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Nicol JL, Cunningham BJ, Woodrow C, Adlard KN, Papinczak ZE, Spence RR, Boytar AN, Mollee P, Weber N, Nicol AJ, Hill MM, Skinner TL. Safety, Feasibility, and Acceptability of a Multisite Individualized Exercise Intervention for People with Multiple Myeloma. Med Sci Sports Exerc 2023; 55:2214-2227. [PMID: 37535331 DOI: 10.1249/mss.0000000000003267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
INTRODUCTION High rates of disease- and treatment-related symptoms, such as bone lesions, in people with multiple myeloma (MM) create uncertainty on the safety and feasibility of exercise. This study determined the safety, feasibility, and acceptability of an individualized exercise medicine program for people with MM at any disease stage. METHODS A multisite, randomized waitlist-controlled trial was conducted of an individualized, high-intensity aerobic, resistance, and impact-loading exercise program. The exercise sessions were supervised twice weekly by accredited exercise physiologists, with one additional unsupervised session per week, for 12 wk. Safety was determined by number of adverse and serious adverse events. Feasibility outcome measures were study eligibility, recruitment, adherence, and attrition. Acceptability was determined by qualitative interviews and subjective levels of enjoyment. RESULTS Of 203 people with MM screened, 88% were eligible, with 34% accepting participation (60 people) and 20% attrition for the between-group analysis, meeting a priori criteria (≥25% and <25%, respectively). No adverse or serious adverse events attributed to testing and/or exercise training were reported. Attendance at supervised exercise sessions was 98%, with 45% completion of the home-based exercise sessions. Adherence rates were 35%, 63%, and 34% for the aerobic, resistance, and impact-loading protocols, with 55%, 80%, and 37% of participants meeting a priori criteria (75% of protocol). Acceptability of the exercise program was high (mean, 82%; 95% confidence interval, 78%-87%) and highly supported by qualitative responses. CONCLUSIONS An individualized, high-intensity aerobic, resistance, and impact-loading exercise medicine program is safe and acceptable, and feasible by some measures for people with MM. Adherence to the prescribed exercise protocols was limited by comorbidities and disease symptoms. Strategies to improve unsupervised exercise completion are warranted in this population.
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Affiliation(s)
| | - Brent J Cunningham
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, AUSTRALIA
| | - Carmel Woodrow
- Haematology Department, Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, AUSTRALIA
| | - Kirsten N Adlard
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, AUSTRALIA
| | - Zoe E Papinczak
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, AUSTRALIA
| | | | - Alexander N Boytar
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, AUSTRALIA
| | | | - Nicholas Weber
- Haematology, Cancer Care Services, Royal Brisbane and Women's Hospital, Queensland, AUSTRALIA
| | - Andrew J Nicol
- Brisbane Clinic for Lymphoma, Myeloma and Leukaemia, Greenslopes Private Hospital, Brisbane, Queensland, AUSTRALIA
| | | | - Tina L Skinner
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, AUSTRALIA
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2
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Goodhew RE, Edwards BA. The effect of exercise interventions on quality of life in patients with multiple myeloma: a systematic review and meta-analysis of randomised controlled trials. Clin Exp Med 2023; 23:3217-3230. [PMID: 37029311 DOI: 10.1007/s10238-023-01058-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/28/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE To determine the effect of exercise interventions on quality of life in adults with multiple myeloma. METHODS A literature search of 10 sources was performed in June 2022 to identify eligible studies for synthesis. INCLUSION CRITERIA randomised controlled trials comparing the effect of exercise interventions with usual care in adults with a diagnosis of multiple myeloma. The risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials. Meta-analysis was performed using a random-effects model with inverse variance and 95% confidence intervals. Forest plots were constructed to present pooled data. RESULTS Five RCTs, which included a total of 519 participants, were selected for inclusion. Four of the five studies were included in the meta-analysis. The mean participant age ranged from 55 to 67 years old. All studies included an aerobic exercise component. Intervention length ranged from 6 to 30 weeks. Meta-analysis of 118 participants showed that exercise interventions had no impact on global quality of life (MD = 2.15, 95% CI: - 4.67, 8.97, p = 0.54, I2 = 0%). Exercise interventions negatively impacted participant grip strength (MD: - 3.69, 95% CI: - 7.12, -0.26, p = 0.03, I2 = 0%) according to pooled data from 186 participants. CONCLUSION Exercise interventions have no positive impact on the quality of life of patients with multiple myeloma. The analysis is limited by a high risk of bias across included studies and low certainty evidence. Further high-quality trials are needed to assess the role of exercise in patients with multiple myeloma.
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Affiliation(s)
- Rebecca E Goodhew
- East and North Hertfordshire NHS Trust, Hertfordshire, UK.
- University of Cambridge, Cambridge, UK.
