STEPS to Enhance Physical Activity after Hematopoietic Cell Transplantation for Multiple Myeloma

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Topic Significance & Study Purpose/Background/Rationale High dose chemotherapy followed by hematopoietic cell transplantation (HCT) is an intensive cancer treatment associated with devastating complications. Persistent physical inactivity after HCT is sufficient to cause muscle mass loss, decreased strength, physical deconditioning, and potential progression to disability. Sustainable physical activity incorporated into activities of daily living may break this negative cycle. This pilot, randomized controlled trial tested the feasibility and preliminary effects of a free-living physical activity intervention (STEPS) compared to usual care on fatigue (primary outcome), functional ability, muscle strength, physical activity, and quality of life (secondary outcomes) in people with multiple myeloma treated with autologous HCT. Methods, Intervention, & Analysis This study used a two-group, randomized block, repeated measures design (n = 32). The six-week STEPS intervention aimed to increase physical activity by 10% weekly through education, goal-setting, daily step tracking using wearable technology, and guided integration of physical activity into daily routines. Data were collected using self-report questionnaires, physical performance tests, and wrist actigraphy prior to HCT and seven weeks following hospital discharge. Split-plot 2 × 2 ANOVAs were used to analyze the preliminary group (STEPS versus usual care), time (prior to HCT versus seven weeks after hospital discharge), and group x time interactions effects. Findings & Interpretation The STEPS group achieved their daily physical activity goal 53% of the time. Compared to usual care, the STEPS group experienced greater appetite loss (p = .05), more diarrhea (p = .05), and slept more (p = .03). Both groups reported improvements in mental fatigue (p = .02), emotional functioning (p = .01), pain (p = .009), sleep disturbance (p = .001), anger (p = .003), anxiety (p = .001), and depression (p = .02) seven weeks after HCT discharge compared to baseline. Conversely, both groups climbed the stairs slower (p = .003) and had weaker hand-grips (p Discussion & Implications The STEPS intervention is feasible for people with multiple myeloma treated with HCT. Although preliminary, differential improvement in the STEPS group's patient outcomes did not occur (no significant group x time interactions). Both groups reported improved symptoms and experienced some declines in physical function seven weeks after HCT hospital discharge.