Perspectives on Exercise Among Individuals with Metastatic Bone Disease and Multiple Myeloma: A Qualitative Interview Study




Miller, Cara

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Background: Individuals with metastatic bone disease (MBD) and multiple myeloma (MM) are commonly excluded from exercise oncology research due to safety concerns regarding potential skeletal complications including the incidence of pain, impaired mobility, pathological fracture, and spinal cord compression. However, over the past decade research has demonstrated that exercise is not only safe for this population but may offer other therapeutic benefits. To our knowledge, the specific perspectives and needs of individuals with MBD related to physical activity and exercise have not yet been explored. The objective of this study was to identify the attitudes towards and needs related to physical activity and exercise among individuals with MBD and MM. Methods: A phenomenological qualitative study utilizing a pragmatic approach to thematic analysis within a patient-oriented research framework was utilized. Semi-structured interview questions and various questionnaires were utilized to gather this descriptive information. Thematic analysis was completed using the 7-stage Framework Method, including transcription, familiarization, coding, analytical framework, and interpreting the data. Results: Of the 20 volunteer participants (90% male), four were living with MM (20%), and 16 had MBD diagnosed within 2-66 months of the study. Half of the participants did not report feeling any bone pain, with none experiencing severe bone pain, and eight (40%) experienced pain specifically with movement. Most participants engaged in a variety of physical activities and at various intensities, although 25% were found to be sedentary/insufficiently active. Five major themes emerged from the interviews including “meaning of physical activity”, “cancer care ‘exercise is medicine’ support (or lack thereof)”, “motivators to engage in physical activity”, “barriers causing a reduction in physical activity post diagnosis”, and “physical activity program preferences”. These themes encompassed a total of 32 categories and 44 subcategories, creating the overall thematic framework. Discussion: Individuals with MBD and MM do engage in regular physical activity, although differences in the frequency and intensity of exercise exist. Exercise has a recognized and valued role in their lives and health, including bone health. These patients are genuinely interested in some form of exercise program as part of their cancer care. Movement or activity modifications may be required for some based on bony lesions and fracture prevention. Differences may also be related to comorbidities, preferences, and/or abilities. While there is no “one size fits all” approach to oncology-based exercise prescription and implementation among this population, the findings of this study demonstrate that there is a strong patient-identified need to support those living with MBD and MM to engage in regular exercise in order to obtain its physical and psychological benefits.



Exercise, Physical activity, Cancer, Oncology, Bone Metastases, Multiple Myeloma, Perspectives, Qualitative, Interview