Exercising Safely with Myeloma: Your Definitive Guide

Living with multiple myeloma presents unique challenges, and maintaining physical activity might seem daunting. However, exercise isn’t just beneficial; it’s a crucial component of managing your condition, improving quality of life, and even enhancing treatment outcomes. The key lies in understanding how to exercise safely and effectively. This guide cuts through the noise, offering actionable, practical advice to empower you on your fitness journey with myeloma.

Understanding the Landscape: Myeloma and Exercise Considerations

Before lacing up your shoes, it’s vital to grasp why exercising with myeloma requires a tailored approach. Myeloma affects bone marrow, often leading to bone lesions, pain, fatigue, and a weakened immune system. These factors directly influence the type, intensity, and frequency of exercise you can safely undertake.

Your primary considerations will revolve around:

• Bone Health: Myeloma can cause osteolytic lesions, making bones more fragile and susceptible to fractures. High-impact activities or movements that twist or jar the spine must be avoided.

• Fatigue: Myeloma-related fatigue isn’t just tiredness; it’s a debilitating exhaustion that can significantly impact your ability to exercise. Pacing yourself and listening to your body are paramount.

• Peripheral Neuropathy: Some treatments can cause nerve damage, leading to numbness, tingling, or pain, particularly in the hands and feet. This can affect balance and coordination.

• Anemia: A common side effect of myeloma and its treatments is anemia, which can reduce oxygen delivery to muscles, leading to breathlessness and fatigue.

• Infection Risk: A compromised immune system means a higher risk of infection. Exercising in clean environments and avoiding large crowds during peak illness seasons is wise.

Always consult your hematologist or oncology team before starting or significantly changing any exercise program. They understand your specific disease progression, treatment regimen, and potential complications. They can provide personalized recommendations and clear any activities that might pose a risk.

Building Your Foundation: The Pillars of a Safe Myeloma Exercise Plan

A safe and effective exercise program for individuals with myeloma is built upon three core pillars: Low-Impact Aerobics, Gentle Strength Training, and Balance & Flexibility.

Pillar 1: Low-Impact Aerobics for Cardiovascular Health and Energy

Cardiovascular exercise strengthens your heart and lungs, improves circulation, boosts energy levels, and can help combat fatigue. For myeloma patients, “low-impact” is non-negotiable. This means activities that put minimal stress on your bones and joints.

How to Do It – Concrete Examples:

• Walking: The simplest yet most effective.
  • Start Slow: Begin with 5-10 minutes of gentle walking, 3-4 times a week.

  • Gradual Increase: Incrementally add 1-2 minutes to each session as your stamina improves. Aim for 20-30 minutes most days of the week.

  • Pace Yourself: Walk at a conversational pace where you can talk comfortably but feel your heart rate elevate slightly.

  • Surface Matters: Opt for even, soft surfaces like a track, paved park paths, or a treadmill. Avoid uneven terrain or areas with potential tripping hazards.

  • Example: “Today, I’ll walk around my local park for 15 minutes, ensuring I maintain a steady, comfortable pace on the paved path.”

• Stationary Cycling: Provides an excellent cardiovascular workout without weight-bearing impact.

  • Proper Setup: Adjust the seat height so your knee has a slight bend at the bottom of the pedal stroke. Ensure handlebars are comfortable.

  • Resistance Control: Start with very low resistance and gradually increase it as your strength builds. Focus on smooth, continuous pedaling.

  • Listen to Your Body: If you feel any joint pain, reduce resistance or stop.

  • Example: “I’ll use the stationary bike for 20 minutes, keeping the resistance light enough to feel my heart working but without straining my knees.”

• Elliptical Trainer: Mimics walking or running motion with reduced impact.

  • Smooth Motion: Focus on a fluid, elliptical movement, keeping your feet firmly on the pedals.

  • No High Incline/Resistance: Avoid settings that make you feel unstable or put excessive pressure on your knees or hips.

  • Handrails for Balance: Use the handrails for stability, especially if you experience neuropathy.