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3
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Nicol JL, Chong JE, McQuilten ZK, Mollee P, Hill MM, Skinner TL. Safety, Feasibility, and Efficacy of Exercise Interventions for People With Multiple Myeloma: A Systematic Review. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:86-96. [PMID: 36450625 DOI: 10.1016/j.clml.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/08/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022]
Abstract
Bone lesions and other disease- and treatment-related side effects commonly experienced by people with multiple myeloma (MM) may impede their ability to exercise. This systematic review evaluated the safety, feasibility, and efficacy of exercise program participation on the physiological and/or psychological health of people with MM. Literature searches were conducted through five electronic databases and appraised using the Delphi list of criteria. Controlled trials that assessed the safety and feasibility of an exercise intervention and its effects on disease- or treatment-related symptoms in people with MM were included. Seven studies of varying quality involving 563 participants were included. All studies concluded that exercise was safe, reporting zero serious and 4 adverse events attributable to exercise testing or training. Attendance ranged from 58% to 96%, however no study reported adherence to the exercise prescription. Compared to a control group, exercise did not appear to affect fatigue, depression, anxiety, body composition, quality of life, or sleep. Isolated studies identified between-group differences favoring exercise in lower limb strength (+8.4 kg, 95% CI 0.5, 16.3, P= .04), peak oxygen uptake (+1.2 mL/kg/min, 95% CI 0.3, 3.7, P= .02), physical activity (+6.5MET-hs/wk, P< .001), stem cell collection attempts (1.1 ± 0.2 vs. 1.5 ± 0.9, P< .01), and red blood cell (1.8 ± 2.2 vs. 2.4 ± 2.6, P< .05) and platelet transfusions (2.3 ± 1.6 vs. 3.5 ± 3.4, P < .05) during transplantation. Exercise interventions appear safe and well attended by people with MM. The lack of improvements in disease- and treatment-related symptoms requires further exploration to determine whether exercise is a sufficient stimulus to elicit benefits in this unique population.
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Affiliation(s)
- Jennifer L Nicol
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia.
| | - Jamie E Chong
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Zoe K McQuilten
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Peter Mollee
- Haematology Department, Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia
| | - Michelle M Hill
- QIMR Berghofer Medical Research Institute, Brisbane, Australia; UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Tina L Skinner
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
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4
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Lu HB, Ma RC, Yin YY, Song CY, Yang TT, Xie J. Clinical Indicators of Effects of Yoga Breathing Exercises on Patients With Lung Cancer After Surgical Resection: A Randomized Controlled Trial. Cancer Nurs 2023; Publish Ahead of Print:00002820-990000000-00105. [PMID: 36716034 DOI: 10.1097/ncc.0000000000001208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cancer itself and surgery pose a heavy burden on adults with lung cancer. Yoga breathing exercises have been proposed as a form of pulmonary rehabilitation exercises to improve these patients' perioperative outcomes. OBJECTIVE To investigate the impact of yoga breathing exercises based on a problem-solving model on dyspnea, exercise capacity, anxiety, depression, and postoperative indwelling time of thoracic drainage tube and compliance in adults with lung cancer undergoing surgery. METHODS One hundred eight lung cancer patients were randomly assigned to receive problem-solving model-based yoga breathing exercises, yoga breathing exercises, or usual care. Outcomes were collected at admission, the day before surgery, and at discharge. RESULTS Patients in the combined intervention group showed a significantly greater improvement in dyspnea, exercise capacity, and anxiety compared with the control group. Yoga breathing training can significantly improve patients' dyspnea and anxiety. Significant difference favoring the combined group was observed in exercise capability and compliance between the 2 intervention groups. However, there was no significant difference in depression or indwelling time of thoracic drainage tube among the 3 groups at any time point. CONCLUSION Findings indicate that yoga breathing exercises are effective in alleviating perioperative symptoms of lung resection patients. Compared with yoga breathing exercises, applying additional problem-solving model may achieve a better effect. IMPLICATIONS FOR PRACTICE Yoga breathing exercises can be considered as a promising pulmonary rehabilitation strategy for lung cancer patients with surgery. The problem-solving model could be integrated into yoga breathing exercises in clinical practice to enhance the rehabilitation effect.
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Affiliation(s)
- Han-Bing Lu
- Author Affiliations: School of Nursing, Jilin University, Changchun, Jilin Province, China
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Colton A, Smith MA, Broadbent S, Rune KT, Wright HH. Perceptions of Older Adults with Hematological Cancer on Diet and Exercise Behavior and Its Role in Navigating Daily Tasks. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15044. [PMID: 36429764 PMCID: PMC9690783 DOI: 10.3390/ijerph192215044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/08/2022] [Accepted: 11/12/2022] [Indexed: 06/16/2023]
Abstract
Diet and exercise are associated with the maintenance of physical function, independence and better health-related quality of life in cancer survivors. Adherence to healthy diet and exercise guidelines, however, remains low. The aim of this study was to explore the perceptions of hematological cancer survivors (HCS, ≥50 years) on the role of diet and exercise in navigating daily tasks using a qualitative descriptive research method. Eligible HCS completed an online survey gathering demographic information including physical functioning, exercise frequency, malnutrition and frailty risk. Following a semi-structured telephone interview, thematic analysis was used. Nine HCS (67 ± 2 years) were included in the final analysis, with 55.5% sufficiently active, three at risk of malnutrition and five of frailty. Three primary themes reflected the survivors' perceptions: (1) beliefs about the impact of diet and exercise on physical and mental wellbeing, (2) the ability to overcome barriers to adhere to healthy diet and exercise behavior, and (3) diet and exercise empowered and gave hope. Participants had a more nuanced understanding of the role of exercise in physical function but lacked insight into the role of a healthy diet. Knowledge, support and instruction were key enablers of diet and exercise behavior, with community connection a unique enabler identified in this group.
