Guest article written by Michaela Hillengass, PT, ACSM and Jens Hillengass MD, PhD

Recent research has shown that physical activity has a stimulating effect on some cell subsets of the immune system of cancer patients. While inactivity leads to bone loss, being active helps bones get stronger. 

Though it may seem counterintuitive at first, being active seems to be the best treatment of disease-and treatment-related fatigue.

We recommend a thorough examination with imaging before performing any kind of physical activity. But once cleared, with potential limitations identified, continuing with or even starting a new physical activity routine is possible and should be encouraged.

Setting goals is an important part of managing myeloma. Achieving them can be difficult because the disease is often chronic and it can be difficult to find the motivation patients need to keep fighting the disease. 

This is made more difficult because relapses are common and can occur every few years or even months. But life should also go on beyond the disease, and positive lifestyle changes might even be a factor in having better responses to treatment.

For some patients going back to the gym or restarting other kinds of physical activity is one of those goals. The challenges, however, should not be underestimated.

The fact that myeloma can cause destructive bone lesions is a major factor that has to be taken into account. Fracture risk while performing physical exercises or even during gardening or household chores is a real risk for many myeloma patients.

Another challenge is that myeloma and treatment may cause immune suppression. This limits access to some public facilities where hygiene might not be the highest priority.

How can this dilemma be resolved?  At the Roswell Park Comprehensive Cancer Center, we have decided to systematically assess the rewards and risks of exercise for myeloma patients. We also plan to measure the positive effects of physical activity on fatigue, immune function, bone disease and general quality of life within a prospective clinical trial. 

In our pilot study, patients get a thorough physical therapist’s evaluation and, if needed, consultation with an orthopedist or neurosurgeon before starting their workouts. Workouts are limited to walking or supervised resistance training. Currently, it is in person at our center but future plans call for offering the option of remote training.

Initial impressions have demonstrated that patients tolerate supervised exercise training well, benefitting on several levels. Some participants report that their workouts are allowing to perform certain tasks in their daily life that were not possible because of their disease.

In our current trial, patients train in groups of two-to-four at a time, which allows for casual communication and exchange of experiences with other patients. This was something we did not anticipate and it has a great motivating effect.

The positive impact of physical exercise for cancer patients has been demonstrated repeatedly. While the challenges for myeloma patients regarding immune defects and bone lesions remain a concern, finding the right path to physical activity that works for you should be a priority in your treatment plan.