Patients suffering from multiple myeloma (MM) experience anaemia, thrombocytopenia (too little platelets), pancytopenia (reduction of all blood cells) or fractures due to side effects of medical treatment or the cancer itself. These patients are often hospitalised, causing their physical condition to decline rapidly. Therefore, it is important to mobilise these patients before, during and after treatment. The recommendations given by the researchers are twofold: 1) a guide for the therapist to decide based on blood results whether or not to mobilise in the acute phase and 2) evidence-based guidelines on how patients can be trained best before, during and after chemotherapy and stem cell transplantation to improve their muscle strength, condition, mobility, sleep, and quality of life.
Physiotherapists should look closely at the blood tests and consult a doctor before initiating treatment. Physiotherapy is generally contraindicated in patients with haemoglobin levels lower than 8g/ dl (4.96 mmol/ L). In these patients, it is better to wait with mobilisation; physiotherapists can best monitor vital functions and look for signs of exhaustion (pain on the chest, shortness of breath, dizziness etc.)
According to the authors, there is no clear cut-off point for suspending physical activity in MM-patients with too little platelets. However, because it is common for patients to receive platelet transfusions after chemotherapy at less than 10,000/ µL of platelets, in such cases they advise physiotherapists to only assist the patient with transfers to the toilet and to gently move the joints while lying or sitting. The higher the platelet count, the more the patient is allowed to exercise. For numbers between 10,000 and 20,000/ µL strength training without resistance and standing mobilising exercises, for numbers between 20,000 and 40,000/ µL strength training with an elastic band and numbers above 40,000/ µL, patients are allowed to exercise cautiously on a bicycle. Physiotherapists must always pay attention; avoid high blood pressure as it can cause bleeding.
MM patients with a reduced immune response due to leukopenia and neutropenia (shortness of white blood cells and neutrophils) do well to wear a mouth mask and wash their hands after every physiotherapy session. According to the authors, this reduces the chance of infection.