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.