An Exercise Training Programme Produces Significant Improvements in Quality of Life (QoL), Muscle Strength and Cardiorespiratory Function in Patients with Myeloma.
Authors: Groeneveldt Lara J. , Garrod Rachel , Yong Kwee L. , Dangwa Flora , Jewell Andrew P. , van Someren Ken , Rabin Neil , Nicholls Lisa , D’Sa Shirley P. 
Published: October 2019

Abstract
Cancer patients frequently suffer with anxiety, fatigue, loss of well-being and functionality. In myeloma patients this is compounded by the effects of lytic bone disease, causing chronic pain and impaired mobility. The result is a decrease in physical fitness and loss of confidence in carrying out day-to-day activities, contributing to a reduced QoL. The development of novel therapies has extended the survival of these patients, hence such issues are of increasing importance and effective rehabilitation programmes are urgently needed. We carried out a pilot study of a tailored exercise training programme in patients in stable plateau phase. The primary aims were to determine the feasibility, adherence rate, and the effects on QoL, physiological and cardiorespiratory functions. Eligible patients underwent radiological and cardiac screening prior to study entry. There was a 25% screening failure rate due to disease progression or fracture risk, these patients proceeding to prophylactic surgery or radiotherapy. Twenty-five patients were given a programme based on their current exercise capacity, level of functioning and individual rehabilitative needs. Patients undertook exercise training 3 times a week for 6 months, with 1 supervised exercise session each week in the hospital outpatient gym. Each session comprised stretching and mobility, aerobic (treadmill, cycle ergometer or walking to 50–60% of heart rate reserve and 15–30 minutes duration) and resistance training (theraband, ankle, hand weights and body-weight) in order to improve flexibility, cardiorespiratory fitness and muscle strength. QoL and physiological outcomes were assessed at baseline, 4-weekly for 3 months, then 6 weekly for 3 months during the 6-month study period. A preliminary analysis of 17 patients who completed 3 months on the programme has been performed. Average attendance at the weekly exercise class was 84%. Adherence to the exercise programme, as assessed by inspection of a log-book was >50% in all patients; 35% achieved >90% adherence. Significant improvements were found in the FACT G (baseline: median 85; range 62 – 104, 3 months: 90; range 70 – 108, p<0.01), FACIT-Fatigue (baseline: 40; range 14 – 50, 3 months: 43; range 19 – 52, p<0.05) and HAD anxiety scores (baseline: 5; range 0 – 19, 3 months: 2; range 0 – 11, p<0.01). Upper limb strength, assessed by handgrip dynamometry also improved significantly (baseline: 28.80kg; range 8.75 – 51.30, 3 months: 30.65kg; range 18.15 – 50.00, p<0.05), as did VO2max, assessed by a submaximal stress test (baseline: 24.8 ml/kg/min; range 19.2 – 34.7, 3 months: 26.7 ml/kg/min; range 21.1 – 35.0, p<0.01). Several patients reduced their analgesia usage, and many are now able to undertake new activities such as lifting a grandchild, climbing ladders to decorate, and walking along a pebbled beach. Such reports of personal benefits are being captured using qualitative methods. In summary, an exercise training programme is feasible in patients with myeloma, resulting in significant benefits as assessed by QoL, physiological and cardio-respiratory measures. Our results provide the evidence base for the regular use of exercise prescription in the rehabilitation of myeloma patients.