Introduction
Multiple myeloma (MM) is a clonal plasma cell malignancy, characterized by uncontrolled proliferation of cancerous plasma cells. In China, it accounts for 10%-15% of hematological malignancies [ 1 ]. MM ranks as the second most common hematologic cancer, with its annual incidence rising by 0.8% globally [ 2 ]. According to World Health Organization (WHO) 2022 data, approximately 300,000 new MM cases were diagnosed worldwide. Patients with MM frequently develop joint stiffness, muscle atrophy, and pathological fractures due to immune dysfunction. Notably, 70% of patients report severe cancer-related fatigue [ 3 ]. These symptoms cause physical debilitation and reduced stamina, severely impairing motor function and qstudy [of life (QoL). A study [ 4 ] of 16,095 cancer survivors revealed that MM patients had the lowest physical function scores and highest psychological distress levels among all cancer types. Long-term disease progression and treatment-related toxicity further worsen post-therapy outcomes. Patients often experience declining physical abilities, mental health deterioration, and symptoms like chronic pain, depression, insomnia, and persistent fatigue. Modern therapies (e.g., proteasome inhibitors, CAR-T) have significantly improved survival rates [ 5 – 6 ]. However, prolonged survival means patients now face extended periods of disease burden and treatment side effects. Consequently, optimizing QoL and expanding rehabilitation services have become critical priorities in MM care.
A comprehensive review of the literature addresses much evidence supporting the beneficial effects of exercise interventions on the cancer patients’ physical and mental health. The benefits of exercise in cancer patients are now well established, with evidence supporting positive effects on cardiorespiratory fitness and other physiological functions, including muscle strength. Exercise interventions are established as an evidence-based strategy in cancer rehabilitation, demonstrating significant efficacy in enhancing quality of life (QoL) and restoring physical function among cancer patients. Clinical trials [ 7 ] have validated that structured exercise programs improve systemic health outcomes, including muscle strength, bone density, and neuromuscular coordination. Importantly, such interventions mitigate treatment-related toxicities, such as cancer-related fatigue (reported in 70-90% of patients), chemotherapy-induced peripheral neuropathy, and cardiotoxicity. The therapeutic value of exercise has prompted global clinical consensus. To date, over 15 countries have incorporated exercise protocols into multiple myeloma (MM) management guidelines, establishing it as the primary rehabilitation modality for this population. Patient-reported data [ 8 ] further reinforce this imperative: 75% of MM patients prioritize physical performance improvement, 59% express willingness to adopt exercise regimens, and 55% prefer structured programs. However, a striking implementation gap persists. Despite robust evidence and patient motivation, only 12-25% of MM patients engage in regular physical activity. This disparity underscores an urgent need to address barriers between rehabilitation guidelines and real-world adherence..
Despite the recognized importance of exercise in MM rehabilitation, no disease-specific exercise guidelines exist for this population. Existing cancer rehabilitation protocols—priminitially developed for solid tumors—fail to address the unique pathophysiological complexities of MM, including osteolytic bone lesions, renal impairment, and heightened fracture risk. Clinical heterogeneity further complicates intervention design: MM patients exhibit marked variability in exercise tolerance across treatment phases (e.g., induction therapy vs. maintenance) and disease trajectories (e.g., smoldering vs. active myeloma). Consequently, researchers frequently adopt overly conservative protocols—reducing exercise intensity or excluding patients with comorbidities—to prioritize safety. This practice introduces methodological fragmentation: systematic reviews reveal substantial discrepancies in intervention parameters across studies, including exercise modality (aerobic vs. resistance), duration (4–24 weeks), and monitoring methods (subjective scales vs. wearable devices). Critically, such variability undermines the reproducibility and comparative analysis of outcomes, as exercise efficacy is inherently dose-dependent [ 8 ].