  • Example: “My goal is 25 minutes on the elliptical, maintaining a steady rhythm and using the handrails for support to ensure I don’t lose my balance.”

• Swimming or Water Aerobics: The buoyancy of water supports your body weight, making it ideal for joint protection.

  • Water Walking: Walk laps in the shallow end of a pool. The water resistance provides a gentle workout.

  • Lap Swimming: If comfortable, gentle laps using various strokes can be highly effective. Avoid forceful push-offs from the wall.

  • Structured Classes: Many community centers offer water aerobics classes specifically designed for individuals with limited mobility or joint issues.

  • Example: “I’ve signed up for the beginner water aerobics class twice a week. The instructor understands joint considerations, and I feel much lighter in the water.”

Key Action Points for Aerobics:

• Warm-up: 5 minutes of light movement (e.g., gentle marching in place, arm circles) before each session.

• Cool-down: 5 minutes of gentle stretching after each session (see flexibility section).

• Hydration: Drink water before, during, and after exercise.

• Monitor Symptoms: Stop immediately if you experience dizziness, chest pain, severe shortness of breath, or new bone pain.

Pillar 2: Gentle Strength Training for Bone and Muscle Support

Strength training is critical for maintaining muscle mass, improving bone density (where possible), and supporting your skeletal structure. For myeloma patients, this means focusing on light resistance and controlled movements, never heavy lifting or movements that compress the spine.

How to Do It – Concrete Examples:

• Bodyweight Exercises (Modified):
  • Wall Push-ups: Stand facing a wall, hands shoulder-width apart on the wall. Lean in, bending your elbows, then push back to the starting position. This strengthens chest and shoulders without putting stress on the spine.

  • Chair Squats: Sit on a sturdy chair, then slowly stand up using your leg muscles, and gently lower back down. This builds leg and glute strength. Use a chair with arms for assistance if needed.

  • Modified Planks (on Knees or Forearms): Start on your hands and knees, then lower onto your forearms, keeping your back straight and core engaged. This strengthens core muscles without direct spinal compression.

  • Example: “I’ll do 3 sets of 10 wall push-ups and 3 sets of 8 chair squats every other day to strengthen my upper body and legs without risky movements.”

• Resistance Bands: Offer versatile and adjustable resistance.

  • Band Rows: Anchor a band to a sturdy object (or loop it around your feet while seated). Pull the band towards your chest, squeezing your shoulder blades. Strengthens back muscles.

  • Band Bicep Curls: Stand on the middle of a band, holding an end in each hand. Curl your hands towards your shoulders. Strengthens biceps.

  • Band Leg Abduction: Lie on your side with a band around your ankles. Lift your top leg up, keeping it straight. Strengthens hip abductors for stability.

  • Example: “I’ve purchased a light resistance band. I’ll do seated band rows for my back and bicep curls, aiming for 12-15 repetitions per set.”

• Light Hand Weights (1-3 lbs max, or even soup cans):

  • Arm Raises: Hold a light weight in each hand. Slowly raise arms out to the sides (lateral raises) or forward (front raises), no higher than shoulder height. Avoid jerky movements.

  • Shoulder Presses (seated): Sit upright. Hold light weights at shoulder height, palms forward. Gently press weights straight up overhead, then lower slowly. Crucially, if you have any spinal concerns, only press to a comfortable height, avoiding full overhead extension that could arch the back.

  • Example: “I’m using 1-pound weights for gentle arm raises and seated shoulder presses, focusing on slow, controlled movements to protect my shoulders.”

Key Action Points for Strength Training:

• Focus on Form: Proper technique is more important than the amount of weight or resistance. Incorrect form can lead to injury.

• Listen to Your Bones: If a movement causes any bone pain, stop immediately.

• Breathe: Exhale on exertion, inhale on release. Avoid holding your breath.

• Frequency: Aim for 2-3 strength training sessions per week, with at least one rest day in between to allow muscles to recover.