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Affiliation(s)
- Alana Colton
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sunshine Coast, QLD 4556, Australia
| | - Monica A. Smith
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sunshine Coast, QLD 4556, Australia
- Australian Centre for Pacific Islands Research, University of the Sunshine Coast, Sunshine Coast, QLD 4556, Australia
| | - Suzanne Broadbent
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sunshine Coast, QLD 4556, Australia
| | - Karina T. Rune
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sunshine Coast, QLD 4556, Australia
| | - Hattie H. Wright
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sunshine Coast, QLD 4556, Australia
- Sunshine Coast Health Institute, Birtinya, QLD 4575, Australia
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6
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Purdy GM, Venner CP, Tandon P, McNeely ML. Feasibility of a tailored and virtually supported home exercise program for people with multiple myeloma using a novel eHealth application. Digit Health 2022; 8:20552076221129066. [PMID: 36249481 PMCID: PMC9554139 DOI: 10.1177/20552076221129066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction eHealth exercise interventions have the unique ability to leverage the benefits of in-person programming (tailoring and supervision) with the benefits of home programming (flexibility). There may be a role for eHealth-delivered exercise for people with multiple myeloma (MM), as exercise tailoring and supervision are critical for successful outcomes due to the significant impacts/risks of myeloma-related side effects. The purpose of this study was to determine the safety, feasibility, and preliminary efficacy of a 12-week virtually supported eHealth exercise program. Methods Participants with MM completed a 12-week virtually supported home exercise program involving virtually supervised group workouts, independent workouts, and aerobic exercise. Tailoring was facilitated by the functionality of HEAL-Me, a novel eHealth app. Participants completed virtual fitness assessments and questionnaires at baseline and week 12. Results Twenty-nine participants consented, 26 completed all follow-up testing (90%). Exercise adherence was 90% (group), 83% (independent), and 90% (aerobic). No serious adverse events (grade ≥3) occurred. Significant improvements were found for quality of life and physical fitness. There was a high level of program/app satisfaction: 96% of participants agreed or strongly agreed that the exercise program was beneficial, 93% found it enjoyable, 89% were satisfied or very satisfied with delivery through the HEAL-Me app, and 48% felt that the eHealth program helped them manage cancer-related symptoms and side-effects. Conclusion An eHealth intervention that is individually tailored and includes virtual supervision and active support from the healthcare team is feasible and acceptable to people with MM. The findings from this study warrant investigation using a large-scale randomized controlled trial.
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Affiliation(s)
- Graeme M. Purdy
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada,Margaret L. McNeely, Department of Physical Therapy, Faculty of Rehabilitation Medicine, Department of Oncology, Cross Cancer Institute, University of Alberta, 3-44L Corbett Hall, Edmonton, Alberta, Canada.
| | | | - Puneeta Tandon
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Margaret L. McNeely
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada,Cross Cancer Institute, Edmonton, Canada
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Misiąg W, Piszczyk A, Szymańska-Chabowska A, Chabowski M. Physical Activity and Cancer Care—A Review. Cancers (Basel) 2022; 14:cancers14174154. [PMID: 36077690 PMCID: PMC9454950 DOI: 10.3390/cancers14174154] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/01/2022] [Accepted: 08/23/2022] [Indexed: 11/22/2022] Open
Abstract
Simple Summary The aim of this paper is to outline the role and potential benefits of physical activity for cancer patients. We present a review of publications on the subject in order to compare the findings reported in the literature and draw general conclusions that could help clinicians who provide cancer care to develop a more comprehensive treatment approach. This review may also help patients overcome barriers and become more motivated to take up physical activity, which would improve their quality of life. We wish to demonstrate to patients that physical activity should not be regarded as a burdensome medical recommendation but rather as a factor that can reduce the risk of cancer mortality and recurrence. Abstract In 2020, 19.3 million new cancer cases were diagnosed, and almost 10 million deaths from cancer were recorded. Cancer patients may experience fatigue, depression, anxiety, reduced quality of life and sleep problems. Cancer treatments cause numerous side effects and have a negative impact on all body systems. Physical activity is important for cancer patients. The aim of this review is to analyse recent studies on the role of physical activity in cancer patients and emphasize its importance. The review included 36 papers published in English between 2017 and 2021. The findings from these studies show that physical activity decreases the severity of side effects of cancer treatment, reduces fatigue, improves quality of life, has a positive impact on mental health and improves aerobic fitness in cancer patients. Moreover, it reduces the risk of cancer recurrence and death. Physical activity is recommended for patients with any type of cancer and at all stages of treatment. The type of physical activity should depend on the condition of the individual patient. It is extremely difficult to determine what type, intensity and duration of physical activity is likely to have the greatest effect.