Current evidence on exercise interventions for multiple myeloma (MM) remains constrained by methodological heterogeneity (e.g., inconsistent outcome measures) and limited generalizability, with 85% of published studies classified as Level III/IV evidence according to the Oxford Centre for Evidence-Based Medicine hierarchy. These limitations preclude definitive conclusions about intervention efficacy, necessitating preliminary evidence mapping prior to conducting systematic reviews or meta-analyses. Scoping reviews [ 9 ] serve as a critical exploratory tool in such contexts, enabling researchers to: delineate conceptual boundaries of emerging research domains; synthesize heterogeneous evidence across study designs; identify evidence-practice gaps through systematic knowledge mapping.
Therefore, following the scoping review framework developed by Arksey et al. [ 10 ] and refined by Levac et al. [ 11 ], this study compares different types of exercise interventions for patients with multiple myeloma (MM). By analyzing the content and characteristics of these interventions, we aim to clarify their adaptability (e.g., suitability for diverse patient subgroups) and scalability (e.g., feasibility in clinical vs. home settings). This analysis will support the personalization of exercise plans, addressing individual patient needs while mitigating safety concerns. Ultimately, these findings may enhance rehabilitation effectiveness, improve quality of life, and inform future research directions for healthcare providers.
Methods
Research questions
What are the different characteristics (timing, manner, intensity, frequency, duration) of exercise interventions in patients with multiple myeloma?
How is the effectiveness of the exercise intervention program (including safety assessment and efficacy assessment) evaluated?
Protocol and registration
Our protocol was drafted using the Preferred Reporting Items for systematic reviews and meta-analysis extension for scoping reviews Scoping Reviews (PRISMA-ScR). The final protocol was registered prospectively with the Open Science Framework on 14 October 2024 (10.17605/OSF.IO/UDWM4).
Inclusion and exclusion criteria
Inclusion criteria: (a) The research subjects were patients with MM; (b) The research involves providing exercise interventions for patients with MM; (c) The intervention environment was not limited and included home, community, gym, etc.; (d) Regardless of the type of research design, the report was original; (e) Studies were included if they encompassed participants aged 18 and older, irrespective of geographical location.
Exclusion criteria: (a) Reports with incomplete information or data; (b) Conference abstracts, reviews, experimental protocols, and news reports; (c) Literature that was published repeatedly; (d) Literature published in languages other than Chinese and English.
Search strategy
The databases searched included PubMed, Web of Science, Cochrane Library, Embase, Scopus, CINAHL, CNKI, Wanfang, VIP, and CBM. The search strategy employed a combination of subject headings, free-text terms, and Boolean logic operators, with a time limit set from the establishment of the databases until October 1st, 2024. The cutoff was chosen to include the latest studies without compromising the comprehensiveness of the review. The search keywords comprised: " Multiple Myeloma”, “Myelomas, Multiple”, “Myeloma, Multiple”, “Myeloma, Plasma Cell”, “Plasma Cell Myeloma”, “Myelomatosis”, “Plasma Cell Myeloma”, “Kahler Disease”, “Rehabilitation Exercise”, “Exercise Ability”, “Exercise Therapy”, “Physical Activity”, “Physical Therapy”, and “Exercise Prescription”. Figure 1 illustrates the search strategy, using PubMed as an example.
Study selection and data extraction
The retrieved documents were imported into EndNote. After removing duplicates, two evidence-based trained researchers conducted a preliminary screening of the literature, independently reviewing the titles and abstracts of all articles. Following the preliminary screening, the researchers performed full-text readings of the remaining articles. Two blinded authors (ZD, ZY) independently screened the articles, and any possible conflicts were resolved through a discussion with two expert authors (YS, PY). Specific details of the selection process are better illustrated in the PRISMA flow diagram (Fig. 2 ). The main features of the included studies in relation to the aim of the review were reported in a data extraction form. This form was previously developed, discussed, implemented and accepted by all the authors of the study. The major characteristics extracted from the included works were: the name of the first author, publication date, country, study design, sample size, intervention method, intervention duration, outcome indicators, and study results.
Results
Literature search results
A total of 391 articles were retrieved, with 234 remaining after duplicates were removed. The researchers reviewed the titles and abstracts of each publication and excluded 195 articles. The remaining 39 articles were then re-screened. 22 studies were further excluded based on the following criteria: (a) study subjects, (b) study background, (c) study participants, and (d) type of literature. In the end, a total of 17 articles were included. See Fig. 2 for flow of citations.
