) and disease severity (“Probably, the included patients are skewed according to the severity of disease and have fewer complications at diagnosis than the general population”).

So, while the sutdy showed that beginning therapy soon after a diagnosis is feasible and safe for older patients with MM with bone disease involvement, researchers must continue assessing the actual effectiveness of exercise interventions, because those results remain unclear and previous studies have produced conflicting results.

Reference

Larsen RF, Jarden M, Minet LR, Frølund UC, Abildgaard N. Supervised and home-based physical exercise in patients newly diagnosed with multiple myeloma—a randomized controlled feasibility study. Pilot Feasibility Stud. 2019;5:130. doi: 10.1186/s40814-019-0518-2.