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Affiliation(s)
- Weronika Misiąg
- Student Research Club No. 180, Faculty of Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Anna Piszczyk
- Student Research Club No. 180, Faculty of Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Anna Szymańska-Chabowska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Mariusz Chabowski
- Department of Nursing and Obstetrics, Faculty of Health Science, Wroclaw Medical University, 51-618 Wroclaw, Poland
- Department of Surgery, 4th Military Teaching Hospital, 50-981 Wroclaw, Poland
- Correspondence: ; Tel.: +48-691-097-454
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Rosko AE, Huang Y, Jones D, Presley CJ, Jaggers J, Owens R, Naughton M, Krok-Schoen JL. Feasibility of implementing an exercise intervention in older adults with hematologic malignancy. J Geriatr Oncol 2022; 13:234-240. [PMID: 34446377 PMCID: PMC8863976 DOI: 10.1016/j.jgo.2021.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 05/20/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
Older adults with Hematologic Malignancy (HM) are vulnerable to functional decline secondary to disease and treatment. Interventions for physical deconditioning, in concert with routine hematology care are limited. The feasibility of accrual, retention, and demand for an exercise intervention among a high-risk HM population was piloted. METHODS Older adults with HM, on active treatment, with functional impairment were recruited prospectively to participate in a 6-month Otago Exercise Programme (OEP). Measures of motivation, self-efficacy, patient identified barriers to exercise, barriers to clinical trial enrollment, study satisfaction, and serious adverse events were captured. RESULTS 63 patients were approached, 18 declined trial enrollment, 45 consented, 30 patients enrolled in the exercise program. The main barrier for trial enrollment was transportation/travel concerns (n = 15). Of the 45 consented participants, 8 (12.7%) dropped out due to clinical deterioration, 5 (7.9%) withdrew, and 2 (3.2%) were ineligible prior to exercise-intervention intiation. The median age was 75.5 years (range 62-83) with plasma cell dyscrasia (63%), non-Hodgkin lymphoma (20%) and leukemia (17%). Retention of the physical therapist (PT) led-OEP was 76.6% of patients (n = 23/30), and end-of-study retention was 66.7% (n = 20/30). Of the evaluable patients, 23/29 completed the PE-led OEP yielding a completion rate of 79%. Participants were extremely motivated (72.4%) and strongly intended (89.7%) to engage in regular physical activity. Exercising when tired increased from a median score of 50 at Visit 1 to 70 at Visit 2, but dropped significantly to 45 at Visit 3 (p < 0.001). Participants reported significantly lower self-efficacy to exercise over the next 6 months from Visit 1 to Visit 3 (p = 0.001). CONCLUSIONS Older patients with HM had higher completion of in-person, PT-led exercise compared to at-home, independent exercise. Older adults were motivated and found the program acceptable, yet the ability to sustain a structured exercise program was challenging due to changes in health status. ClinicalTrials.gov Identifier: NCT02791737.
