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Rebuilding bone with exercise in multiple myeloma

This study’s objectives are to determine the effect of highly targeted exercise on the bone health and quality of life of people with multiple myeloma.

Researcher: Tina Skinner
Grant type: Regular Grant Programme
Countries: Australia
Cancer types: Haematological
Exposures: Physical activity
Status: Ongoing
Area: Cancer survivorship

Background

Multiple myeloma is an incurable cancer of bone marrow. While new therapies can extend life expectancy, people with multiple myeloma are left with the most physical limitations, and among the highest distress and lowest quality of life of any cancer population. One of the defining features of multiple myeloma is bone health degeneration.

We have shown that bone health can be improved through a specific type and intensity of physical exercise. These exercises have been shown to be safe and feasible for people with poor bone health, advanced cancer, and bone metastases. However, no research has examined what the effect of exercise is on the bone health of people with multiple myeloma.

How exercise improves bone health is not well understood because it is difficult to study bone cells in humans. Animal studies have shown that applying loading forces to bone, like the loads applied to human bones during targeted exercise, increase bone mass in healthy mice. In mice with myeloma, these loading forces can prevent the progression of multiple myeloma induced bone lesions and supress the progression of tumours.

We have shown that tumour growth in bone is determined by the activity of the bone forming cells (called osteoblasts) and bone resorbing cells (called osteoclasts).

Aims and Objectives

This study’s objectives are to determine the effect of highly targeted exercise on the bone health and quality of life of people with multiple myeloma.

We hypothesise that bone targeted exercise will not only maintain bone health but will delay the progression of bone tumours by altering the behaviour of bone cells. Further, it will increase muscle strength and physical function, and reduce pain, improving quality of life in people with multiple myeloma.

How it will be done

Study volunteers with multiple myeloma will be randomly assigned to either an exercise (n=39) or usual care (n=39) group. The exercise group will receive their usual medical care plus twice weekly bone targeted exercise for 9 months.

The usual care group will receive their usual medical care and will be asked to maintain current lifestyle activities over the same timeframe.

A comprehensive assessment of bone health, muscle strength, physical function, bone pain, quality of life and tumour load will be conducted at baseline and 9 months.

Potential impact

If our hypotheses are correct, targeted exercise in people with multiple myeloma will increase bone strength, reduce, prevent, or even reverse other treatment-related side-effects such as muscle weakness, which will ultimately reduce the number and severity of fractures in this high-risk population.

This study also provides valuable preliminary evidence of whether targeted exercise can suppress the development of bone lesions and delay disease progression. We designed this study to address the most important disease- and treatment-related side effects reported by people with multiple myeloma, ensuring it will have the most meaningful impact.

Furthermore, our team have the capacity and connections to immediately implement the findings into clinical practice and within international professional and consumer resources.

Over 80% of people with multiple myeloma, an incurable cancer of bone marrow, experience osteolytic lesions and reduced bone density leading to a high fracture risk.

This study will explore the potential for a highly targeted exercise program to enhance the bone health and quality of life of people with multiple myeloma.
Professor Tina Skinner