Efficacy of exercise interventions in multiple myeloma: a systematic review and meta-analysis

To synthesize and quantify the effects of exercise interventions on physical function and patient-reported outcomes in adults with multiple myeloma (MM).

A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines and prospectively registered in PROSPERO (CRD420251271216). PubMed, EBSCO, Cochrane Library, Scopus, and Web of Science were searched from inception to April 2026. Randomized and nonrandomized studies evaluating structured exercise interventions in adults with MM were considered eligible. Methodological quality was assessed using the PEDro scale, and risk of bias was evaluated with the RoB 2 tool. Random-effects meta-analyses were performed using standardized mean differences.

The search identified 10,907 records, of which 20 studies met the eligibility criteria for qualitative synthesis (n = 1,032) and 9 for quantitative synthesis (n = 576). Exercise interventions lasted a mean of 14.4 weeks, were performed 3.3 times per week, and were most commonly based on combined aerobic and resistance training. Quantitative synthesis was conducted for aerobic capacity, quality of life, fatigue, upper-limb strength, lower-limb strength, and pain. Across outcomes, pooled effects were generally small and did not reach statistical significance. Heterogeneity was low to moderate for most outcomes, although substantial inconsistency was observed for aerobic capacity and lower-limb strength. Methodological quality ranged from fair to good, and 55.6% of the randomized studies were rated as having a high risk of bias, mainly due to missing outcome data. Mean study-level attrition rates were observed in both exercise and control groups, supporting the feasibility of exercise interventions in this population.

Exercise interventions in patients with MM appear feasible, but current evidence shows small and non-significant effects on aerobic capacity, muscle strength, fatigue, quality of life, and pain. Given the limited number of studies, small sample sizes, and methodological heterogeneity, the true magnitude of exercise-related benefits remains uncertain. Larger, well-designed randomized controlled trials with standardized exercise protocols are needed to clarify the efficacy and optimal prescription of exercise in this population.

This study indicates that structured exercise programs are feasible and well-tolerated by individuals with MM. Although current evidence shows limited immediate effects on physical function and quality of life, patients can safely engage in combined aerobic and resistance training. Survivors should discuss personalized, well-monitored exercise options with their healthcare team to maintain activity levels while more definitive guidelines are established.