A Supervised Group Exercise Program for Patients with Multiple Myeloma.
Authors: Chen Christine I. , Rolfe Danielle , Delosreyes Faith , Ahuja Devi , Lee Christina 
Published: April 2020

Abstract
Background: Cancer-related fatigue, anemia, bone pain, treatment toxicities, depression, and advanced age contribute to debilitation in myeloma. Myeloma pts are reluctant to exercise due to lack of disease-specific exercise guidelines and fear of injury. At our centre, a disease-modified, supervised exercise pilot program has been evaluated with 20 subjects.
Methods: Subjects attending myeloma clinic were accrued over 6 wks in response to posted notices. Eligibility: no recent bone fracture/radiation, max. MET (metabolic equivalent) ≥6 (21mL O2 consumption/kg/min, VO2) sufficient to undergo regular exercise (DASI screen). The 12 wk program included weekly supervised group sessions (90 min) and individualized home-based exercises (twice weekly). Exercises were based on American College of Sports Medicine guidelines modified to cancer pts (Lucia et al 2003) and outlined in a manual. Exercises: 1) low-intensity aerobic (treadmills, track walking, recumbent cycle ergometers to 45–75% max. HR); 2) resistance training (therabands, balls, hand wts, or body wt); 3) flexibility training (stretch exercises). Subjects were assessed at baseline and 12 wks for: 1) body composition (wt, BMI, bioelectrical impedence); 2) fitness (HR, peak VO2, max. grip strength, endurance, flexibility measures); 3) quality of life (FACT-F questionnaire); 4) pain (Brief pain inventory); 5) mental health (Hospital Anxiety Depression Scale).
Results: 20 subjects took part in the pilot program: 6M:14F; median age 60 yrs(42–74); median disease duration 29 mos(15mos–14yrs); median prior therapies 3(0–8); prior ASCT 16/20 - median time from ASCT 20 mos(3mos–12 yrs), 15/20 with bone disease/pain, 10/20 on active myeloma therapy. Comorbidities: 10/20 had lung, arthritis, or heart disease; 2/20 active smokers. Median Hb 116g/L (range 81–147) - 5/20 subjects had Hb≤100g/L. 18/20 subjects completed the 12 wk program (2 dropouts: 1 hospitalization, 1 unexpected travel). Attendance was variable - 24%(54/216) of total visits missed, most due to minor illness or disease/medication complications. Monthly program evaluations showed enthusiasm for the group format with individualized instruction helping to allay fears of injury. Despite weekly travel, subjects preferred the group setting vs home exercises alone, citing motivation from peers/instructors as vital.
Conclusions: A formal exercise program for myeloma is feasible with potential benefits in fitness and mental health. Detailed exercise diagrams/video, expanded strength training, and increased individualized time to ensure proper technique were suggestions for incorporation into our current program. A planned RCT comparing our tailored exercise program to standard care will help develop a prescription for maintaining longterm quality of life for myeloma survivors.
Mean baseline (SD) Mean Wk 12 (SD) Difference P-value (paired t-test) *Difference post-6 min walk to resting HR* 45 (18) 44 (19) −1.5 (21) 0.797 SBP* 21.4 (10.7) 18.5 (16.2) −2.9 (13.0) 0.427 6min walk 548 (102) 588 (114) 40 (48) 0.008 Peak VO2 12.6 (1.7) 13.3 (1.9) 0.7 (0.8) 0.007 Wt (kg) 72.6 (11.4) 71.8 (11.6) −0.8 (2.8) 0.320 BMI (Wt/Ht2) 27.5 (4.1) 27.2 (4.4) −0.3 (1.0) 0.328 Body fat (%) 34.7 (6.8) 34.8 (6.7) 0.0 (1.3) 0.328 Strength test 11.5 (3.2) 14.9 (5.6) 3.4 (3.4) 0.005 Flexibility test 20.4 (5.6) 22.9 (8.9) 2.5 (7.6) 0.288 FACT-F 113.7 (22.5) 117.6 (24.1) 3.9 (11.7) 0.214 HAD scale 6.5 (2.4) 5.2 (2.5) −1.2 (1.6) 0.012