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Multiple myeloma is a cancer that harms plasma cells in the bone marrow. Plasma cells normally help fight infection, but in this case, they become cancerous. As the cancer grows and spreads, it may travel into and damage your bone tissue.
Brian Durie, MD, director of research and myeloma programs at Cedars-Sinai Comprehensive Cancer Center in Los Angeles , explains, “During the active phase of myeloma when the cancer cells are growing in the bone marrow, they make chemicals that can dissolve bone. There are certain places where there are literally holes ‘punched’ clear through the bone.”
As the cancer attacks more areas of bone, you may feel pain and be at greater risk for fractures. The effects are similar to those that occur in someone with osteoporosis, although the initial treatments for the 2 diseases are different. Doctors may prescribe chemotherapy, radiation, bone marrow transplants, and stem cell transplants to treat multiple myeloma.
Is Exercise Safe With Multiple Myeloma?
There is currently a lack of research on the benefits of exercise in people with multiple myeloma. However, Durie believes exercise can be helpful physically and mentally—if performed safely and cautiously. “It is known that certain exercises strengthen bones, as seen in people with osteoporosis. If the cancer is under control, there’s no reason to believe exercise wouldn’t also help people with myeloma,” he says.
However, Durie cautions that there is a time not to do vigorous exercise. This is when you are receiving treatment for multiple myeloma. “When the cancer is actively growing in bones, the bones are very vulnerable to fractures. During cancer treatment, the focus should not be to exercise heavily,” he says.
Durie recommends that you talk with their doctor about the areas of bone damage so that you are aware of and can protect delicate bones.
“After finishing treatment for myeloma, the goals are to regain bone and muscle strength, and to return to normal, daily physical activities as much as possible. These will help improve your independence and quality of life,” says Durie.
Starting Out
During the early stages of multiple myeloma, you may receive physical or rehabilitative therapy to condition your body. A physical therapist is trained to guide people to do mild exercises.
Meredith O’Brien, a physical therapist at Dana Farber Cancer Institute in Boston , sees people with multiple myeloma during or after a bone marrow transplant. “They often feel ill and are inactive from having low blood counts and chemotherapy. Fatigue is a huge factor. Our main goal is to keep them functioning by getting them to walk and to move and rotate different muscles and joints,” she says.
When you leave the hospital, the physical therapist can recommend basic exercises to do at home. However, you should temporarily avoid high-impact or intense activities such as heavy strength training or jogging. These can cause damage to the spine--which is often affected in multiple myeloma.
If there are only limited areas of bone damage, you can do careful exercise that avoids risk to the specific areas. For example, if there is bone damage in your arm, you could safely do brisk walking. Swimming is another good low-impact activity. The water offers some resistance but also supports and lowers pressure on your legs, spine, and joints.
Creating an Exercise Routine That Works for You
After your doctor says it’s OK to begin an exercise routine, the first step is to choose activities that you like. This sounds obvious, but if you don’t enjoy an activity, the sooner you may stop doing it.
Doug Blasdell, a certified personal trainer and fitness consultant to the International Myeloma Foundation, says, “After months of cancer treatments, people feel weak and depressed. You want to encourage them to do things that get them moving.”
Different activities benefit your body in different ways. A well-rounded exercise routine includes the following things.
Warm-up. This helps loosen your muscles to prepare your body for more active movements and to prevent injury. One way to warm up includes walking at a moderate pace for 5 to 10 minutes while swinging your arms lightly.
Aerobic or cardiovascular exercise. These activities help strengthen your heart and lungs. Heart-pumping activities include walking, swimming, or using a stair machine, elliptical trainer, or stationary bike. Start with a comfortable goal of about 10 to 15 minutes, 3 to 5 times a week. As you feel able, increase your time by a few minutes every week. Work up to a goal of 20 to 30 minutes most days of the week. Avoid high-impact activities such as running, jogging, horseback riding, and biking outdoors. They can jolt and harm your spine or other fragile bones.
Strength or resistance training. These are repetitive movements designed to build or maintain muscle strength. It is best to learn these exercises from a trainer or physical therapist to make sure you perform them properly. You can start with 1- or 2-pound hand weights or rubber resistance bands (both available at sporting goods stores). Do strength exercises up to 3 times a week, every other day. Give yourself a day of rest in between. Your muscles need time to rest and repair. Avoid heavy weights of more than 5 pounds, unless directed by a trainer.
Stretching. This helps loosen and relax stiff joints and muscles. End your routine with a few different stretches for 5 to 10 minutes. For best results, hold stretches for up to 20 to 30 seconds without bouncing. You can learn these moves from your trainer or physical therapist.
If you feel any of the following symptoms, stop exercising or slow down your pace.
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Sharp pain in a specific area (this is different from the dull, general pain that is felt a day or 2 after exercising, which is normal)
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Nausea
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Extreme fatigue or tiredness
Never overdo any exercise, and if any of these symptoms persist for more than a day, see your doctor at once. Blasdell says, “The point of exercise is to make you feel better. If it doesn’t, slow down. You can move ahead when you feel stronger. Remember, progress takes time.”
Finding a Qualified Exercise Consultant
A physical therapist or certified fitness trainer can create a safe, effective exercise regimen done at home or in a gym. But be choosy.
A physical therapist undergoes years of education and training to treat people with injury or disease. A personal fitness trainer may or may not be as qualified. Blasdell warns people to be careful when seeking a personal trainer. “Many people call themselves ‘personal trainers,’ but they may be neither certified nor insured.”
Even with certification, a personal trainer may have little or no experience with multiple myeloma or other diseases. Also, the training needed to receive certification varies greatly. It depends entirely on who is offering the certification.
Refer to the Yellow Pages or a local fitness center for a personal trainer certified from a respected group. Examples are the American College of Sports Medicine (ACSM) or the National Strength and Conditioning Association (NSCA). They offer certificates for clinical exercise trainers who must pass a rigorous exam that requires knowledge of various illnesses and disabling conditions. The ACSM also requires a degree in a health-related field and many hours of training clients in a hospital setting.
In addition, have the personal trainer or physical therapist contact your doctor. Your doctor can inform them of your health condition and of any safety measures needed.
Many insurance plans cover the cost of a physical therapist in a hospital. But you may need to pay out-of-pocket for outpatient services or home visits. Check with your insurance policy about coverage for physical therapy. Insurance does not usually cover the cost of personal fitness trainers. However, a few initial visits with a qualified personal trainer may be enough to get you started safely and may be well worth your money.
These suggestions are all general guidelines. Talk with your doctor before starting any exercise program.