Leslie P. Ternes

Background: The clinical characteristics of sarcopenia, including low muscular strength, are commonly seen among people with multiple myeloma. A scoping review was conducted to explore the role of exercise as a potential countermeasure for sarcopenia in this population. Our objectives were to (1) describe the design and findings of the studies and (2) identify the outcomes used in exercise-related studies to characterize sarcopenia. Methods: A systematic search (to March 2025) was conducted for published studies involving exercise or physical activity for individuals with multiple myeloma using key databases (MEDLINE, Embase, CINAHL, Scopus). Results: Of 971 articles reviewed, 12 articles were included, involving 967 total participants and 624 with multiple myeloma. All 12 studies included a measure for muscle physical performance, 9 studies included measures for muscular strength, and 7 studies included measures for muscle quantity/quality. Five studies reported a significant improvement from exercise for measures of muscular strength, four studies reported a significant benefit for physical performance, and three studies reported a benefit in muscle quantity. Few studies included outcomes that met all the international criteria recommended to characterize sarcopenia. Conclusions: Further multicentre research trials are needed to better understand whether and how exercise may be helpful for people with multiple myeloma, especially in the context of sarcopenia.

Background: Current guidelines endorse the integration of exercise into cancer care. The diagnosis of cancer and its treatment, however, may introduce factors that make exercise engagement difficult, especially for individuals with advanced stages of disease. In this paper, we describe the baseline screening and triage process implemented for the Alberta Cancer Exercise (ACE) hybrid effectiveness-implementation study and share findings that highlight the multifaceted complexity of the process and the direct role of the clinical exercise physiologist (CEP). Methods: ACE was a hybrid effectiveness-implementation study examining the benefit of 12-week cancer-specific community-based exercise program. The ACE screening process was developed by integrating evidence-based guidelines with oncology rehabilitation expertise to ensure safe and standardized participation across cancer populations. The screening process involved four steps: (1) a pre-screen for high-risk cancers, (2) completion of a cancer-specific intake form and the Physical Activity Readiness Questionnaire for Everyone (PAR-Q+), (3) a CEP-led interview to further evaluate cancer status, cancer-related symptoms and other health issues (performed in-person or by phone), and (4) a baseline fitness assessment that included measurement of vital signs. Results: A total of 2596 individuals registered and underwent prescreening for ACE with 2570 (86.6%) consenting to participate. After full screening including the baseline fitness testing, 209 participants (8.1%) were identified as requiring further medical clearance. Of these, 191 (91.4%) had either a high-risk cancer, metastatic disease or were in the palliative end-stage of cancer, and 161 (84.3%) reported cancer-related symptoms potentially affecting their ability to exercise. In total, 806 (31.4%) participants were triaged to CEP-supervised in-person programming, 1754 (68.2%) participants to ACE community programming, and 8 (0.3%) specifically to virtual programming (post-COVID-19 option). Conclusions: The findings highlight the complexity and challenges of the screening and triage process, and the value of a highly trained CEP-led iterative approach that included the application of clinical reasoning.