Author(s): NORMANN, A., WILSON, R., DIELI-CONWRIGHT, C., Institution: BOSTON UNIVERSITY, Country: UNITED STATES, Abstract-ID: 2457

INTRODUCTION:
Patients with multiple myeloma present with compromised muscle strength, immobility, and frailty, necessitating individualized exercise prescription prior to autologous stem cell transplant. Few studies have examined virtually supervised prehabilitative exercise in this population to mitigate physical dysfunction and frailty prior to autologous stem cell transplant. This study reports preliminary attendance and compliance to a virtually supervised, tailored prehabilitative exercise intervention in patients with multiple myeloma awaiting transplant.
METHODS:
The ongoing two-arm (prehabilitative exercise or waitlist control) randomized controlled PROTECT Trial (NCT05706766) is enrolling patients with multiple myeloma ≥18 years, sedentary (<60 min/week structured exercise), with ≥4 weeks to transplant, and cleared to exercise by treating oncologist. The intervention delivers up to 24 supervised exercise sessions over 8 weeks aligned with the patient treatment timeline. Sessions occur 3 times per week for ~60 minutes and include progressive resistance (2–3 sets with 8-15 repetitions at 55–85% 1RM) and aerobic exercise (15-20 minutes at 60-75% HRmax) adapted to frailty and bone disease risk. Sessions were considered attended if a patient joined virtually, regardless of the exercise amount achieved in the session. Attendance at ≥80% of sessions defined exercise compliance. Resistance and aerobic exercise was considered modified if time, target heart rate, sets, repetitions, or load were reduced versus the planned exercise prescription set prior to session start time. Analyses used descriptive statistics presented as mean ± standard deviation and number (percentage), as appropriate. 
RESULTS:
Eleven patients have been enrolled to date and are 55% female, 62±9 years of age and overweight (BMI 28.6±5.1kg/m2). Of 5 patients randomized to exercise, 2 (40%) had the scheduling availability to progress through the full 8-week intervention and 3 (60%) had a truncated window (available for 7–19 sessions). Mean attendance was 13.0±7.0 sessions with ≥80% attendance achieved by 40% (n=3) and <80% by 60% (n=2) of participants. Missed sessions were attributed to myeloma-related bone pain (n=16; 50%), non-study injury (n=10; 31%) and illness (n=6; 19%). Among attended sessions, 15% of resistance exercise bouts required modification, while 38% of aerobic exercise bouts required reduction. The most common reason for exercise modification was bone pain (n=8; 73%).
CONCLUSION:
Virtually supervised prehabilitative exercise in patients with multiple myeloma prior to transplant yields challenges to exercise intervention attendance. Multiple myeloma-related bone pain notably impacted attendance and ability to meet planned exercise prescription, thus future investigations are critical to understand exercise tailoring during the pre-transplant phase.