Exercise Efficacy on Bone Health in Multiple Myeloma

Evidence for Bone-Specific Outcomes

Combined resistance and impact exercise programs demonstrate the most promise for preserving bone health, particularly at the lumbar spine, while safely improving physical function, quality of life, and reducing fatigue, according to the American College of Cardiology 1
Recreational soccer training in men with prostate cancer on androgen deprivation therapy showed increases in bone formation markers and preserved bone mass at 12 weeks, 32 weeks, and 5 years of follow-up, as recommended by the National Comprehensive Cancer Network 2
Exercise alone may be insufficient to improve bone health in cancer survivors and should be combined with adequate calcium and vitamin D supplementation (>800 IU daily), as suggested by the National Comprehensive Cancer Network and the American College of Cardiology 1, 2

The National Comprehensive Cancer Network recommends an exercise protocol incorporating aerobic, resistance, and flexibility exercises with specific precautions for bone metastases, with a duration of 60+ minutes per session, 2-3 times per week, for a minimum of 7 months 1, 3, 4

Exercise interventions led to small but statistically significant improvements in self-reported physical function among patients with hematologic malignancies (SMD 0.15; 95% CI, -0.01 to 0.32; 8 trials, N=1,329 patients), according to the American Society of Clinical Oncology 5
Exercise produces moderate to large reductions in cancer-related fatigue in hematologic malignancies (SMD -0.52; 95% CI, -0.70 to -0.34), as reported by the American Society of Clinical Oncology 5
Among patients with hematologic malignancies, exercise showed a nonsignificant impact on QoL (SMD 0.11; 95% CI, -0.03 to 0.24; 8 studies, N=1,259 patients), though patients treated with bone marrow transplantation reported significant improvement (MD 3.38 points; 95% CI, 0.37 to 6.39; 11 studies, N=624 patients), according to the American Society of Clinical Oncology 6

Fracture risk assessment must precede exercise prescription, and lesions >2.5 cm in diameter or encompassing >50% of bone diameter create high fracture risk and require surgical stabilization before rehabilitation, as recommended by the American College of Cardiology 1
Individualized assessment must account for lesion size, location in weight-bearing areas, and pain refractory to radiation, according to the American College of Cardiology 1

Obtain whole-body low-dose CT to identify and characterize bone lesions, as suggested by the American College of Radiology 7
Assess fracture risk based on lesion size (>2.5 cm or >50% bone diameter = high risk), and refer for surgical stabilization before initiating exercise if high fracture risk exists, according to the American College of Cardiology 1
Prescribe combined resistance and impact exercise program, with concurrent calcium and vitamin D supplementation (>800 IU daily), as recommended by the National Comprehensive Cancer Network and the American College of Cardiology 1, 2

The American Academy of Family Physicians recommends aerobic exercise, focusing on activities using large muscle groups, as part of a combined exercise program 8
The American Academy of Family Physicians suggests starting resistance training with lower resistance (40-60% of one repetition maximum) and higher repetitions (15-20 repetitions), and beginning conservatively with as few as 2-3 repetitions if needed, progressing to 10-12 repetitions over time 8, 9
The American Academy of Family Physicians advises focusing on major muscle groups with proper form and breathing technique to prevent Valsalva maneuver 8
Weight-bearing options, such as walking programs, are recommended if bone stability permits, while non-weight-bearing alternatives like cycling, elliptical training, or hydrotherapy are suggested for patients with higher fracture risk 8, 9

Active disease flare-ups or acute complications are considered absolute contraindications for exercise, according to the American Academy of Family Physicians 8, 9
The American Academy of Family Physicians recommends monitoring for unusual fatigue, increased weakness, or decreased range of motion, and discontinuing exercise if joint swelling or pain persists >1 hour post-exercise 8, 9

Bisphosphonate therapy is critical for reducing skeletal-related events and should continue with active disease, according to Haematologica 10