Basic characteristics of the literature
Key characteristics of the included studies were presented in Table 1 . Of the 17 studies reviewed, there were significant variations in the aims and designs of the studies.
Table 1
Basic information of the included literature
Note: ① Safety index; ② Feasibility; ③ Treatment tolerance; ④ Health indicators (muscle strength, cardiorespiratory fitness, and body composition); ⑤ Degree of pain; ⑥ Disease status; ⑦ Psychological state; ⑧ Sleep; ⑨ Quality of life; ⑩ Fatigue
| Author | Date of publication (years) | Country | Type of research | Intervention method | N total | Intervention duration | Outcome indicators |
| Czerwińska-Ledwig et al. [ 12 ] | 2024 | Poland | RCT | Test group: Nordic Walking Training (3 times / week, 1 h / time) & 14 h intermittent fasting | 35 | 6 Weeks | ①④ |
| F. Larsen et al. [ 13 ] | 2024 | Denmark | RCT | 10-week structured exercise supervised by an exercise physiologist: resistance, aerobic, and flexibility exercises (3 times / week) | 86 | 10 Weeks | ①④⑤⑨ |
| Hillengass et al. [ 14 ] | 2024 | America | Quasi-experimental study | strength training 60 min twice a week or walk 150–300 active minutes per week | 42 | 6 Months | ①②④ |
| Nicol et al. [ 15 ] | 2023 | Australia | RCT | Test group: an individualized, high-intensity aerobic, resistance and impact load exercise program was used. These training courses were supervised by approved exercise physiologists twice a week, and unsupervised training courses were added once a week | 41 | 12 Weeks | ①②③ |
| Dapunt et al. [ 16 ] | 2023 | Germany | Retrospective study | Moderate aerobic training (150 min / week), resistance training (2–3 times / week) | 91 | 3–4 Months | ④⑤ |
| Czerwinska-Ledwig et al. [ 17 ] | 2023 | Poland | Single arm test | Medium-intensity Nordic walking training (60–70% of HRmax) | 30 | 6 Weeks | ⑥ |
| Julie et al. [ 18 ] | 2022 | China | RCT | Test group: individualized exercise for 20 min / time, 3 times / week. The level of aerobic walking allows for 65–80% of the maximum heart rate, and the resistance training intensity is 60–80% of the maximum repetition weight. Control group: routine exercise instruction | 106 | 21 Months | ④⑥⑦⑧ |
| Purdy et al. [ 19 ] | 2022 | Canada | Single arm test | Virtual support home exercise programs including virtual supervised group exercise, independent home exercise and independent aerobic exercise. Conduct moderate intensity resistance training 2 times / week and moderate intensity aerobic exercise for 90 min / week | 26 | 12 Weeks | ①②④⑨⑩ |
| Lee et al. [ 20 ] | 2022 | America | RCT | 8 weeks of remote supervised health exercise (90 min per week) plus 8 weeks of voluntary exercise | 60 | 16 Weeks | ①②⑨ |
| Hacker et al. [ 21 ] | 2022 | America | Quasi-experimental study | Trial group: Free-living physical activity intervention a free-living physical activity intervention using a physical activity tracker Control group: usual care | 32 | 6 Weeks | ①②④⑨⑩ |
| Czerwinska-Ledwig et al. [ 22 ] | 2022 | America | Single arm test | Nordic Walking Training (3 times / week, 1 h / time) | 33 | 6 Weeks | ④⑥ |
| Huang Liming et al. [ 23 ] | 2021 | China | RCT | Test group: multimodal exercise prescription 5 days / week, 2 times / day, 30–40 min / time, preintervention investigation, evaluated patients’ exercise needs, and designed exercise items accordingly Control group: usual care | 80 | 4 Weeks | ⑨⑩ |
| Möller et al. [ 24 ] | 2021 | Germany | RCT | Moderate aerobic exercise was 150 min / week, and large muscle group resistance training twice / week Control group: usual care | 106 | 6 Months | ③⑨ |
| Koutoukidis et al. [ 25 ] | 2020 | Britain | The Zelen’s design | Test group: aerobic exercise + resistance exercise (3 times / week, aerobic exercise increased from 10 min to 30 min, target intensity is 50–75% of the predicted maximum heart rate; resistance exercise gradually according to published principles) design personalized exercise plan according to ability; exercise diary during exercise, and the physical therapist gave behavioral feedback accordingly Control group: usual care | 131 | 6 Months | ④⑨⑩ |
