Feasibility Of A Progressive Walking-based Exercise Programme In Clonal Plasma Cell Disorders

Abstract

Epidemiological data shows that regular physical activity is associated with reduced risk of developing the blood cancer Myeloma. Myeloma is preceded by the asymptomatic stages Monoclonal Gammopathy of Undetermined Significance (MGUS) and Smouldering Myeloma (SM). International guidelines do not advocate treatment for MGUS and SM, instead disease biomarkers are routinely monitored. The effect of exercise training on MGUS and SM disease activity has not yet been investigated despite evidence that an active lifestyle may reduce Myeloma risk. PURPOSE: Determine the feasibility of a progressive exercise programme for MGUS and SM patients, for subsequent investigation of its effect on disease activity. METHODS: 62 patients (21 MGUS, 41 SM) were invited to participate in a single-arm trial. The exercise programme comprised 2 supervised and 1 home-based session per week for 16 weeks. Supervised exercise involved treadmill walking (30 mins progressing from 40% to 80% V̇O2MAX). At home participants completed a moderate intensity walk for ≥40 mins. Results are mean ± SD. RESULTS: Uptake was 31% and retention was 79%. Ten participants (2 MGUS, 8 SM, 50% male, 60 ± 11 years) have completed the trial to date. Adherence was higher for supervised (91 ± 7%) than home-based (74 ± 26%) sessions. In supervised sessions, compliance to duration was high (98 ± 3%) but compliance to intensity was low (61 ± 20%) due to a drop-off at intensities >70% V̇O2MAX (<70% = 70 ± 30%; >70% = 52 ± 28%). The 40-min home-based walk target was exceeded (47 ± 11 mins). No severe adverse events occurred. CONCLUSION: Exercise is safe for patients with MGUS and SM. Adherence to supervised exercise was high, as was compliance to 30 mins of walking at 40-70% V̇O2MAX. Walking exercise >70% V̇O2MAX was not feasible. Future studies could evaluate interval training to maximise exercise intensity with the aim of delaying disease progression from MGUS and SM to Myeloma. Grants: Physiological Society & University of Bath Alumni Fund