Physical activity boosts functional performance in MM

Exercises that include walking and resistance training are effective interventions that improve frailty in patients with multiple myeloma (MM) who are receiving systemic treatment, according to a new study.

Patients in the strength building and walking groups had enhanced performance of mobility through all five categories measured. The 30-second sit-to-stand test led to lasting and improved results post intervention. However, the progress gained with mobility and the timed-up-and-go tests were partially lost post intervention, whereas the 6-minute walk test gains were unchanged. [International Myeloma Society Annual Meeting, abstract OA-38]

“Patients with MM live longer and have deeper remission. They want to go back to normal life. Often, they ask if they can do physical activity, engage in sports, or go to the gym,” said presenting author Dr Jens Hillengass from Roswell Park Comprehensive Cancer Center, Buffalo, New York, US. “But there are not enough data to show they can.’’

Frailty in MM patients

The immunosenescence  that occurs with ageing and MM reduces strength and walking speed, causing decreased energy expenditure and physical activity among patients. These factors cause a negative feed-back loop and clinical worsening, resulting in frailty.

Frailty increases the risk of treatment-related adverse events and mortality. Integrating frailty scores and geriatric assessments could help support treatment decisions, explained Hillengass.

“Frailty is a parameter we measure and assess when we see our patients. Then, we decide if they are transplant-eligible or chimeric antigen receptor [CAR] T-cell-eligible,” he continued.

However, little is known if patients with MM, particularly those with bone disease, could benefit from exercise.

Resistance training vs walking

Hillengass and his team sought to assess if physical activity can enhance functional performance and improve frailty scores in patients with MM.

Each patient had an option to participate in 1 of 2 groups based on exercise intervention type. Group 1 (n=24) underwent supervised, physical resistance training twice weekly for 6 months. Group 2 (n=18) underwent behavioural intervention through remote prompts, targeted at 150–300 minutes of walking weekly for 6 months.

The non-randomized nature of the trial enabled patients to participate despite their distance from the trial institution or COVID-19–related issues. Five patients were unable to complete the trial for various reasons, including COVID-19 infection.

Age, BMI, and race were comparable between cohorts. Seventeen patients in the strength building cohort and 9 patients in the walking cohort had an ECOG performance status of 0. Seven and eight patients, respectively, had ECOG performance status of 1.

No grade 3 or higher adverse events were reported. There were no fractures, only musculoskeletal soreness. Both interventions were safe and effective in this cohort.