| Persoon et al. [ 26 ] | 2017 | Holland | RCT | Test group: high-intensity resistance exercise and interval training program (2 times / week in the first 12 weeks, 1 time / week in week 13), exercise intensity set according to exercise ability, maximum muscle strength measurement and steep slope test every 4 weeks, to adjust the training load accordingly | 109 | 18 Weeks | ④⑨⑩ |
| Larsen et al. [ 27 ] | 2019 | New Zealand | RCT | Test group: moderate intensity exercise (3 / week, 30 min / day, lasting 10 min / time). In addition, at least twice a week, the activity must be high intensity, including strengthening exercise and stretching. | 30 | 10 Weeks | ①② |
| Groeneveldt et al. [ 28 ] | 2013 | Britain | Single arm test | Aerobic exercise + resistance exercise (3 times / week, aerobic exercise increases from 15 min to 30 min, exercise intensity increases from 50% of heart rate reserve to 60%) Set exercise plan according to cardiopulmonary fitness and exercise ability; monitor heart rate during exercise and score exercise intensity using the Borg scale | 37 | 6 Months | ②④⑨ |
The 17 articles included [ 12 – 28 ] were from nine countries: the United States ( n = 4), Denmark ( n = 1), the United Kingdom ( n = 2), China ( n = 2), Australia ( n = 1), Germany ( n = 2), Canada ( n = 1), New Zealand ( n = 1), the Netherlands ( n = 1), and Poland ( n = 2). Among these, 15 publications were in English and 2 were in Chinese. No studies were identified from other regions.
The studies consisted of 10 controlled trials, 4 single-arm trials, 1 retrospective cohort study, and 2 quasi-experimental studies. The overall sample sizes of the included studies were relatively small, with a maximum sample size of 131 cases and a minimum of 26 cases. The total sample sizes in the included single-arm trials and quasi-experimental studies were even smaller, ranging from 26 to 42, significantly amplifying the risk of bias. Notably, some studies reported the use of physiotherapy sessions in their control groups, which most likely included supervised exercise, suggesting a high rate of contamination.
Sex difference of participants
Several studies [ 12 , 16 , 17 , 20 ] failed to specify participants’ gender distribution, and despite prevalent gender imbalances across studies, none examined potential impacts of sex differences on exercise interventions strategy selection or efficacy.
Preparation before exercise
In the inclusion criteria of various studies, more attention was paid to the patient’s life expectancy, motor ability, and whether there was nerve damage than to the stage of myeloma. Most studies screened patients to confirm eligibility before the exercise interventions, even prior to baseline and randomization. Participants were required to undergo X-ray, magnetic resonance imaging, whole-body CT, or electrocardiogram examinations to assess physical function, bone injury, and fracture risk, in order to develop appropriate exercise strategies. Some studies [ 13 – 15 , 17 , 22 ] specifically reviewed the bone stability of participants and determined whether certain patients needed to be excluded from exercise interventions programs. Patients known to have spinal instability, spinal cord compression or neurological deficit, recent spinal surgery or other pathological fracture surgery, resting ECG abnormalities, or unstable angina, were excluded. Additionally, patients who were unable or unwilling to participate in regular exercise programs, or who were unable or unwilling to provide informed consent, were excluded. Some studies required patients to achieve sufficient adequate recovery of blood indicators (such as Hb > 10.5 g/dL, platelets > 80 × 10 9 /L) before participating in exercise interventions, following exercise testing. Furthermore, some studies [ 12 , 15 , 19 , 20 , 25 ] provided relevant educational courses and exercise guidance to patients before the exercise sessions, ensuring that all exercise programs were tailored to individual circumstances to promote appropriateness and adherence to the protocol.
