Six-Month Resistance Training Interventions Are Associated with Improvements in Fatigue and Pain in Multiple Myeloma Patients

Background

Improvements in multiple myeloma (MM) treatments have led patients and doctors to pursue strategies to promote long-term quality of life (QOL). Often, physicians do not recommend physical exercise (PE) because of MM-related bone disease. Nonetheless, our group and others have shown that patients with MM can safely perform PE, including resistance training (RT) and walking (W). The goal of this study was to examine the impact on QOL, including fatigue, pain, depression and anxiety, of 3 PE interventions in patients with MM.

Methods

Patients included in this analysis participated in either (1) a 6-month pilot intervention that had a supervised, in-person RT arm (n=24) and an unsupervised home-based W arm (n=18); or (2) an ongoing 6-month remotely supervised RT intervention (n=34). Questionnaires were administered at baseline before beginning the intervention, at the end of the intervention, and 6 months later. Fatigue, pain, depression, and anxiety were assessed with the European Organisation for Research and Treatment of Cancer Quality-of-Life Fatigue Questionnaire; a 100-point visual analog scale (VAS) for pain; the Patient Health Questionnaire-9 (PHQ-9) for depression; and the General Anxiety Disorder Questionnaire (GAD-7). Additionally, 9 questions drawn from the 39-item National Comprehensive Cancer Network Distress Thermometer supplemented the assessment of these states, bringing the total number of elements assessed to 40 (14 fatigue, 2 pain, 13 depression, 11 anxiety). Frequencies of individuals reporting “not at all” versus “any” for each issue and mean total scores for the VAS, PHQ-9, and GAD-7 were compared by timepoint. Patients were only included in comparisons if they had completed the questionnaires at both timepoints. Evidence of a change in each of the 4 states was concluded if the majority of the elements associated with each state changed in the same direction (favorably or unfavorably) and at least 1 element changed statistically significantly, with McNemar’s tests of differences in dichotomous variables and paired samples t-tests for differences in continuous variables. In all comparisons, a value of p < 0.05 was considered significant. All analyses were performed using SAS 9.4 for Windows (SAS Institute, Cary, NC, USA).

Results

The combined sample (n=76) was 54.0% female, 93.4% White, and 94.7% non-Hispanic, with a mean age of 63.4 years, and no differences by study or arm. Fatigue improved from baseline to the end of the intervention in the combined sample and in both the RT groups, with 10 of 14 elements improving and significantly fewer people reporting any exhaustion (22.4%), discouragement (26.3%), and problems with sleep (12.7%). However, improvements in fatigue were lost after the intervention, with 12 of 14 elements getting worse and significant increases in people reporting lacking energy (15.9%), feeling slowed down (18.2%), and problems with sleep (18.6%). During the intervention, pain improved in the supervised, in-person RT group, with both elements improving and the reduction in the VAS score being significant (12 points); these improvements were not lost in follow-up. Depression did not change during or after the intervention in any of the groups. However, anxiety got worse during the intervention in the combined sample, with 7 of 11 elements getting worse and significantly more people reporting any dread (8.6%). Although not significant in any of the groups, the change in anxiety was apparent only in the W group, with 8 of 11 measures getting worse in that group, and no consistent trend in either RT group. It is unknown if the change in anxiety in the W group can be tied to the intervention or disease-related or other factors.

Conclusions

In the current analysis, 6-month supervised RT interventions are associated with improvements in fatigue and pain, but improvements in fatigue are lost after the intervention. These findings provide support for RT interventions in MM patients to promote physical QOL, as well as further research into how to help patients achieve sustained improvements.