OA-38: Physical activity interventions to improve functional performance in patients with multiple myeloma

Introduction: Frailty is a frequent limitation for treatment and an adverse prognostic factor for multiple myeloma (MM) patients. In other settings, including oncology, physical exercise has been shown to be beneficial in improving patients’ fitness. The IMWG has developed a frailty score based on patient-reported parameters. There are, however, only limited data on the safety and efficacy of physical exercise in MM to improve functional performance, especially with bone disease present. To address this gap in knowledge, we performed a two-arm non-randomized pilot exercise study in MM patients.

Methods: Patients self-selected into one of two active interventions: a six-month, twice weekly, in person, supervised resistance training (strength training group, STG) and a six-month behavioral intervention using fitness trackers with regular remote prompts to motivate patients to achieve 150-300 active minutes per week (walking group, WG). The non-randomized design allowed patients to participate in the remote arm if they lived too far from the institution to attend regular training sessions or had COVID-19-related concerns. After informed consent, a patient’s most recent imaging results were reviewed in an interdisciplinary tumor board; the patient was either cleared for participation, cleared with limitations, or declined for participation. Assessments of functional parameters occurred after three and six months of the intervention and three and six months after the intervention.

Results: A total of 87 patients were informed of the trial. Of those, 44 patients refused to participate, mostly due to travel distance. Of the 43 enrolled patients, 24 chose the STG and 20 the WG. For different reasons, including the COVID-19 pandemic, five patients did not complete the trial. The tumor board recommended restrictions for seven patients (e.g., no overhead exercises; no impact exercises). There were no significant differences between the groups in terms of age, BMI, sex, race, ECOG performance status, disease response, disease status, and likelihood of completing the intervention.
The combined study sample showed significant improvements in mobility (AM-PAC Basic Mobility Short Form, P< 0.01), six-minute walk test (6MWT, P< 0.01), 30-second sit-to-stand test (30STS, P< 0.01), timed up-and-go test (TUG, P< 0.01), and pain (visual analogue scale, P< 0.01) during the intervention. The 30STS remained significantly improved six months after the intervention, while the gains made in mobility and the TUG were partially lost. The gains in 6MWT and pain were not significantly changed after the intervention.

Conclusions: In this pilot study, both the STG and the WG were feasible in patients with MM and led to improvements in relevant parameters of functional capacity. This work lays the foundation for future exercise interventions aimed at improving physical function and resilience in MM patients undergoing systemic treatment.