• Progression: Only increase weight/resistance or repetitions when you can comfortably complete your target sets with perfect form. Small increments are key.

Pillar 3: Balance & Flexibility for Stability and Range of Motion

Myeloma and its treatments can impact balance due to neuropathy, muscle weakness, or general fatigue. Improving balance reduces the risk of falls, a critical concern with fragile bones. Flexibility exercises maintain joint range of motion and can alleviate stiffness.

How to Do It – Concrete Examples:

• Balance Exercises:
  • Chair Support Balance: Stand behind a sturdy chair, holding onto the back for support. Lift one foot slightly off the ground, holding for 10-30 seconds. Repeat on the other side. As you improve, try letting go of the chair for brief periods.

  • Heel-to-Toe Walk: Walk in a straight line, placing the heel of one foot directly in front of the toes of the other. Use a wall or rail for support if needed.

  • Tai Chi or Qi Gong: These practices are excellent for balance, coordination, and mindfulness, performed with slow, deliberate movements. Look for beginner or modified classes.

  • Example: “Every morning, I practice my chair-supported balance for 30 seconds on each leg to improve my stability and reduce my fall risk.”

• Flexibility Exercises (Gentle Stretching):

  • Neck Rolls: Gently roll your head from side to side, ear towards shoulder, then chin towards chest. Avoid full circular rolls if you have neck issues.

  • Shoulder Rolls: Roll your shoulders forward in a circular motion, then backward.

  • Gentle Hamstring Stretch (Seated): Sit on the edge of a chair, one leg extended with the heel on the floor. Lean forward from your hips, keeping your back straight, until you feel a gentle stretch behind your thigh.

  • Calf Stretch (Wall Support): Stand facing a wall, hands on the wall. Step one foot back, keeping the heel on the floor and the leg straight, feeling the stretch in your calf.

  • Child’s Pose (Modified): Kneel on the floor, bring your big toes together and spread your knees wide. Rest your torso between your thighs and extend your arms forward. If kneeling is uncomfortable, perform a similar stretch seated, leaning forward.

  • Example: “After my walk, I spend 5 minutes doing gentle stretches, focusing on my hamstrings and calves, holding each stretch for 20-30 seconds.”

Key Action Points for Balance & Flexibility:

• Move Slowly: All movements should be slow and controlled. Avoid bouncing or rapid movements.

• Hold, Don’t Bounce: Hold stretches for 20-30 seconds, feeling a gentle pull, not pain.

• Listen to Your Body: If any stretch causes sharp pain, stop immediately.

• Consistency: Daily flexibility exercises can make a significant difference in stiffness and range of motion.

Navigating Specific Myeloma-Related Challenges with Exercise

Beyond the general principles, addressing specific myeloma-related issues is crucial for safe and effective exercise.

Managing Myeloma Bone Disease (MBD) and Fracture Risk

This is perhaps the most critical consideration. Osteolytic lesions weaken bones significantly.

• Spinal Protection:
  • Avoid Spinal Twisting: No golf swings, rotational exercises, or aggressive twisting.

  • No Spinal Compression: Avoid sit-ups, crunches, overhead squats, deadlifts, or any exercise that puts direct downward pressure on the spine.

  • Log Rolling: When getting out of bed, roll onto your side first, then push up with your arms to avoid twisting your spine.

  • Posture: Maintain good posture whether sitting, standing, or walking to minimize spinal strain.

• Weight-Bearing Modification: While some weight-bearing is beneficial for bone health, high-impact weight-bearing is dangerous.

  • Walk, Don’t Run: Opt for walking instead of jogging or running.

  • No Jumping: Avoid jumping jacks, plyometrics, or any jumping movements.

  • Stair Climbing (Cautious): If climbing stairs, use handrails for support and take it one step at a time, avoiding any quick or forceful movements.

• Fall Prevention:

  • Clear Pathways: Keep your home free of clutter, loose rugs, or anything that could cause a trip.

  • Adequate Lighting: Ensure all areas are well-lit.

