Exercise Improves Frailty Scores in Multiple Myeloma

Jens Hillengass, MD, PhD

Strength training and walking improves the relevant parameters of functional capacity for patients with multiple myeloma (MM) as they undergo systemic treatment, according to findings presented by Jens Hillengass, MD, PhD, at the 20th International Myeloma Society (IMS) held in Athens, Greece and virtually, September 27-30, 2023.¹

The 5 exercises used in the study were activity measure for post-acute care/basic mobility short form, 6-minute walk test, 30-second sit-to-stand test, timed up-and-go test, and pain visual analogue scale. These were used to measure activities of daily living, mobility, endurance, frailty, and pain tolerance in the strength building arm vs the walking arm. Each resulted in a P value of 0.01 at the end of the set duration of 6 months.1 Both groups showed enhanced performance of mobility through the 5 categories for measurement and the 30-second sit-to-stand test showed lasting and improved results post intervention. However, the progress gained with mobility and the timed-up-and-go tests were partially lost post intervention and the 6-minute walk test gains were unchanged.

“The reason for this study is basically because patients ask us to do it. Because [patients with MM] live longer and have deeper remission, they want to go back to their normal life. Oftentimes, the question is, can I do sports? Can I do physical activity? Can I go to the gym? ... Usually, my answer was I don't know, there aren’t a lot of data,” Hillengass, a professor of oncology and internal medicine at Roswell Park Comprehensive Cancer Center, Buffalo, New York, explained. “We know that frailty is a parameter that we measure and that we assess when we see our patients and we decide if they are transplant-eligible or chimeric antigen receptor [CAR] T-cell-eligible. And frailty is something we can work on especially with, in my opinion, physical activity. So, the aims of this study were to assess this impact.”

Physical exercise is known to improve functional performance and patient fitness; however, little is known if patients with MM, especially those with bone disease, can benefit from an exercise regimen. Investigators set out to evaluate data on the safety and efficacy regarding physical exercise for patients with MM in order to enhance functional performance and to see if frailty scores, which is an important risk-factor for patients with MM, can be improved by physical activity.1

Each patient had the choice to participate in 1 of the 2 groups based on exercise intervention type: group one (n = 24) underwent supervised resistance training twice weekly, in person for a duration of 6 months. Group 2 (n = 18) underwent behavioral intervention through remote prompts, to achieve 150 to 300 minutes of walking per week for 6 months. The non-randomized nature of the trial enabled patients to participate despite their distance from the trial institution or COVID-19–related issues; however, 5 patients were unable to complete the trial for various reasons, including COVID-19–related reasons.

Across both cohorts, age (63.9 years vs 62.2 years), body mass index (30.9 kg/m2 vs 29.5 kg/m2; P = .49), and race were similar. Seventeen patients (70.8%) in the strength building cohort compared with 9 patients (50.0%) in the walking cohort were ECOG performance status 0. Seven (29.2%) patients in the strength building arm were ECOG performance status 1 compared with 8 (44.4%) patients in the walking arm.

In the strength building arm, 1 patient (4.2%) had active disease and 23 (95.8%) had inactive disease (P = .26). In the walking arm, 3 patients (16.7%) had active disease and 15 (83.3%) had inactive disease (P = .17). There were 14 (58.3%) female patients in the strength building arm and 12 (66.7%) in the walking arm. The timepoints from baseline were 24% (100.0%) vs 17% (94.4%) to 6-month post-intervention, 19% (79.2%) vs 11% (61.1%; P = 0.36).

Hillengass reported that no patients from either intervention group experienced grade 3 or higher adverse events (AEs), including no new fractures. Musculoskeletal soreness was the main AE reported. The 2 interventions were safe for patients with MM and were effective both immunologically and functionally.

Further evaluation of strength building and walking is underway in the Host-Factor study (NCT05312255),2 which consists of 100 patients who will undergo 6 months of resistant training twice a week. In this study, investigators will measure bone density, body composition pre- and post-intervention, immune flow, quality of life, and fatigue.

“When we combined the 2 exercise groups, we saw an improvement of T-cell exhaustion marker. The ratio between exhausted vs non-exhausted T cells improved for patients pre- and post-intervention, which was encouraging to us. We're looking to evaluate specific antibodies and CAR T cells next,” Hillengass said.

_References

_{1.Hillengass J. Physical activity interventions to improve functional performance in patients with multiple myeloma. Presented at: 2023 International Myeloma Society Annual Meeting; September 27-30, 2023; Athens, Greece. Abstract OA-38.}

_{2. Hillengass J. Improving host factors in patients with monoclonal gammopathies. Roswell Park Comprehensive Cancer Center. Accessed September 28, 2023. https://www.roswellpark.org/clinical-trials/list/4833}