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Affiliation(s)
- Ashley E. Rosko
- The Ohio State University Comprehensive Cancer Center, Columbus, OH,Division of Hematology, The Ohio State University, Columbus, OH,Corresponding author at: A345 Starling Loving Hall, 320 W. 10th Ave., Columbus, OH 43210,
| | - Ying Huang
- Division of Hematology, The Ohio State University, Columbus, OH
| | - Desiree Jones
- Division of Hematology, The Ohio State University, Columbus, OH
| | - Carolyn J. Presley
- The Ohio State University Comprehensive Cancer Center, Columbus, OH,Division of Medical Oncology, The Ohio State University, Columbus, OH
| | - Jordon Jaggers
- College of Medicine, The Ohio State University, Columbus, OH
| | - ReNea Owens
- Rehabilitation Services, The Ohio State University, Columbus, OH
| | - Michelle Naughton
- The Ohio State University Comprehensive Cancer Center, Columbus, OH,Cancer Prevention and Control, The Ohio State University, Columbus, OH
| | - Jessica L. Krok-Schoen
- The Ohio State University Comprehensive Cancer Center, Columbus, OH,Division of Medical Dietetics and Health Sciences, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH
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Clinical exercise therapy program with multiple myeloma patients: Impacts on feasibility, adherence and efficacy. Support Care Cancer 2022; 30:9615-9623. [PMID: 36190557 PMCID: PMC9633464 DOI: 10.1007/s00520-022-07369-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/18/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Multiple myeloma (MM) is a severe hemato-oncological disease with high mortality and increasing incidence rate. Since evidence on exercise therapy in MM patients remains limited, this study examines feasibility, adherence, and efficacy based on real-life data from an oncologic care structure. METHODS A data evaluation of MM patients who participated in the oncologic exercise and movement therapy (OTT) at the Cologne University Hospital between 2012 and 2019 was conducted. The patient flow was incrementally reduced to four cohorts, intention-to-treat cohort (ITTC), safety cohort (SC), adherence cohort (AC), and efficacy cohort (EC). Cohorts were evaluated descriptively and by means of correlation analysis as well as group and time comparisons. RESULTS Thirty patients registered at the OTT between 2012 and 2019 (ITTC). The SC (N = 26) attended exercise therapy on average about one session per week over a period of 8 months. One-third dropped out within 3 months. In the AC (N = 15), BMI at baseline exhibited a strong and very significant negative correlation with exercise adherence. In the EC (N = 8), a significant improvement in physical functioning and a tendency towards significance in fatigue reduction between two measurement points was observed. No adverse events were documented. CONCLUSIONS The present observatory study reveals safety and feasibility while indicating adherence and efficacy of exercising MM patients under real-life therapy circumstances. Found obstacles to exercising as well as improvements in questionnaire scale scores need to be further examined in confirmatory study designs.
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10
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Physical Activity in People with Multiple Myeloma: Associated Factors and Exercise Program Preferences. J Clin Med 2020; 9:jcm9103277. [PMID: 33066153 PMCID: PMC7601964 DOI: 10.3390/jcm9103277] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/04/2020] [Accepted: 10/08/2020] [Indexed: 11/26/2022] Open
Abstract
People with multiple myeloma (MM) often experience disease symptoms and treatment toxicities that can be alleviated through physical activity (PA). However, the majority of people with MM are insufficiently active. This study explored PA among people with MM, including differences by treatment stage, symptoms and demographics, and programming preferences. Overall, 126 people with MM (77% response rate) completed the survey. Pre-diagnosis, 25.4% were sufficiently active, with 12.0% remaining active after treatment. Respondents who were physically active pre-diagnosis were 46.7 times (95% confidence intervals CI: 2.03, 1072.1) more likely to meet PA guidelines following an MM diagnosis compared to people not meeting guidelines pre-diagnosis. Experiencing MM symptoms and receiving PA advice from healthcare professionals were not associated with meeting PA guidelines. People with MM were interested in exercise programs (55%) that are low-cost (77%), offered at flexible times (74%), and at locations close to home (69%), both during active treatment and remission (57%), and supervised by an exercise oncology specialist (48%). People with MM, particularly those insufficiently active prior to diagnosis, should be offered convenient, low-cost exercise programs supervised by an exercise oncology specialist to increase PA participation.
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11
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Jeevanantham D, Rajendran V, McGillis Z, Tremblay L, Larivière C, Knight A. Mobilization and Exercise Intervention for Patients With Multiple Myeloma: Clinical Practice Guidelines Endorsed by the Canadian Physiotherapy Association. Phys Ther 2020; 101:5911069. [PMID: 32975563 PMCID: PMC7781094 DOI: 10.1093/ptj/pzaa180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/10/2020] [Indexed: 12/04/2022]
Abstract
OBJECTIVE Individuals with multiple myeloma (MM) often have reduced functional performance due to the cancer itself or as a direct side effect of cancer treatments. Physical therapy is a part of cancer rehabilitation; however, no guidelines are available to provide information and direction for physical therapists managing patients with MM. The goal of this guideline is to provide recommendations based on a systematic review and consensus process that physical therapists can use to manage patients with MM. METHODS A systematic review of the literature published until August 2018 was performed in 8 databases with 2 independent reviewers assessing quality. Seventeen articles were identified as relevant, and a draft guideline was developed in the form of action statements. A total of 10 physical therapists with hematology experience and 10 patients with MM were recruited for consensus process. A priori threshold of 80% agreement was used to establish a consensus for each statement. The draft guidelines were reviewed externally by 4 methodologists using the AGREE II tool and a stakeholder representing OH (Cancer Care Ontario) Program in Evidence Based Care, McMaster University. The final guideline was reviewed and officially endorsed by the Canadian Physiotherapy Association. RESULTS A total of 30 action statements were developed that achieved consensus, indicating physical therapy recommendations based on physiological markers (ie, hemoglobin, platelet count), complete patient presentation, and the stage of medical treatment. CONCLUSION These clinical practice guidelines were developed to aid physical therapists in implementing evidence-based and best-practice care for patients with MM to optimize rehabilitation outcomes. IMPACT These guidelines fill an important knowledge gap and are the first to provide information specifically for physical therapist management of patients with MM.