  • Supportive Footwear: Wear shoes with good grip and support, even indoors. Avoid going barefoot on slippery surfaces.

  • Assistive Devices: Don’t hesitate to use a cane or walker if recommended by your physical therapist.

  • Example: “Instead of my previous core routine, I’ll focus on modified planks and bird-dog exercises, which strengthen my core without any spinal twisting or compression. I’ve also removed all loose rugs in my home to prevent accidental falls.”

Combating Myeloma-Related Fatigue

Fatigue is a hallmark of myeloma and its treatments. Exercise, paradoxically, can help combat it, but only if approached correctly.

• Pacing is Key: Don’t try to push through extreme fatigue. On days you feel particularly tired, opt for very short, gentle activities (e.g., 5-10 minutes of slow walking or stretching).

• Break It Up: Instead of one long session, divide your exercise into several short bursts throughout the day (e.g., three 10-minute walks instead of one 30-minute walk).

• Listen to Your Body: If you need to rest, rest. Recovery is just as important as activity.

• Early Day Exercise: Many find they have more energy earlier in the day. Schedule your exercise for when you feel your best.

• Pre-emptive Rest: If you know you have a busy day, plan for more rest beforehand and after.

• Example: “Today I’m feeling fatigued, so instead of my planned 30-minute bike ride, I’ll do two 10-minute slow walks, one in the morning and one in the afternoon. I’ll make sure to sit down and rest if I feel overwhelmed.”

Addressing Peripheral Neuropathy

Neuropathy can affect balance and increase the risk of falls.

• Stable Footwear: Wear well-fitting, supportive shoes with good grip.

• Visual Cues: Look at your feet when walking if balance is significantly impaired.

• Handrails and Support: Use handrails on stairs, walls for balance exercises, or a walker if necessary.

• Awareness: Be extra mindful of your surroundings to avoid tripping hazards.

• Proprioceptive Exercises: Activities that help your body sense its position in space can be beneficial. These include standing on one leg (with support), walking heel-to-toe, and standing on uneven surfaces (like a firm pillow, with supervision).

• Example: “Due to my neuropathy, I always wear my supportive sneakers, even when walking around the house. When I do my balance exercises, I make sure to hold onto the counter for safety until I feel more stable.”

Exercising During Active Treatment and Remission

Your exercise approach will likely evolve with your myeloma journey.

• During Active Treatment (Chemotherapy/Radiation):
  • Reduced Intensity: This is when fatigue and side effects might be most pronounced. Focus on very gentle activities like short walks, stretching, and chair exercises.

  • Hygiene: Be extra vigilant about cleanliness in public gyms/pools. Wipe down equipment, use hand sanitizer, and avoid close contact with others if your immune system is compromised.

  • Flexibility: Be prepared to modify or skip sessions based on how you feel on any given day.

  • Example: “During my chemotherapy cycle, I limit my activity to a daily 15-minute gentle walk around my garden and some seated stretches, focusing on maintaining some movement rather than pushing myself.”

• During Remission/Maintenance Therapy:

  • Gradual Progression: As you regain strength and energy, you can slowly and cautiously increase the duration and intensity of your workouts.

  • Set New Goals: Perhaps aim for longer walks, slightly more resistance with bands, or more challenging balance exercises.

  • Continued Vigilance: Even in remission, bone health remains a concern. Continue to avoid high-impact activities or movements that twist the spine.

  • Example: “Now that I’m in remission, I’ve increased my walks to 45 minutes, and I’m adding a second day of light resistance band training to my weekly routine, always remembering to protect my spine.”

Essential Safety Protocols and Red Flags

Safety is paramount. Understanding when to modify or stop exercise is crucial.

• Warm-up and Cool-down: Always dedicate 5-10 minutes to gentle warm-up exercises (e.g., marching in place, arm circles) before and cool-down stretches after your main workout. This prepares your body and aids recovery.

• Listen to Your Body: This cannot be overstressed. Myeloma symptoms can fluctuate daily. Some days you’ll feel stronger, others weaker. Adjust your activity accordingly.

