Individualized exercise during treatment for newly diagnosed multiple myeloma

Evidence label: Mixed randomized evidence; primary strength result negative · Clinical goal: preserve strength, function and quality of life during initial myeloma treatment

Evidence at a glance

Population: 100 newly diagnosed patients in a Danish trial; 86 were evaluable.
Intervention: a 10-week individualized program adapted after assessment of lytic bone disease.
Result: no significant between-group benefit was found; a separate 34-person trial reported functional and symptom improvements but was too small for cancer-control conclusions.

What was studied

The larger randomized trial compared individualized exercise with usual care and made lesion-specific adaptations. Knee-extension strength was primary; walking, sit-to-stand, grip strength, body composition, bone density, quality of life and pain were secondary. REAL-FITNESS randomized 34 patients during VCd induction to guideline-level aerobic and resistance activity or usual activity.

What the evidence shows

In the 100-person trial, 86 were evaluable and no statistically significant between-group differences were observed. Knee-extension strength declined within the intervention group, while sit-to-stand, aerobic capacity and global quality of life improved in both groups. This does not establish harm from exercise, but it does mean the primary benefit claim was not supported.

REAL-FITNESS found feasibility and improvements in several secondary functional and symptom measures. Its response and event-free-survival differences were not statistically significant and must not be read as cancer-control evidence.

Limits and uncertainty

The trials were modest in size, used different programs and had incomplete evaluability. The larger study received regional, hospital, professional and industry support, including Amgen Denmark. The smaller study was not powered for disease response or survival.

Safety and practical context

Myeloma bone lesions, fracture risk, spinal instability, anemia, infection, neuropathy and renal disease require individualized clearance. Imaging and lesion location can change which movements and loads are safe; new focal bone pain or neurologic symptoms need urgent assessment.

Questions for the care team

Have my lytic lesions and fracture risk been mapped for exercise planning?
Which movements or loading directions should I avoid?
Are we targeting strength, fatigue or mobility—and how will we measure it?

Sources

Literature searched: October 22, 2026 · Record appraised: October 22, 2026

Educational evidence summary, not personal medical advice. Research regimens describe what was studied; they are not personal prescribing instructions and should not replace cancer treatment or individualized supportive care.