Typical aspects in the rehabilitation of cancer patients suffering from metastatic bone disease or multiple myeloma

Abstract

SummaryBackgroundThe aim of this study was to present a practical concept focusing on typical aspects of regular physical activity, exercise and physical modalities for patients suffering from metastatic bone disease or multiple myeloma.MethodsA narrative review of the relevant scientific literature and presentation of clinical experiences.ResultsIn cancer patients with metastatic bone disease or multiple myeloma, pain is treated in an interdisciplinary and multimodal setting by using medication, radiotherapy and physical medical modalities (e.g. transcutaneous electrical nerve stimulation); however, modalities increasing local blood flow, such as ultrasound therapy, thermotherapy, massage, various electrotherapy options, are not performed at the site of the tumor. For physical activity and exercise, a suitable indication of the static and dynamic capacity of the affected skeletal structures is essential. This process includes strategies to maintain and improve mobility and independence. Individually tailored and adapted physical activity and exercise concepts (programs) within a multidisciplinary and interdisciplinary setting (tumor board) are used to manage the condition and bone load-bearing capacity of the patient. Typical clinical features and complications, such as pathological fractures in patients suffering from metastatic bone disease and additionally hypercalcemia, monoclonal gammopathy with bone marrow aplasia and risk of renal failure in patients with multiple myeloma have to be considered when planning supportive strategies and rehabilitation.ConclusionIn order to ensure the safety and effectiveness of regular physical activity, exercise, and physical modalities in patients with metastatic bone disease or multiple myeloma, typical contraindications and considerations should be noted.

Relevant parameters for recommendations of physical activity in patients suffering from multiple myeloma

“…Patients with impaired subjective and objective walking performance should therefore be encouraged to at least maintain physical activity levels for as long as possible and perform suitable and supervised individual exercise to improve sensorimotor function, mobility, muscle strength, endurance capacity and independence from others' help. In comparison, exercise studies with multiple myeloma patients usually exclude patients with pathological fractures or increased risk of fractures [11,16,17]. Therefore, a multidisciplinary and interdisciplinary approach as described is necessary to manage the actual condition and to evaluate bone load-bearing capacity of this patient group [11,18,19].…”

“…In comparison, exercise studies with multiple myeloma patients usually exclude patients with pathological fractures or increased risk of fractures [11,16,17]. Therefore, a multidisciplinary and interdisciplinary approach as described is necessary to manage the actual condition and to evaluate bone load-bearing capacity of this patient group [11,18,19].…”

“…Regular physical activity and exercise are important measures to improve health-related quality of life and physical performance in cancer patients [4][5][6][7]. Recommendations for regular physical activity and exercise consist of 150 min/week of moderately intense or 75 min/week of vigorously intense activity or an equivalent combination, muscle strengthening activities of at least moderate intensity at least 2 days/week for each major muscle group and stretching of major muscle groups and tendons [2,[4][5][6][7][8][9][10][11][12].…”

“…Nevertheless, the opportunity to be involved in myeloma exer-cise groups does not yet exist in Austria. Due to bone manifestation of multiple myeloma and special clinical features (especially hypercalcemia and monoclonal gammopathy), a multiprofessional and interdisciplinary approach is required for planning and prescribing regular physical activity and exercise [2,[8][9][10][11][12]. Hereby, physical performance seems to be an important factor to identify which patients should receive an individual therapy or a therapy in an exercise group [11,[16][17][18][19].…”

Musculoskeletal medicine: an Austrian perspective part 1

“…Keilani et al present a practical concept focusing on typical aspects of regular exercise and physical therapy for patients suffering from metastatic bone disease or multiple myeloma. The authors mention typical contraindications and considerations to ensure the safety and effectiveness in these patient groups [5].…”