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Affiliation(s)
- Deepa Jeevanantham
- Health Sciences North, Sudbury, Ontario, Canada,Northern Ontario School of Medicine, School of Human Kinetics, Laurentian University, Sudbury, Ontario, Canada,Address all correspondence to Dr. Jeevanantham at:
| | - Venkadesan Rajendran
- Health Sciences North, Sudbury, Ontario, Canada,Northern Ontario School of Medicine, School of Human Kinetics, Laurentian University, Sudbury, Ontario, Canada
| | | | - Line Tremblay
- Clinical Sciences Division, Northern Ontario School of Medicine, Laurentian University, Sudbury, Ontario, Canada
| | - Céline Larivière
- Medical Sciences Division, Northern Ontario School of Medicine, School of Human Kinetics, Laurentian University, Sudbury, Ontario, Canada
| | - Andrew Knight
- Northern Ontario School of Medicine, School of Human Kinetics, Laurentian University, Sudbury, Ontario, Canada
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12
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Servadio M, Cottone F, Sommer K, Oerlemans S, van de Poll-Franse L, Efficace F. Physical activity and health-related quality of life in multiple myeloma survivors: the PROFILES registry. BMJ Support Palliat Care 2019; 10:e35. [PMID: 31253733 DOI: 10.1136/bmjspcare-2018-001755] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 05/13/2019] [Accepted: 05/29/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To investigate whether physical activity (PA) is associated with health-related quality of life (HRQOL) outcomes in multiple myeloma (MM) survivors up to 11 years after diagnosis. METHODS We used data from the Patient Reported Outcomes Following Initial treatment and Long term Evaluation of Survivorship registry. We included 175 MM survivors diagnosed between 1999 and 2009 as registered by the Netherlands Cancer Registry. Sixty-four per cent (n=112/175) of patients who received the questionnaires, completed the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and the EORTC QLQ-MY20. Patients were classified into two groups: physically active and not physically active patients. Univariable and multivariable linear regression models were used to evaluate associations between PA and HRQOL outcomes. RESULTS Physically active patients reported a statistically significant higher global health status/HRQOL (p=0.001), lower fatigue (p=0.002) and fewer side effects of treatments (p=0.001), than not physically active patients. PA was not associated with psychological symptoms (ie, anxiety and depressive symptoms) (anxiety: p=0.139; depressive symptoms: p=0.073). Exploratory analyses performed on the other scales of the EORTC QLQ-C30 indicated statistically significant better outcomes in several functional and symptom subscales for physically active patients. CONCLUSIONS These findings might contribute to a better understanding of the relationship between PA and disease specific HRQOL aspects in MM survivors. Prospective studies are warranted to further elucidate on the beneficial effects of PA on HRQOL outcomes of MM survivors.
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Affiliation(s)
- Michela Servadio
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Francesco Cottone
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Kathrin Sommer
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Simone Oerlemans
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Lonneke van de Poll-Franse
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg, the Netherlands.,Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Fabio Efficace
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
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13
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Cha S, Kim I, Lee SU, Seo KS. Effect of an Inpatient Rehabilitation Program for Recovery of Deconditioning in Hematologic Cancer Patients After Chemotherapy. Ann Rehabil Med 2019; 42:838-845. [PMID: 30613077 PMCID: PMC6325318 DOI: 10.5535/arm.2018.42.6.838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 07/02/2018] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the effect of a rehabilitation program in terms of De Morton Mobility Index (DEMMI) score, in hematologic cancer patients after chemotherapy. METHODS Hematologic cancer patients admitted for chemotherapy were reviewed. They received a rehabilitation program during their hospital stay. DEMMI score measurement was performed, before and after rehabilitation. Demographics, diagnosis, chemotherapy information, rehabilitation program duration, mortality, body mass index (BMI), and laboratory test results were collected. For analysis, patients were classified according to diagnosis (multiple myeloma, leukemia, and others), mortality, and additional chemotherapy. RESULTS There was statistically significant improvement in DEMMI score of 10.1 points (95% confidence interval, 5.9-14.3) after rehabilitation. It was more evident in the multiple myeloma group, and they revealed less mortality. When patients were divided according to mortality, survivors received the program earlier, and in a shorter period than in mortality cases. Although survivors revealed higher initial DEMMI score, improvement after rehabilitation did not differ significantly. CONCLUSION In hematologic cancer patients, rehabilitation program was effective for recovery from deconditioning, revealing significant increase in DEMMI score. Multiple myeloma patients may be good candidates for rehabilitation. Rehabilitation could be sustained during chemotherapy and for high-risk patients.
