Virtual Exercise for Multiple Myeloma
Virtual Exercise for Multiple Myeloma
The primary objective of this pilot study is to determine the safety and feasibility a
 12-week virtually supported home-based aerobic and resistance exercise program progressing
 cancer survivors with Multiple Myeloma to meet standards identified in the 2019 Exercise
 Guidelines for Cancer Survivors.

 The protocol will be measuring recruitment, adherence, completion, cost tracking, as well as
 fitness and quality of life outcomes. The study will be a single-group prospective before and
 after study that will help inform a future larger-scale project. We will aim to recruit 25
 participants.

 The Health Research Ethics Board of Alberta Cancer Committee will approve this study.
 Participants will participate in a combined resistance and aerobic exercise program biweekly
 for 12 weeks. Exercise sessions will be supported and progressive in nature, between 40 and
 75 minutes each.

 Analyses: fitness testing and quality of life scales will be administered before and after
 the intervention. Scores will be compared to evaluate changes over the course of the
 intervention. Safety and feasibility information will be collected throughout the study and
 evaluated to determine program feasibility. Program satisfaction will be evaluated using a
 satisfaction survey.
Multiple myeloma (MM), a cancer of the plasma cells in bone marrow, is associated with
 osteolytic bone destruction, leading to deformities, chronic pain, reduced mobility and
 functioning, fatigue, and risk of fracture. Although incurable, newly developed therapies are
 extending survival, but some with significant side-effects. Patients may be living longer but
 with lasting, debilitating side-effects.

 Exercise has been proposed as a way to optimize patient function and quality of life in the
 face of lasting symptom burden. However, current evidence-informed exercise guidelines for
 cancer survivors may not be appropriate for those with bone fragility, including those with
 MM, as they are based on findings from studies in breast and prostate cancers. In MM
 specifically, the literature presents mixed results, and several studies have limited
 generalizability, reproducibility, or were underdosed.

 The main objective of this study is to determine the safety and feasibility of a 12-week
 virtually supported home-based aerobic and resistance exercise program that aims to progress
 individuals to the 2019 Exercise Guidelines for Cancer Survivors in a sample of cancer
 survivors with multiple myeloma, as defined by:

 -  Recruitment rate: ≥ 21 participants consenting to the study over a 7-month recruitment
 period (primary endpoint)

 -  Completion rate: ≥ 80% of participants consenting to the study complete the 12-week
 assessment

 -  Safety: no increase in the rate of bony events above those estimated to occur in the
 target population

 -  Adherence: average completion of ≥ 75% of the exercise prescription amongst participants

 We will aim to recruit 25 participants from clinics at the local cancer hospital, the local
 disease-group support society, and from the currently accruing Alberta Cancer Exercise
 program. Subjects will be screened for eligibility and if they meet all eligibility criteria,
 an information letter of the study will be provided, and they will be asked to contact the
 investigators if interested in taking part in the study. All participants will be required to
 provide written informed consent as per the Health Research Ethics Board of Alberta: Cancer
 Committee (HREBA).

 Participants will participate in a 12-week virtually supported home-based aerobic and
 resistance exercise program, twice weekly using the Heal-Me application. Sessions will be
 completed as virtual live classes or supported follow-along independent home workouts.
 Sessions will progress in duration and difficulty over the course of the program, aiming to
 have participants meet the 2019 Exercise Guidelines for Cancer Survivors by the end of the
 program. Each session will include aerobic exercise (i.e. walking, cycling, or cardio
 circuit), and a full-body resistance training routine using free weights, body weight
 exercises, and/or bands, followed by balance and stretching exercises.

 Analyses: Demographic and medical information will be presented using median and range and
 percentage for interval and nominal data, respectively. Descriptive statistics (mean ± SD and
 frequencies) will be used to report safety and feasibility measures. Adherence will be
 tracked as the percentage of total training load prescribed that was actually completed.
 Wilcoxon Signed Rank Tests will be used to compare and pre- and post-intervention fitness
 assessment and quality of life scores. All analyses will be conducted using Stata/MP (version
 13.0, StataCorp LLC, College Station, TX), with alpha set to 0.05.
Inclusion Criteria:

 1. 18 years of age and older

 2. Diagnosis of multiple myeloma

 3. In one of the following three treatment categories:

 -  Transplant ineligible patients, currently in first line treatment

 -  Transplant eligible patients, sufficiently recovered from transplantation (>3
 months following transplantation)

 -  Patients with relapsed/recurrent myeloma with either 1-3 prior lines of treatment
 or 4+ prior lines

 4. Able to provide informed written consent in English

 5. Approved for physical activity participation by their oncologist and cleared for
 physical activity by the Certified Exercise Physiologist on the PAR-Q+

 Exclusion Criteria:

 1. Unstable cardiac/metabolic condition that would be deemed unsafe to exercise

 2. Severe anemia

 3. Spinal instability requiring surgical intervention

 4. AL amyloidosis, solitary plasmacytoma, or Waldenstrom macroglobulinemia

 5. Too frail to participate in home exercise, as determine by baseline physical
 assessment (i.e., unable to complete a single sit-to-stand or balance on one foot for
 ≥ 3 seconds).

 6. Inability to provide consent

 7. Inability to commit to, and/or comply with the intervention due to personal reasons
 (e.g. vacation planned during the intervention period)