Multiple Myeloma

Physical fitness is a matter of movement.  Healthy individuals take for granted the simplest of movements, while people who are ill can find the most basic activities overwhelming. Lack of movement causes weakness, a breakdown in muscular strength, and poor functioning of vital organs.  Regular physical activity, during and after treatment, will help to maintain muscle tone, joint motion, physical strength and proper functioning of all the vital organ systems. Exercise does not have to be structured, expensive or, time intensive.  Any activity you enjoy counts as exercise.

Bone problems with multiple myeloma often involve the lower back and the hips. In addition to weakened bones, muscles may also become weak as a side effect of drugs used to treat the disease. Depending on your fitness level, type of treatment, and myeloma symptoms, activities might include:
-Range-of-motion exercises. If you can’t do a lot of activity, these simple movements can help keep you limber and better able to move around.
-Non-jarring exercises. If you are able, activities in the pool, on an elliptical trainer or stationary bike will allow you to work out and minimized the impact on bones
and joints
-Avoid participating in any activity that require hard, quick twisting movements –such as tennis – because of the increased risk of spinal compression fractures
-Treadmill.  As long as myeloma symptoms or treatments don’t prevent it.
Use these guidelines as an incentive to exercise instead of reasons NOT to exercise.

How to Begin?
-Obtain permission from physician
-Begin exercising with short duration, low intensity work-outs, increasing gradually
-If experiencing fatigue, break up work-out to 5 minutes several times a day or 10 minutes in the AM & in the PM
-Do what is FUN for you – INDIVIDUALIZE
-Develop a support system
-Monitor your body’s reaction to exercise
-HYDRATE! HYDRATE! HYDRATE!

Stop Exercising if you have:
Sudden shortness of breath, muscular weakness or tiredness
-Sudden onset of nausea
-Blurred vision, dizziness, faintness or light-headedness
-Vomiting or diarrhea within previous 24 to 36 hours
-Disorientation or confusion
-Pallor (paleness) or cyanosis (bluish skin)
-Fever
-Excessive fatigue
-Chronic muscle soreness that interferes with activities of daily living
-Bruises or swelling  may be a sign of a bacterial or viral infection, or a sign the lymph system is not functioning

Treatment, Lab Values or Blood Cell Counts (from your doctor):
High-dose intravenous (IV) chemotherapy within previous 24 hours
-Platelet count below 50,000/mm3
-White blood cell count below 3,000/mm3
-Absolute granulocyte count below 2,500/mm3

Additional Precautions:
Avoid public gyms within one year post bone marrow transplantation and/or if WBC’s are low
-If have central line (PORT/PICC), avoid water, and/or resistance training of muscles in area of central line
-If undergoing radiation therapy, avoid chlorine exposure
-Minimize activities in which you may fall, such as walking on uneven ground
-If your feet are numb – which can be related to myeloma treatment – stick with exercises in which you’re not as likely
to fall such as a recumbent bike
-Reduce exercise intensity in hot or humid environments or in altitudes above 5000 ft
– Avoid exercise when you experience tenderness in a joint that worsens with activity
-Avoid strenuous aerobic activity during viral infections such as the flu or an  upper respiratory tract infection

References

American Cancer Society web site www.cancer.org article “Keeping your exercise program on track”

American College of Sports Medicine (2000) ACSM’s Guidelines for exercise testing and prescription, 6th ed

Brown, J.K., Courneya, K.S. et al (2003) Nutrition and physical activity during and after cancer treatment:  An American Cancer Society guide for informed choices.  CA A Cancer Journal for Clinicians, 53, 268-291

Carlson, L.E., et al (2006) Individualized exercise program for the treatment of severe fatigue in patients after allogeneic hematopoietic stem-cell transplant: a pilot study.  Bone Marrow Transplantation, 37: 945-954

Coleman, E.A, et al (2003) Feasibility of exercise during treatment for multiple myeloma. Cancer Nursing, 26 (5), 410-419

Courneya, K.S. (2003) Exercise in cancer survivors:  An overview of research. Medicine & Science in Sports & Exercise, 35 (11), 1846-1852

Drake, D., et al (2004) Physical fitness training. Outcomes for adult oncology patients.  Clinical Nursing Research, 13(3), 245-264

Jarden, J., et al (2007), Pilot Study of a multimodal intervention:  mixed-type exercise and psychoeducation in patients undergoing allogeneic stem cell transplantation.  Bone Marrow Transplantation, 40, 793-800

Mock, V. (2004) Evidence-based treatment for cancer-related fatigue (electronic version). Journal of the National Cancer Institute Monographs, 32, 112-118. National Center on Physical Activity and Disability (2009) Indication for the Termination of Testing or Training; web site www.ncpad.org/disability/fact_sheet

Rosenbaum, E.H. and Rosenbaum, I. Everyone’s Guide to Cancer Supportive Care. Kansas City: Andrews McMeel Publishing, 2005

Schneider, C.M., Dennehy, C.A. and Carter, S.D. Exercise and Cancer Recovery. Champaign, Illinois: Human Kinetics, 2003

Wilson, R. et al (2005) Pilot study of a home-based aerobic exercise program for sedentary cancer survivors treated with hematopoietic stem cell transplantation, Bone Marrow Transplantation, 35: 721-727

Wilson, R. W., Taliaferro, L.A. and Jacobsen, P.B. 2006. Pilot study of a self-administered stress management and exercise intervention during chemotherapy for cancer. Supportive Care in Cancer 14(9): 928-935

Winningham, M.L. (1991)  Walking Program for people with cancer:  Getting started.  Cancer Nursing, 14, 270-276

Wiskemann, J, Huber, G. (2008) Physical exercise as adjuvant therapy for patients undergoing hematopoietic stem cell transplantation. Bone Marrow Transplantation, 41: 321-329

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