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Affiliation(s)
- Seungwoo Cha
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Inho Kim
- Division of Hematology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Kwan Sik Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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14
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Islam MS. Treat patient, not just the disease: holistic needs assessment for haematological cancer patients. Oncol Rev 2018; 12:374. [PMID: 30283608 PMCID: PMC6151346 DOI: 10.4081/oncol.2018.374] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/20/2018] [Indexed: 12/25/2022] Open
Abstract
Haematological malignancies can have devastating effects on the patients' physical, emotional, psycho-sexual, educational and economic health. With the improvement of therapies patients with these malignancies are living longer, however significant proportion these patient show poor quality of life (QoL) due to various physical and psychological consequences of the disease and the treatments. Health-related QoL (HRQoL) is multi-dimensional and temporal, relating to a state of functional, physical, psychological and social/family well-being. Compared with the general population, HRQoL of these patients is worse in most dimensions. However without routine holistic need assessment (HNA), clinicians are unlikely to identify patients with clinically significant distress. Surviving cancer is a chronic life-altering condition with several factors negatively affecting their QoL, such as psychological problems, including depression and excessive fear of recurrence, as well as social aspects, such as unemployment and social isolation. These need to be adequately understood and addressed in the healthcare of long-term survivors of haematological cancer. Applying a holistic approach to patient care has many benefits and yet, only around 25% of cancer survivors in the UK receive a holistic needs assessment. The efforts of the last decade have established the importance of ensuring access to psychosocial services for haematological cancer survivors. We need to determine the most effective practices and how best to deliver them across diverse settings. Distress, like haematological cancer, is not a single entity, and one treatment does not fit all. Psychosocialoncology needs to increase its research in comparative effectiveness.
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Affiliation(s)
- Md Serajul Islam
- Department of Haematology, Guy's & St. Thomas Hospital, London.,Department of Haematology, Broomfield Hospital, Chelmsford, UK
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15
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Rome S, Noonan K, Bertolotti P, Tariman J, Miceli T, Board A. Bone Health, Pain, and Mobility: Evidence-Based Recommendations for Patients With Multiple Myeloma. Clin J Oncol Nurs 2017; 21:47-59. [DOI: 10.1188/17.cjon.s5.47-59] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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Dalzell MA, Smirnow N, Sateren W, Sintharaphone A, Ibrahim M, Mastroianni L, Vales Zambrano LD, O'Brien S. Rehabilitation and exercise oncology program: translating research into a model of care. ACTA ACUST UNITED AC 2017; 24:e191-e198. [PMID: 28680286 DOI: 10.3747/co.24.3498] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The Rehabilitation and Exercise Oncology model of care (ActivOnco) was established to optimize cancer survivorship through exercise prescription and active lifestyle promotion, providing a transition of care from hospital to community. Patients having any cancer diagnosis, stage of disease, and treatment were eligible for evaluation and exercise prescription upon deterioration of performance status. The team of professionals included hospital-based physiotherapists proactively screening for rehabilitation needs, loss of functional independence, and exercise eligibility, plus exercise specialists in a community-based Wellness Centre to provide follow-up or direct access for post-treatment or non-complex patients. METHODS From January 2011 to December 2015, the hospital team assessed 1635 patients representing all major cancer sites, and the Wellness Centre team evaluated and prescribed exercise for 1066 participants. Primary interventions provided were education about fatigue management, physical activity promotion, exercise prescription, fracture risk reduction, referral to specialized follow-up services (for example, occupational therapy, lymphedema clinic), and coordination for mobility aids and paratransit services. RESULTS AND CONCLUSIONS Implementation of the ActivOnco model of care showed that exercise alone is not a panacea for all functional deterioration associated with the cancer trajectory and its treatment. However, screening to identify rehabilitation needs combined with exercise prescription can effectively improve the quality of survivorship in cancer patients. Program developments are limited by the cost of human resources, lack of hospital-based physical resources, and lack of public funding, all of which significantly limit the scope and development of appropriate services.
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Affiliation(s)
- M A Dalzell
- Hope and Cope, Jewish General Hospital, Montreal, QC
| | - N Smirnow
- Hope and Cope, Jewish General Hospital, Montreal, QC
| | - W Sateren
- Hope and Cope, Jewish General Hospital, Montreal, QC.,Rossy Cancer Network, Montreal, QC.,Segal Cancer Centre, Jewish General Hospital, Montreal, QC
| | | | - M Ibrahim
- Hope and Cope, Jewish General Hospital, Montreal, QC
| | - L Mastroianni
- Hope and Cope, Jewish General Hospital, Montreal, QC
| | | | - S O'Brien
- Hope and Cope, Jewish General Hospital, Montreal, QC
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17
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Snowden JA, Greenfield DM, Bird JM, Boland E, Bowcock S, Fisher A, Low E, Morris M, Yong K, Pratt G. Guidelines for screening and management of late and long-term consequences of myeloma and its treatment. Br J Haematol 2017; 176:888-907. [PMID: 28107574 DOI: 10.1111/bjh.14514] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A growing population of long-term survivors of myeloma is now accumulating the 'late effects' not only of myeloma itself, but also of several lines of treatment given throughout the course of the disease. It is thus important to recognise the cumulative burden of the disease and treatment-related toxicity in both the stable and active phases of myeloma, some of which is unlikely to be detected by routine monitoring. We summarise here the evidence for the key late effects in long-term survivors of myeloma, including physical and psychosocial consequences (in Parts 1 and 2 respectively), and recommend the use of late-effects screening protocols in detection and intervention. The early recognition of late effects and effective management strategies should lead to an improvement in the management of myeloma patients, although evidence in this area is currently limited and further research is warranted.
