Janine Joseph, MS, MBA, is a senior research specialist at Roswell Park Comprehensive Cancer Center.

Joseph on the Research Behind the Role of Exercise and Supportive Care in Myeloma

"I hope that what comes out of this is more research into how we can potentially use exercise to derail myeloma before it even starts."

Janine Joseph, MS, MBA, a senior research specialist at Roswell Park Comprehensive Cancer Center, discussed the current state of research and future directions for resistance training interventions in patients with multiple myeloma.

Although the role of exercise in this patient population is gaining interest, this area of remains in its infancy, and many questions remain unanswered, Joseph explained. Preliminary evidence has supported the use of exercise to address key quality-of-life outcomes such as fatigue and pain; however, further research is needed to define the clinical value of resistance training beyond symptom management, she noted.

Future investigations should explore whether resistance training can influence biological end points, such as the tumor-immune microenvironment in the bone marrow, Joseph stated. Since accessing the bone marrow is invasive, ongoing efforts are focused on leveraging standard-of-care bone marrow biopsies to assess exercise-related changes in the myeloma niche, she said. This strategy may allow researchers to gain mechanistic insights without placing additional burden on patients, she added.

Moreover, Joseph emphasized the need to examine whether resistance training can enhance treatment response and survival outcomes. Key areas of interest include identifying the most effective exercise modalities, determining optimal frequency and duration, and improving the scalability and durability of interventions in clinical practice, she explained.

Importantly, Joseph also highlights the opportunity to investigate the role of exercise earlier in the disease course, particularly in individuals with precursor conditions such as monoclonal gammopathy of undetermined significance (MGUS). Given that MGUS is a well-defined precursor state for multiple myeloma, resistance training may have potential as a preventive strategy to delay or prevent disease progression, she noted.

Although there is growing recognition of its potential benefits, exercise interventions have yet to be fully integrated into standard treatment frameworks. Future research should prioritize mechanistic endpoints, treatment synergy, and long-term maintenance strategies, she concluded.

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Janine Joseph, MS, MBA, discusses the current state of research and future directions for resistance training interventions in patients with multiple myeloma.

Janine Joseph, MS, MBA, discusses the effects of resistance training interventions on fatigue and pain levels in patients with multiple myeloma.

Dr Joseph on the Effects of Resistance Training on Fatigue and Pain in Multiple Myeloma

“We’re excited about the fatigue and the pain [improvements], and we’re also excited to get the message out that future trials need to focus not just on what can be done during the period of the trial, but on how we can make these changes durable.”

Janine Joseph, MS, MBA, senior research specialist, Roswell Park Comprehensive Cancer Center, discusses findings from studies investigating the effects of resistance training interventions on fatigue and pain levels in patients with multiple myeloma.

A combined analysis of 2 studies evaluating the effects of supervised resistance training interventions in patients with multiple myeloma demonstrated significant improvements in fatigue and pain, Joseph begins. These interventions consisted of twice-weekly, 1-hour, whole-body resistance training sessions, which were conducted either in person or remotely by physical trainers, she explains. Notably, patients experienced a reduction in fatigue from baseline to the end of the intervention period. However, their fatigue returned to baseline levels once the intervention was discontinued, suggesting that ongoing participation in resistance training is necessary to maintain its benefit, she explains.

Pain outcomes were also improved through resistance training, particularly in the in-person supervised resistance training cohort, and these pain reductions persisted even after the intervention ended, Joseph notes. Overall, these study findings are significant for patients with multiple myeloma, as fatigue and pain are key factors affecting their quality of life, she emphasizes.

In contrast, patients who engaged in an unsupervised home-based walking intervention, which involved wearing a step tracker and being encouraged to gradually increase their active minutes daily, did not experience significant improvements in fatigue, pain, or other measured outcomes. Furthermore, across all intervention groups, investigators did not see significant changes in anxiety or depression levels.

These findings highlight the importance of supervised resistance training as an effective intervention for fatigue and pain management, and simultaneously emphasize the need for sustainable strategies to maintain these benefits beyond the intervention period, she reports. Future research should focus on identifying ways to prolong these positive effects, Joseph concludes.

Janine Joseph, MS, MBA

Articles

Joseph on the Research Behind the Role of Exercise and Supportive Care in Myeloma

Joseph on the Effects of Resistance Training on Fatigue and Pain in Multiple Myeloma