Orthopaedic specialist Internal Medicine V, GMMG-Study Group at University Hospital Heidelberg, Heidelberg, Germany Heidelberg, Baden-Wurttemberg, Germany
Introduction: Multiple Myeloma is often associated with severe loss of bone substance which might endanger stability of the skeletal system. Even though the benefits of regular physical exercise in cancer patients have been demonstrated in depth and patients frequently express interest in structured exercise programs, uncertainties regarding bone stability are of great concern to both patients and oncologic healthcare providers. Because of the heterogeneity of bone involvement, exercise programs should be tailored to individual clinical conditions and require an interdisciplinary assessment.
Methods: Data of multiple myeloma patients (n=100) who received a precision-based exercise program (PEP) according to an orthopaedic evaluation of bone stability and individual physical fitness were analysed retrospectively. Bone stability was assessed by current whole-body CT-scan according to established scoring systems (Spinal Instability Neoplastic Score (SINS), Mirels’ score). All patients with stable and unstable osteolyses received a PEP which included body awareness, stretching, coordination and muscle strength training at different levels. Subsequently, PEP was continued home-based supported by an exercise therapy mobile app or under 1:1 supervision led by a local physical therapist. Patients (n=91) were contacted for a follow-up interview.
Results: Median age was 61.5 years (range: 27-83, IQR: 13) and the majority of patients (53%) asked for consultation on physical exercise during maintenance therapy. Whole body CT-scans showed multiple (>7) osteolytic lesions in most patients and in 60 % at least one osteolysis of the spine was considered potentially unstable or unstable according to SINS. 90% of patients already pursued some aerobic exercise and 24% resistance training. Following consultation on bone stability and a PEP-introductory session, the number of patients performing resistance training could be significantly increased (55% ≥2 sessions/week, 24% 1 session/week or intermittent, 21% no training). Musculoskeletal pain was reported frequently (31% mild, 36% moderate, 8% severe). At the follow-up interview, 75% of patients who performed PEP stated that painful symptoms could be effectively alleviated by exercise. Moreover, only patients that exercised regularly were able to discontinue pain medication. No injuries were reported in association with PEP.
Conclusions: We were able to demonstrate that individualized resistance training is feasible and safe, even for patients with unstable bone lesions (SINS >12). By means of a precision-based exercise program, patients’ self-efficacy in managing musculoskeletal pain was enhanced and pain medication could be reduced.