• Pain is a Warning Sign:

  • STOP Immediately if: You experience new or worsening bone pain, sharp or sudden pain, chest pain, dizziness, lightheadedness, nausea, or unusual shortness of breath.

  • REPORT to your Doctor: Any persistent or new pain, especially bone pain, must be reported to your medical team.

• Hydration: Drink plenty of water throughout the day, especially before, during, and after exercise.

• Nutrition: Fuel your body with a balanced diet to support energy levels and recovery.

• Rest and Recovery: Allow your body adequate rest days. Overtraining can exacerbate fatigue and increase injury risk.

• Supervision (Initially): Consider working with a physical therapist or exercise physiologist who has experience with oncology patients. They can design a personalized program and teach you proper form, which is invaluable.

• Emergency Plan: Know who to call and what to do if you experience a medical emergency during exercise. Carry your phone and medical information if exercising outdoors.

• Example: “I felt a sharp pain in my lower back during a seated row today, so I immediately stopped. I’ll monitor it and call my doctor if it doesn’t resolve by tomorrow, and I’ll review my form next session to ensure I’m not arching my back.”

The Mental Benefits: Beyond the Physical

While the physical benefits are clear, the psychological impact of exercise with myeloma is equally significant.

• Stress Reduction: Exercise is a powerful stress reliever, helping to manage the anxiety and emotional toll of a cancer diagnosis.

• Improved Mood: Physical activity releases endorphins, natural mood elevators that can combat depression and improve overall well-being.

• Sense of Control: Taking an active role in your health through exercise can foster a sense of empowerment and control over your condition.

• Better Sleep: Regular, moderate exercise can improve sleep quality, which is often disrupted by myeloma and its treatments.

• Social Connection: If comfortable, group classes (like gentle yoga or water aerobics) can provide social interaction and a sense of community.

• Example: “Even on days when I feel a bit down, my 20-minute walk clears my head and lifts my spirits. I also find I sleep much better on the nights I’ve been active.”

Crafting Your Personalized Myeloma Exercise Plan

There’s no one-size-fits-all plan. Your program must be dynamic, adapting to your symptoms, treatment phase, and overall well-being.

1. Consult Your Healthcare Team: This is the absolute first step. Get clearance and specific recommendations.

2. Assess Your Current Fitness Level: Be realistic. If you’ve been sedentary, start incredibly small.

3. Identify Your Limitations: Are you experiencing bone pain, neuropathy, severe fatigue? Tailor your activities accordingly.

4. Set Realistic Goals: Don’t aim for a marathon. Aim for consistency and small, achievable increments (e.g., “I will walk for 15 minutes, 3 times this week”).

5. Start Slowly and Progress Gradually: The tortoise wins the race here. Slow and steady reduces injury risk and builds sustainable habits.

6. Diversify Your Routine: Incorporate elements from all three pillars (aerobics, strength, balance/flexibility) for a well-rounded program.

7. Track Your Progress: Keep a simple log. Note what you did, for how long, and how you felt. This helps you see progress and identify patterns.

8. Be Flexible: Life with myeloma is unpredictable. Don’t beat yourself up if you miss a session. Just get back on track when you can.

9. Celebrate Small Victories: Acknowledge your efforts and progress, no matter how small. It builds motivation.

10. Consider Professional Guidance: A physical therapist or certified cancer exercise specialist can provide invaluable one-on-one coaching, ensuring your exercises are safe and effective for your unique situation.

Conclusion

Exercising safely with multiple myeloma is not just possible; it’s a powerful tool in your health management arsenal. By focusing on low-impact aerobic activities, gentle strength training, and crucial balance and flexibility work, you can significantly enhance your physical and mental well-being. Prioritize bone safety, listen intently to your body, and always consult with your medical team. Your journey with myeloma is unique, and your exercise plan should reflect that. Embrace movement as a form of self-care and empowerment, and you’ll discover a renewed sense of strength and vitality.