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Staying Fit With Multiple Myeloma

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Multiple myeloma is a cancer that harms plasma cells in the bone marrow. Plasma cells normally help fight infection, but in this case, they become cancerous. As the cancer grows and spreads, it may travel into and damage your bone tissue.

During the active phase of myeloma when the cancer cells are growing in the bone marrow, they make chemicals that can dissolve bone. There are certain places where there are literally holes "punched" clear through the bone.

As the cancer attacks more areas of bone, you may feel pain and be at greater risk for fractures. The effects are similar to those that occur in someone with osteoporosis, although the initial treatments for the two diseases are different. Doctors may prescribe chemotherapy, radiation, or blood stem cell transplants to treat multiple myeloma.

Is Exercise Safe With Multiple Myeloma?

There is currently a lack of research on the benefits of exercise in people with multiple myeloma. However, studies have shown that exercise can be helpful physically and mentally--if performed safely and cautiously. Exercise can benefit you in many ways. It can boost your energy level, help you maintain range of motion in your joints and muscles, improve fatigue, lower stress, decrease anxiety and depression, and help you feel hungry.

Certain exercises may also strengthen bones, as seen in people with osteoporosis.

However, while receiving treatment for multiple myeloma, you should not do vigorous exercise since this is a time when cancer is actively growing in bones and they are very vulnerable to fractures. During cancer treatment, the focus should not be to exercise heavily. Decisions on how to maintain, or when to start an exercise program depend on the patient's condition and personal preferences. People getting chemotherapy and radiation therapy who are already on an exercise program may need to exercise at a lower intensity and progress at a slower pace for a while. But the primary goal should be to maintain activity as much as possible. For those who were sedentary before diagnosis, low-intensity activities such as stretching and short, slow walks should be started and slowly advanced. For older patients and those with bone disease or significant problems like arthritis or peripheral neuropathy, balance should be considered along with safety to reduce the risk for falls and other injuries.

Talk with your doctor about the areas of bone damage so that you are aware of and can protect delicate bones. After finishing treatment for myeloma, the goals are to regain bone and muscle strength, and to return to normal, daily physical activities as much as possible. These will help improve your independence and quality of life.

Starting Out

During the early stages of multiple myeloma, you may receive physical or rehabilitative therapy to condition your body. A physical therapist is trained to guide people to do mild exercises.

People with multiple myeloma during or after a bone marrow transplant often feel ill and are inactive from having low blood counts and chemotherapy. Fatigue is a huge factor. The main goal is to keep them functioning by getting them to walk and to move and rotate different muscles and joints.

When you leave the hospital, the physical therapist can recommend basic exercises to do at home. However, you should temporarily avoid high-impact or intense activities such as heavy strength training or jogging. These can cause damage to the spine--which is often affected in multiple myeloma.

If there are only limited areas of bone damage, you can do careful exercise that avoids risk to the specific areas. For example, if there is bone damage in your arm, you could safely do brisk walking. Swimming is another good low-impact activity. The water offers some resistance but also supports and lowers pressure on your legs, spine, and joints.

Creating an Exercise Routine That Works for You

After your doctor says it's OK to begin an exercise routine, the first step is to choose activities that you like. This sounds obvious, but if you don't enjoy an activity, the sooner you may stop doing it.

After months of cancer treatments, you may feel weak and depressed. You may want to start exercising with a loved one or a personal trainer who can encourage you to do things that get you moving.

Different activities benefit your body in different ways. A well-rounded exercise routine includes the following things.

Warm-up. This helps loosen your muscles to prepare your body for more active movements and to prevent injury. One way to warm up includes walking at a moderate pace for 5 to 10 minutes while swinging your arms lightly.

Aerobic or cardiovascular exercise. These activities help strengthen your heart and lungs. Heart-pumping activities include walking, swimming, or using a stair machine, elliptical trainer, or stationary bike. Start with a comfortable goal of about 10 to 15 minutes, 3 to 5 times a week. As you feel able, increase your time by a few minutes every week. Work up to a goal of 20 to 30 minutes most days of the week. Avoid high-impact activities such as running, jogging, horseback riding, and biking outdoors. They can jolt and harm your spine or other fragile bones.

Strength or resistance training. These are repetitive movements designed to build or maintain muscle strength. It is best to learn these exercises from a trainer or physical therapist to make sure you perform them properly. You can start with 1- or 2-pound hand weights or rubber resistance bands (both available at sporting goods stores). Do strength exercises up to 3 times a week, every other day. Give yourself a day of rest in between. Your muscles need time to rest and repair. Avoid heavy weights of more than 5 pounds, unless directed by a trainer.

Stretching. This helps loosen and relax stiff joints and muscles. End your routine with a few different stretches for 5 to 10 minutes. For best results, hold stretches for up to 20 to 30 seconds without bouncing. You can learn these moves from your trainer or physical therapist.

If you feel any of the following symptoms, stop exercising or slow down your pace.

  • Shortness of breath

  • Sharp pain in a specific area (this is different from the dull, general pain that is felt a day or two after exercising, which is normal)

  • Dizziness

  • Nausea

  • Extreme fatigue or tiredness

Never overdo any exercise, and if any of these symptoms persist for more than a day, see your doctor at once. The point of exercise is to make you feel better. If it doesn't, slow down. You can move ahead when you feel stronger. Remember, progress takes time.

Finding a Qualified Exercise Consultant

A physical therapist or certified fitness trainer can create a safe, effective exercise regimen done at home or in a gym. But be choosy.

A physical therapist undergoes years of education and training to treat people with injury or disease. A personal fitness trainer may or may not be as qualified, so be careful when seeking a personal trainer. Many people call themselves "personal trainers," but they may be neither certified nor insured.

Even with certification, a personal trainer may have little or no experience with cancer or other diseases. Also, the training needed to receive certification varies greatly. It depends entirely on who is offering the certification.

Refer to the Yellow Pages or a local fitness center for a personal trainer certified from a respected group. Examples are the American College of Sports Medicine (ACSM) or the National Strength and Conditioning Association (NSCA). They offer certificates for clinical exercise trainers who must pass a rigorous exam that requires knowledge of various illnesses and disabling conditions. The ACSM also requires a degree in a health-related field and many hours of training clients in a hospital setting.

In addition, have the personal trainer or physical therapist contact your doctor. Your doctor can inform them of your health condition and of any safety measures needed.

Many insurance plans cover the cost of a physical therapist in a hospital. But you may need to pay out-of-pocket for outpatient services or home visits. Check with your insurance policy about coverage for physical therapy. Insurance does not usually cover the cost of personal fitness trainers. However, a few initial visits with a qualified personal trainer may be enough to get you started safely and may be well worth your money.

These suggestions are all general guidelines. Talk with your doctor before starting any exercise program.

FYH

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