Types of exercise interventions
The types of exercise interventions mainly included aerobic training and resistance training. Aerobic training methods encompassed treadmill walking, bicycle dynamometer, joint exercises, motion interactions, cross trainers, and steppers. Resistance training involved exercises targeting the torso, upper body, and lower body, using weightlifting equipment, free weights, or resistance bands. This included vertical rowing, leg press, bench presses, chest presses, push-ups, isometric muscle exercises, as well as wrist rotation and elbow flexion. A study [ 29 ] suggested that these exercise interventions should be performed unless there were specific conditions, such as spinal deformities or low back pain, that warranted exclusion.
Strength, frequency, and duration of the exercise interventions
According to the definition provided by the World Health Organization, physical activity should include 150 min of moderate-intensity aerobic exercise per week, along with resistance training for large muscle groups at least twice a week. 4 studies [ 15 , 18 , 19 , 26 ] described how to evaluate the target intensity of exercise training using the Borg Dyspnea Scale or the Berg Self-perceived Exercise Intensity Scale, ensuring that participants did not feel fatigued when they woke up the next day. 6 studies [ 18 – 20 , 24 , 26 , 28 ] suggested that the intensity of aerobic exercise training was typically set at 50–75% of the maximum heart rate, starting with a lower initial training intensity. The intensity of resistance training was set at 60–80% of the maximum strength (1 repetition maximum, 1 RM), which was the maximum weight that could be lifted in a single repetition. 3 studies [ 15 , 20 , 25 ] set the initial intensity of resistance training at 30% of 1 RM and recommended gradually increasing the load according to the patient’s tolerance, ultimately choosing a light to moderate intensity exercise mode.
The exercise frequency included in the study mostly ranged from 3 to 5 times per week. Some of the interventions studied [ 13 , 15 , 26 ] involved participants receiving treatment once a week at the hospital gym and exercising twice at home during the first 3 months. In the subsequent three months (from the 4th to the 6th month), participants switched to exercising at home three times a week and attending the hospital gym once a month.
Monitoring during exercise
The included studies mainly monitored relevant signs and symptoms during the exercise interventions period. In terms of physical sign monitoring, studies [ 19 , 22 , 27 ] employed portable oximetry to track heart rate and oxygen saturation, ensuring that the maximum heart rate and exercise heart rate (calculated as 220 minus age, with a target range of 50–75%) were maintained. Some researchers [ 14 , 16 , 18 , 26 ] guided participants to keep exercise diaries, supervised and guided them, and adjusted exercise plans as deemed necessary to meet the needs of each patient.
Outcome measures and effects of the exercise interventions
Most studies utilized quality of life, muscle strength, fatigue, and body composition as outcome indicators for exercise interventions, measured using tools such as bicycle ergometers, grip dynamometers, spring resistance meters, 30-second chair stent tests, the Cancer Patient Quality of Life Scale (QLQ-C30), the Multidimensional Fatigue Inventory (MFI-20), the Chronic Disease Treatment Function Assessment Fatigue Scale (FACIT-F), the Self-Rating Sleep Status Scale, the Elderly Physical Activity Scale (PASE), and the Health-Promoting Lifestyle Profile (HPLP). The subjects demonstrated a certain degree of relief following the exercise interventions, and most studies reported significant inter-group differences. However, a study [ 26 ] suggested that these outcomes might be related to poorly timed intervention implementation, contamination in the control group, and/or low compliance with prescribed exercise interventions. Additionally, studies [ 14 , 23 , 27 ] pointed out that exercise interventions required more than 3 months to significantly improve fatigue.
