Study Highlights Unmet Exercise Needs Among Patients With MM

Health care providers need to foster a greater push for physical activity as a part of survivorship care for patients with multiple myeloma (MM), investigators concluded after finding that only 25% of patients were active.

Results of a recent study highlighted an unmet need for physical activity (PA) among patients with multiple myeloma (MM), signaling that current management practices need to be reviewed to ensure that a tailored exercise program is incorporated.

The study, published in BMC Research Notes, provided a better understanding of the prevailing attitude that patients and clinical teams have toward PA and emphasized the need for more health care providers to incorporate it into MM survivorship care.

“Specialists should be involved so that MM related symptoms and treatment toxicities are taken into account in the prescription of individualised programmes. With limited literatures available, more high-quality, large randomised studies are needed to evaluate the impact of PA on different health parameters of MM patients,” the investigators wrote.

Although the list of novel therapies for MM has grown substantially over the years, patients with MM still face challenges regarding regaining psychosocial and physical well-being while coping with symptoms and treatment adverse effects. Additionally, nearly 90% of patients with MM experience osteolytic bone destruction, and PA could increase risk of injury among these patients. Lack of PA mixed with long-term toxicity from complex regimens and stem cell transplants can lead to muscle atrophy, fatigue and defunctioning, and worsened quality of life.

Previous studies have demonstrated that exercise programs were associated with better quality of life, fatigue, and muscle strength in patients with MM. However, more studies are needed to confirm these benefits.

The investigators distributed 3 questionnaires to determine exercise levels, assess health-related quality of life, and assess fatigue levels. In total, 65 patients responded to the questionnaires between March and May 2019. The patients were sourced by attending the MM outpatient clinic at University College London Hospital.

Among the respondents, 66% were currently receiving antimyeloma therapy, of whom 26% had received 3 or more lines. The median time from diagnosis was 3.8 years and 12% were diagnosed more than 10 years prior.

The respondents had a mean score of 15 out of 66 on the questionnaire measuring exercise levels. Based on the scores, 25% of the cohort were deemed physically active, 17% were classified as moderately active, 39% were categorized as inactive, and 20% did not specify their PA level. The mean (SD) quality of life score was 75.1 (21.1) out of 108 and the mean (SD) score for fatigue was 30.3 (14.6) out of 52.

Overall, 75% of the cohort said that they would like to increase their level of PA and 9% said that they would not. The remaining respondents were either neutral to change in PA levels or did not specify.

The most commonly reported barriers to improving PA were weakness (43%), fatigue (40%), and pain (26%). Other common barriers that were mentioned included neuropathy from MM treatments (20%), myeloma bone disease (15%), arthritis (9%), and previous surgery that led to limited mobility (8%). A majority of patients specified that more than 1 factor prevented them from improving PA.

“These low PA levels are hardly surprising; in addition to the fear of injury, related to their bone disease, MM patients suffer with a considerable symptom burden, related to their older age and co-morbidities, as well as treatment toxicities,” the investigators noted.

Nearly 60% of patients said that they’d like to receive advice on PA from a health care professional, with 29% reporting that they like information delivered through written leaflets and 28% preferring face-to-face consultations. Additionally, 14% reported that they like advice delivered over a telephone call, 12% wanted it through a mobile application, and 11% said that they preferred delivery through a website.

The authors noted that the low level of patients reporting that they preferred in-person sessions for improving PA “suggests that formal exercise classes may not suit everyone, and clinicians need to devise flexible ways to promote PA depending on patients’ preference, especially when digital healthcare technologies are becoming increasingly popular.”

Reference

Lecat CSY, McCourt O, Land J, Yong K, Fisher A. Multiple myeloma and physical activity. BMC Res Notes. 2021;14(1):171. doi:10.1186/s13104-021-05591-y