Virtual Exercise for Multiple Myeloma (MY-PROGRESS)

Feasibility of a Virtually Supported Home-Based Resistance and Aerobic Exercise Program for Cancer Survivors With 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.

Study Overview

• Status: Completed
• Conditions: Multiple Myeloma
• Intervention / Treatment: Behavioral: Exercise

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Actual): 31
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Alberta
    • Edmonton, Alberta, Canada, T6G 2G4
      • University of Alberta/ Cross Cancer Institute

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

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)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Behavioural: Exercise; Participants will take part in a twelve week resistance and aerobic exercise program twice per week delivered virtually. Exercise sessions will include a combination of aerobic, resistance, balance, and flexibility exercises

Behavioral: Exercise; 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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Feasibility (Adherence)	The percentage of total exercise dose prescribed that was actually completed (%)	12 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Feasibility (Recruitment rate)	The number of participants recruited per month over the recruitment period and the proportion of patients who participate in the study, out of the total number of eligible patients	7 months
Feasibility (Completion rate)	The number of participants who completed the program and follow-up assessment out of the number of participants who consented to the study	12 weeks
Feasibility (Safety)	The number of adverse events reported by the participants during program participation, including the 12-week program and fitness assessments	12 weeks

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Home-based Stepping Test	Change in 2-minute stepping test (number of steps)	Change from baseline to 12 weeks
Shoulder flexibility	Change in active shoulder flexion range of motion (degrees)	Change from baseline to 12 weeks
Lower Body Flexibility	Change in sit-and-reach test (cm)	Change from baseline to 12 weeks
Leg Strength	Change in 30-second sit-to-stand (number of repetitions)	Change from baseline to 12 weeks
Balance	Change in one legged stance test (seconds	Change from baseline to 12 weeks
Balance Confidence	Activities-specific Balance Confidence (ABC) scale (score)	Change from baseline to 12 weeks
Upper Extremity Function	Change in Upper Extremity Functional Index (score)	Change from baseline to 12 weeks
Lower Extremity Function	Change in Lower Extremity Functional Scale (score)	Change from baseline to 12 weeks
Cancer-Specific Quality of Life	Change in Functional Assessment of Cancer Therapy General, Multiple Myeloma, and Bone Pain Scales (score)	Change from baseline to 12 weeks
Fatigue	Change in FACIT-Fatigue Subscale (score)	Change from baseline to 12 weeks
Six-minute walk test (optional)	Six-minute walk test distance (metres)	Change from baseline to 12 weeks
Upper Extremity Grip Strength (optional)	Hand-grip dynamometry (kg)	Change from baseline to 12 weeks
Upper extremity strength (optional)	One repetition maximum bench press (kg)	Change from baseline to 12 weeks
Lower extremity strength (optional)	One repetition maximum leg press (kg)	Change from baseline to 12 weeks
Core Endurance (optional)	Plank hold (seconds)	Change from baseline to 12 weeks
Fall risk (optional)	Three-metre backwards walk test (seconds)	Change from baseline to 12 weeks

Collaborators and Investigators

• Sponsor: University of Alberta

Study record dates

Study Major Dates

• Study Start (Actual): September 15, 2020
• Primary Completion (Actual): June 15, 2021
• Study Completion (Actual): August 31, 2021

Study Registration Dates

• First Submitted: July 21, 2020
• First Submitted That Met QC Criteria: July 21, 2020
• First Posted (Actual): July 23, 2020

Study Record Updates

• Last Update Posted (Actual): September 17, 2021
• Last Update Submitted That Met QC Criteria: September 16, 2021
• Last Verified: September 1, 2021

More Information

Terms related to this study

• Keywords: exercise; feasibility; pilot
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Immune System Diseases; Neoplasms by Histologic Type; Neoplasms; Lymphoproliferative Disorders; Immunoproliferative Disorders; Hematologic Diseases; Hemorrhagic Disorders; Hemostatic Disorders; Paraproteinemias; Blood Protein Disorders; Multiple Myeloma; Neoplasms, Plasma Cell
• Other Study ID Numbers: HREBA.CC-20-0201

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: No plan in place at this time

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No