Discussion
Summary of evidence
To the best of our knowledge, this is the first scoping review in China aimed at providing a comprehensive overview of the literature regarding the association between intervention methods of exercise and MM. Multiple countries have issued clinical practice guidelines or recommended exercise interventions for patients with MM. However, these guidelines only outline situations where exercise is appropriate or should be avoided, without providing detailed, personalized exercise plans. While existing studies demonstrate significant variability in rehabilitation exercise programs. Currently, there remains a lack of standardized guidelines for developing tailored exercise interventions. Moreover, existing studies neither provided sex-specific exercise interventions nor explored potential impacts of gender differences on the selection of exercise strategies or treatment efficacy. This oversight may partially neglect the impact of gender differences in exercise selection and intensity on outcomes, a critical aspect that warrants further investigation in future research.
Furthermore, results show an increasing interest in this field, with a clear trend of growth in the number of publications over the last years. Regrettably, the current body of high-quality experimental studies is insufficient to conduct a systematic review. In this context, this scoping review examines the current status, assessment tools, risk factors, adverse reactions, and intervention methods of exercise interventions in patients with MM, while highlighting the shortcomings of previous studies and elucidating future research directions.
For patients with MM, exercise interventions are considered safe, feasible, and effective
The research results indicate that exercise interventions can partially improve fatigue, functional ability, quality of life, and mental health in patients with myeloma. This viewpoint has also been supported by Deepa Jeevantham et al. [ 30 ] in the exercise practice guidelines for patients with myeloma. Therefore, it is recommended to incorporate relevant exercise interventions into the routine management of patients with myeloma to address symptoms [ 31 ] such as increased fatigue, muscle weakness, reduced muscle mass, decreased quality of life, and fragmented sleep caused by the disease itself, adverse treatment reactions, complex treatment plans, and long-term follow-up needs. By organizing structured exercise programs that combine aerobic exercise with resistance training and utilizing relevant assessment tools such as the FACIT-F Fatigue Rating Scale, the 6-Minute Walk Test, gait sensors, and the Brief Quality of Life Scale, the effectiveness of exercise interventions can be better evaluated [ 30 ]. It is noteworthy that although exercise interventions positively impact these outcomes, the current quality of evidence is low. Therefore, larger sample randomized controlled trials are needed to more accurately determine the effects of exercise interventions on patients with myeloma as well as identify optimal exercise durations. Safety is an important indicator for evaluating the scientific validity of exercise interventions designs. In patients with MM, exercise interventions carry a risk of fractures associated with bone injury, as patients are prone to complications such as osteolysis and bone destruction. It is estimated that 70–80% of patients with MM will experience bone pain, and 50–60% will suffer fractures [ 32 ]. Therefore, before initiating exercise interventions, patients must undergo thorough examinations and risk assessments to select appropriate exercise methods. Although bone injury is not an absolute contraindication for exercise, adjustments should be made to exercise prescriptions, and additional preventive measures should be taken, such as using appropriate mobility aids and stents to reduce the risk of fractures [ 26 ]. Moreover, due to the high risk of complications and comorbidities in patients with myeloma, investigators should closely monitor patients’ physical conditions during exercise training and be vigilant for sudden changes. Medical personnel need to be cautious when designing exercise plans, as movements such as torsion exercises, anterior bending, overhead extension, pushing, pulling, and lifting may cause or aggravate vertebral fractures in patients with bone injuries. It is recommended that physiotherapists use their clinical judgment and professional knowledge to flexibly adjust exercise plans to meet the specific needs of each patient.
Exercise interventions in patients with MM requires multidisciplinary involvement
The results of this study indicate that exercise interventions encompass not only the specific content of exercise training but also the preparatory work prior to exercise. This includes a clinical assessment of the patient’s physical function status to determine their exercise capacity. Relevant educational courses and exercise guidance help patients understand the importance and effectiveness of exercise, enabling them to adopt correct exercise behaviors. This, in turn, improves their exercise compliance and sustainability, ensuring the effectiveness of the exercise interventions. This shows that the exercise interventions for patients with myeloma is holistic in the design of the exercise program. It is recommended that medical staff focus on an overall approach when developing exercise plans for patients with myeloma. They should conduct detailed evaluations and provide guidance before exercise, and carefully monitor the process during exercise to ensure the effectiveness of the interventions.
