Effects of Exercise on Muscle Strength, Fatigue, and Aerobic Capacity in Patients with Multiple Myeloma Bone Disease: Literature Systematic Review

Lima, Tayla Teixeira; Silva, Cássio Magalhães da Silva e; Rezende, Camila Reinbold; Damasceno, Anita Gabriele de Jesus

doi:10.32635/2176-9745.RBC.2025v71n4.5279

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Literature Review • Rev. Bras. Cancerol. 71 (4) • 2025 • https://doi.org/10.32635/2176-9745.RBC.2025v71n4.5279EN linkcopy

Effects of Exercise on Muscle Strength, Fatigue, and Aerobic Capacity in Patients with Multiple Myeloma Bone Disease: Literature Systematic Review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Introduction: Multiple myeloma (MM) is an oncohematological cancer, characterized by bone pain and osteolytic lesions or myeloma bone disease (BD), which impacts the quality of life and functionality of these individuals. Although there are reviews on the effectiveness of exercise programs in patients with MM, there are no studies specifically focused on those with BD.

Objective: To evidence the effects of exercise programs on muscle function, aerobic capacity, and fatigue in patients with BD from MM.

Method: Systematic review registered in PROSPERO (CRD42024515745) that followed the PRISMA criteria. We searched for randomized controlled trials in the PEDro, MEDLINE/PubMed, Cochrane Library, Scopus, and CINAHL databases, without restrictions on language or publication date. Descriptors and keywords included "multiple myeloma" and "exercise". Methodological quality was assessed using the PEDro scale and the risk of bias by the Risk of Bias 2.0 tool.

Results: Three randomized controlled trials were included, with 219 participants, 160 of whom presented BD, including individuals of both sexes. The exercise protocols were similar, combining moderate-intensity exercises individualized for each patient. As a result, there was a significant improvement in fatigue and muscle strength. Methodological quality scores ranged from five to seven.

Conclusion: This review highlights that physical exercise can improve muscle strength and reduce fatigue in patients with MM who have bone lesions.

Key words:
Multiple Myeloma/therapy; Exercise Therapy/methods; Fatigue/prevention & control; Rehabilitation; Systematic Review

Database	Descriptors
PubMed	((((((((("Multiple Myeloma"[Mesh]) OR (Multiple Myelomas)) OR (Myeloma, Multiple)) OR (Myelomatosis)) OR (Myelomatoses)) OR (Myeloma-Multiple)) OR (Myeloma Multiple)) OR (Myeloma-Multiples)) AND ((((((("Exercise"[Mesh]) OR (Exercises)) OR (Physical Activity)) OR (Physical Activities)) OR (Physical Exercise)) OR (Acute Exercise)) OR (Exercise Training))) AND ((((Randomized Controlled Trial[Publication Type])) OR (Randomized Controlled Trial)) OR (Clinical Trial))
PEDro	"Multiple myeloma" AND "Fitness training" AND "Clinical trial"
Cochrane Library	(Multiple Myeloma) OR (Multiple Myeloma) OR (Myeloma*, Multiple) OR (Myelomatosis) OR (Myelomatoses) OR (Myeloma-Multiple) OR (Myeloma Multiple) OR (Myeloma-Multiples) AND (Exercise) OR (Exercises) OR (Physical Activity) OR (Physical Activities) OR (Physical Exercise) OR (Acute Exercise) OR (Exercise Training) AND (Randomized Controlled Trial) OR (Clinical Trial)
Scopus	"TITLE-ABS-KEY(("Multiple Myeloma" OR "Multiple Myeloma" OR "Myeloma, Multiple" OR Myelomatosis OR Myelomatoses OR "Myeloma-Multiple" OR "Myeloma Multiple" OR "Myeloma-Multiples") AND (Exercise OR Exercises OR "Physical Activity" OR "Physical Activities" OR "Physical Exercise" OR "Acute Exercise" OR "Exercise Training") AND ("Randomized Controlled Trial" OR "Clinical Trial" OR "Controlled Clinical Trial"))
CINAHL	((MH "Multiple Myeloma" OR "Multiple Myeloma"" OR "Myeloma, Multiple" OR Myelomatosis OR Myelomatoses OR "Myeloma-Multiple" OR "Myeloma Multiple" OR "Myeloma-Multiples")) AND ((MH Exercise OR Exercise* OR "Physical Activity" OR "Physical Activities" OR "Physical Exercise" OR "Acute Exercise" OR "Exercise Training*")) AND (("Randomized Controlled Trial" OR "Clinical Trial" OR "Controlled Clinical Trial"))

