What can you do for a patient with multiple myeloma?

Practical guidelines for treatment

  • Review blood tests and consult a doctor before starting treatment
  • Avoid heavy loads on joints to reduce chance of fracture
  • Prevent deconditioning: start exercising before medical treatment

Cancer patients suffering from multiple myeloma – a form of bone marrow cancer – often have to deal with physical limitations for which physiotherapy treatment is required. Because there are no practical guidelines yet that physiotherapists can rely on, Canadian researchers delved into the literature and asked experts and patients for  their opinion. As a result, they present a series of recommendations to support physiotherapists in delivering optimal care to multiple myeloma patients. 


Be careful with twisting movements, bending over, reaching above the head, pushing, pulling, and lifting is the motto of the experts to physiotherapists. These movements pose a risk of fractures in the spine. Almost 80 percent of MM patients suffer from bone pain and over half actually suffers a fracture. Physiotherapists can alter exercises to reduce the chance of a fracture. You can think of using supporting means, such as braces and walkers. On the other hand, it is better to avoid heavy loads on the joints and end of range movements. 

Sleep, exhaustion, and quality of life

Physical activity during and after medical treatment can improve the mental health of the MM patient. The researchers found evidence in a number of studies that physical activity ensures that patients sleep better, are less tired and experience a better quality of life. However, the authors do have some reservations concerning these results: the studies included small groups and not all participants had MM.


The scientists recommend starting with improving fitness and muscle strength before medical treatment. During medical treatments, patients appear to be less compliant to exercise. However, if they exercise before and during treatment, they can slow down the deconditioning process and possibly even speed up recovery.

Consensus and literature research

In total, ten specialised physiotherapists and ten MM patients indicated to what extent they agreed with thirty statements about the physiotherapy treatment for patients with MM. The authors determined in advance that there was consensus if at least eighty percent of the experts and patients endorsed the statements. In addition, the scientists also conducted a systematic literature search, which resulted in 17 usable studies in which they found relevant information about the effectiveness of certain training principles.

> From: Jeevanantham et al., Phys Ther 101 (2021) pzaa180 . All rights reserved to The Author(s). Click here for the online summary. Translation by Casper Martens

Want to read deeper into this topic? You can access a free version of the full text article here!

Expert opinion by Martijn Stuiver, PhD

In their paper, the authors rightly argue that an important starting point is that further damage should be avoided in this vulnerable patient group, but that this does not mean abandoning exercise therapy completely. After all, the latter can also have negative consequences, in particular an even faster decreasing exercise tolerance and negative psychosocial consequences. The authors also emphasise the low number of reported complications of carefully coordinated exercise therapy and training in patients with multiple myeloma. The potential benefits of intervention therefore generally outweigh the additional risks.

Practical implications of this publication are almost no longer necessary, given the very concrete and carefully considered recommendations. The above summary is - of course - not complete. The full paper can be accessed free of charge using the link above.

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