The exercise interventions for patients with MM is dynamic in its implementation, and the formulation of exercise strategies is not static. During exercise, the patient’s condition should be closely monitored, and the intensity and type of exercise should be adjusted based on their endurance and muscle strength. At the same time, researchers should consider the patient’s symptoms, heart rate, and blood oxygen saturation during exercise to ensure their safety.
Exercise interventions for patients with MM should gradually transition from a supervised state to an unsupervised daily routine. Continuous exercise is essential for reducing fatigue, and the consistency of unsupervised exercise is crucial for achieving this improvement.
Some studies [ 14 , 23 , 27 ] indicated that exercising for more than 3 months can significantly improve fatigue. Clinical medical staff can actively explore exercise interventions programs that incorporate mobile health technology to overcome geographical and temporal limitations. This approach provides new channels and ideas for implementing exercise interventions while addressing real-world needs. Additionally, it is important to encourage the patient’s family, friends, or other supporters to participate and take an active role in joint supervision. This will help ensure the sustainability and effectiveness of the exercise interventions.
Strengths and limitations
The strengths of this scoping review include an extensive and repeated search of the literature to capture all relevant articles and limit emissions while strictly adhering to the PRISMA reporting guidelines. Unpublished dissertations often report uncertain or negative results, which may introduce publication bias. These studies were excluded from this review. The literature included in this study lacks large-sample, multi-center, randomized controlled studies, and the methodological rigor and data quality of the included studies have not been systematically evaluated.
Conclusion
This review critically examines the foundational elements of exercise interventions for patients with multiple myeloma (MM), encompassing pre-exercise assessments, exercise modalities, intensity, frequency, duration, and ongoing monitoring. While the conclusion asserts that such interventions can positively impact fatigue, mobility, quality of life, and psychological well-being, several critical issues emerge. Firstly, despite the significant potential of exercise interventions in patient rehabilitation, there is a notable lack of uniformity across studies in terms of specific exercise types, parameters, cycles, and supervision. This inconsistency undermines the reliability and generalizability of the findings. Furthermore, the evidence base is characterized by a low level of rigor, highlighting a pressing need for more robust research. Additionally, the studies predominantly focus on stable patients, leaving a significant gap in understanding the safe and effective exercise protocols for those with both stable and unstable bone lesions. Notably absent are comprehensive guidelines for determining appropriate exercise levels in patients with stable and unstable bone lesions, particularly for newly diagnosed individuals, where data on exercise interventions is virtually nonexistent. These limitations underscore the urgent need for methodologically rigorous and standardized research to refine exercise interventions for individuals with MM.
While the studies stress the clinical relevance of exercise interventions, they do not offer actionable frameworks for personalized plans. Future studies should be encouraged to develop decision trees or risk stratification tools based on patient characteristics (e.g., fracture risk, fitness level). At the same time, providers should focus on assessing the condition and physical function status of patients with MM to develop scientifically sound, applicable, sustainable, and standardized exercise training plans. So, patients who improve the quality of life and willingness to exercise can safely and effectively exercise rehabilitation.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Supplementary Material 1
Acknowledgements
Not applicable.
Abbreviations
Multiple myeloma
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
PRISMA extension for scoping reviews
Randomised controlled trial
Total sample size
Chronic Disease Treatment Function Assessment Fatigue Scale
Cancer Patient Quality of Life Scale
Multidimensional Fatigue Inventory
Elderly Physical Activity Scale
Health-Promoting Lifestyle Profile
Author contributions
Jiayao Li and Shanshan Yu wrote the main manuscript text, Yi Peng helped in revising the manuscript text, Ying Zhang prepared figures 1 , and Di Zhan assisted in preparingp Table 1 . All authors reviewed the manuscript.
Funding
There was no funding.
Data availability
Sequence data that support the findings of this study have been deposited in the Open Science Framework with the primary accession code: 10.17605/OSF.IO/UDWM4.
Declarations
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
Data Citations
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Supplementary Materials
Supplementary Material 1
Data Availability Statement
Sequence data that support the findings of this study have been deposited in the Open Science Framework with the primary accession code: 10.17605/OSF.IO/UDWM4.