Author/Year	Population	Assessment method	Intervention	Results
Koutoukidis et al. (2020)¹⁷	83 participants	FACIT-F, VO2peak estimated on the ergonomic bike, 10MR test, and manual dynamometer	6 months	The IG presented little effect on fatigue at 3 or 6 months. The IG VO2peak increased in 3 months, but with no statistical significance (p=0.08). The LLs MS presented significant improvement between groups, with an 8.4 kg increase (CI 95%: 0.5-16.3) in favor of IG at 3 months and 10.8 kg (CI 95%: 1.2-20.5) at 6 months. However, there was no difference among the hand grip strength groups
Koutoukidis et al. (2020)¹⁷	CG: 42 [29 (69%) with bone disease] IG: 41 [29 (71%) with bone disease]		CG: usual care IG: aerobic exercises (50-75% of max HR) + endured and customized functional exercises
				After 12 months, the means of the results measurements in each experimental group were consistent with those recorded at 3 and 6 months, especially LLs MS
Larsen et al. (2024)1¹⁸	86 participants	Dynamometer, 6WT and 30s STST	10 weeks	Knee stretch strength decreased in the first 6 months for both groups. From T3 to T4, strength returned in both groups, but remained significantly lower than in T1
	CG: 42 [29 (69%) with bone disease] IG: 44 [35 (80%) with bone disease]		CG: usual care + health education (guidance on physical activity and ergonomic instructions for lifting and transferring) IG: Exercise program 3x/week (resistance training, 3x12-15 reps + aerobic training, 20 min, 14-16 RPE) and physical activity 4x/week (~30 min, 12-13 RPE)
				Grip strength decreased significantly in both groups in 6 months, and in IG, also after 12 months
				The 30s STST presented a statistically significant increase in both groups (except IG after 6 months). Increase of 1.6 repetitions in IG (p=0.009) and almost two repetitions in CG (p=0.003) post-intervention. In T4, the number of repetitions increased 2.1 (p<0.001) in IG and 3.5 (p<0.001) in CG
			Time marks: baseline (T1), postintervention (T2), after 6 months (T3), and after 12 months (T4)	In 6WT, there was a statistically significant increase of about 42 m in both groups from T1 to T2. Generally, both groups continue to have little increases over time
McCourt et al. (2023)¹⁹	50 participants	FACIT-F, 6WT, manual dynamometer, and STST	11 months	In phase 3, only IG presented an important significant difference for fatigue (+5.7, CI 95%: 0.1, 11.2) and greater improvements in the 6WT distance median were observed in phase 3 and throughout the study period. There were no significant changes in hand grip strength. The 1-min STST indicated intragroup improvements for IG comparing all phases
	CG: 27 [20 (74%) with bone disease] IG: [18 (78%) with bone disease]		CG: Usual care + physiotherapy or occupational therapy during admission to ASCT IG: Behavior change + aerobic exercises (3x/week; 60–80% HRR, initial duration 15 min, increasing 5 min/week) + functional exercises (3x/week; intensity, progression, and personalized adaptation to bone disease)
			Temporal marks: in-person supervised exercises (Phase 1), telecommunication-supervised (Phase 2), and with no supervision (Phase 3)

Author/year	1*	2	3	4	8	9	10	11	Total
Koutoukidis et al. (2020)¹⁷	Yes	X	X	X	X	X	X	X	7/10
Larsen et al. (2024)¹⁸	Yes	X		X	X	X	X	X	6/10
McCourt et al. (2023)¹⁹	Yes	X		X	X		X	X	5/10

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[1] Captions:

[TFN4] 10MR: 10 maximum repetitions; FACIT-F: Functional Assessment of Chronic Illness Therapy – Fatigue; Max HR: maximum heart rate; HRR: heart rate reserve; MS: muscle strength; CG: control group; IG: intervention group; CI: confidence interval; LLs: lower limbs; rep: repetition; RPE: rate of perceived exertion; ASCT: autologous stem cell transplant; 6WT: 6-minute walk test; STST: sit-to-stand test; VO2peak: peak oxygen uptake.