The impact of physical activity on functional performance in multiple myeloma

As treatments for multiple myeloma (MM) improve, patients are experiencing longer remissions. As a result, patients are expressing more interest in returning to activities of daily life, including physical activity (PA), sports, and hobbies. However, MM-associated bone disease has led to reluctance among physicians to recommend PA for MM patients due to the risk of new fractures that could impact frailty status.¹

At the 20th International Myeloma Society (IMS) Annual Meeting, Hillengass presented findings on the impact of PA on functional performance and quality of life in patients with MM. The Multiple Myeloma Hub is pleased to summarize this presentation here.

Study design¹

Over 6 months, 42 patients from a single center were given a choice of participating one of the following cohorts:

• Resistance (strength) training cohort, consisting of twice weekly supervised sessions; or
• Walking cohort, prompted remotely through a fitness tracker to achieve 150–300 active minutes per week.

Throughout this intervention period, and for a further 6 months following study conclusion, patients were assessed for changes in:

• Functional status
• Immune cell subsets
• Quality of life

Patient characteristics¹

This study aimed to assess the feasibility of PA as an intervention; therefore, the patients selected were primarily fit or intermediate-fit and were classified as having non-active disease. Baseline characteristics are outlined in Table 1.

Table 1. Baseline characteristics*

ECOG, Eastern Cooperative Oncology Group performance status. *Adapted from Hillengass.1
Characteristic, % (unless otherwise specified)	Strength (n = 24)	Walking (n = 18)	p value
Mean age (years)	63.9	62.2	0.52
Mean body mass index (kg/m2)	30.9	29.5	0.49
Sex
Female	58.3	66.7	0.58
Male	41.7	33.3
ECOG, baseline
0 fully active	70.8	50	0.26
1 restricted in strenuous activity	29.2	44.4
Disease status
Active disease	4.2	16.7	0.17
Non-active disease	95.8	83.3
Timepoints
Baseline	100.0	94.4	0.36
3-month	83.3	66.7
6-month	79.2	66.7
3-months post-intervention	75.0	61.1
6-months post-intervention	79.2	61.1

Results

Functional status prior to and following the intervention period was determined using five assessments, outlined in Figure 1, to replicate the activities of daily living.

AM-PAC, activity measure for post-acute care.
*Adapted from Hillengass.¹

In both cohorts, a significant improvement was observed in the activity measure for post-acute care (AM-PAC) form and the timed up-and-go test, with these results largely maintained at follow-up. However, in the sit-to-stand test, improvements observed over the trial period slowly decreased to baseline after the intervention ended.

T-cell exhaustion²

The ratio of exhausted to non-exhausted T-cells was lower at the end of the intervention period in all subsets. Changes in programmed cell death protein 1 and/or T-cell immunoreceptor with Ig and ITIM domain exhaustion markers are outlined in Table 3, with significant changes highlighted in bold.

Table 3. Ratio of exhausted to non-exhausted T cells*

PD-1, programmed cell death protein 1; TIGIT, T-cell immunoreceptor with Ig and ITIM domains. *Adapted from Joseph, et al.2
Ratio, median	Baseline	Final	p value
CD4+
PD-1+ or TIGIT+	1.33	1.15	0.14
PD-1+	1.18	0.92	0.17
TIGIT+	0.71	0.57	0.04
TIGIT+ and PD-1+	0.48	0.41	0.10
CD8+
PD-1+ or TIGIT+	2.36	2.13	0.09
PD-1+	1.81	1.48	0.06
TIGIT+	1.91	1.67	0.18
TIGIT+ and PD-1+	1.25	1.01	0.17

Safety¹

• There were no intervention-related Grade ≥3 adverse events.
• Adverse events were primarily musculoskeletal.
• There were no new fractures.

Conclusion

Physical activity in patients with MM is largely safe and had a positive impact on immunological and functional outcomes. There was also a benefit to quality of life and facilitation of patients returning to activities of daily living. A risk remains to patients in respect of musculoskeletal injury and potential subsequent impacts on frailty status. However, with trained supervision to maximize safety, PA offers a feasible intervention to improve the functional status of patients with MM.