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Affiliation(s)
- John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Diana M Greenfield
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Department of Oncology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jennifer M Bird
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Elaine Boland
- Palliative Medicine, Queen's Centre for Oncology and Haematology, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Stella Bowcock
- King's College Hospital NHS Foundation Trust, London, UK
| | | | | | | | - Kwee Yong
- University College London, London, UK
| | - Guy Pratt
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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18
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Dowling M, Kelly M, Meenaghan T. Multiple myeloma: managing a complex blood cancer. ACTA ACUST UNITED AC 2016; 25:S18-28. [DOI: 10.12968/bjon.2016.25.s18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Maura Dowling
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Mary Kelly
- Advanced Nurse Practitioner (Haematology), Midlands Regional Hospitals, County Offaly, Ireland
| | - Teresa Meenaghan
- Advanced Nurse Practitioner (Haematology) Galway University Hospital, Galway, Ireland
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19
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Giganti MG, Tresoldi I, Sorge R, Melchiorri G, Triossi T, Masuelli L, Lido P, Albonici L, Foti C, Modesti A, Bei R. Physical exercise modulates the level of serum MMP-2 and MMP-9 in patients with breast cancer. Oncol Lett 2016; 12:2119-2126. [PMID: 27602150 DOI: 10.3892/ol.2016.4887] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 05/19/2016] [Indexed: 12/16/2022] Open
Abstract
Matrix metalloproteinases (MMPs) exhibit an important function in extracellular matrix degradation. MMPs modulate the activation of growth factors, cytokines and metastasis. At present, the effect of exercise on serum levels of MMP-2 and -9 remains unclear. The aim of the present study was to investigate the effect of various physical activities on the circulating levels of MMP-2 and -9 in breast cancer (BC) survivors and healthy subjects. A total of 66 female subjects were enrolled in the present study. The cohort included 46 BC survivors and 20 healthy subjects divided into 5 groups: Group A (17 BC survivors, participating in recreational dragon boat paddling), group B (14 BC survivors, participating in recreational physical activity), group C (15 sedentary BC survivors), group D (10 healthy subjects, participating in recreational physical activity) and group E (10 sedentary healthy subjects). ELISA assays revealed a significant increase in the level of circulating MMP-2 in group B compared with all other groups. Recreational physical activity increased the levels of MMP-9 in healthy subjects (group D vs. E), however, the differences were not statistically significant, while in the BC survivor groups the results were opposite, with exercise reducing MMP-9 levels (group B vs. C). Furthermore, a significant increase in MMP-2 was observed in group B lymph node metastasis-positive (N+) subjects compared with group A and C N+ subjects. Thus, the results of the present study indicate that various physical activities modulate the levels of circulating MMP-2 and -9 in BC survivors, and the same exercise program induces a different effect when undertaken by healthy subjects and BC survivors. These results may have important implications with regard to the selection of appropriate physical activities for BC survivors, leading to improvements to their survival and prevention of recurrence, as well as amelioration of physical function, quality of life and fatigue.
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Affiliation(s)
- Maria Gabriella Giganti
- Department of Clinical Sciences and Translational Medicine, University of Rome 'Tor Vergata', Rome 00133, Italy
| | - Ilaria Tresoldi
- Department of Clinical Sciences and Translational Medicine, University of Rome 'Tor Vergata', Rome 00133, Italy
| | - Roberto Sorge
- Department of Systems Medicine, University of Rome 'Tor Vergata', Rome 00133, Italy
| | - Giovanni Melchiorri
- Department of Systems Medicine, University of Rome 'Tor Vergata', Rome 00133, Italy
| | - Tamara Triossi
- Department of Systems Medicine, University of Rome 'Tor Vergata', Rome 00133, Italy
| | - Laura Masuelli
- Department of Experimental Medicine, University of Rome 'Sapienza', Rome 00185, Italy
| | - Paolo Lido
- Internal Medicine Residency Program, University of Rome 'Tor Vergata', Rome 00133, Italy
| | - Loredana Albonici
- Department of Clinical Sciences and Translational Medicine, University of Rome 'Tor Vergata', Rome 00133, Italy
| | - Calogero Foti
- Department of Clinical Sciences and Translational Medicine, University of Rome 'Tor Vergata', Rome 00133, Italy
| | - Andrea Modesti
- Department of Clinical Sciences and Translational Medicine, University of Rome 'Tor Vergata', Rome 00133, Italy
| | - Roberto Bei
- Department of Clinical Sciences and Translational Medicine, University of Rome 'Tor Vergata', Rome 00133, Italy
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