Effect of a 6-Week Cycle of Nordic Walking Training on Vitamin 25(OH)D3, Calcium-Phosphate Metabolism and Muscle Damage in Multiple Myeloma Patients–Randomized Controlled Trial

Abstract

Introduction: Multiple myeloma (MM) is a hematological malignancy affecting older adults. One of the most common myeloma-defining events is the development of symptomatic lytic bone disease. The serum concentrations of calcium (Ca), inorganic phosphorus (P), and vitamin 25(OH)D3 in the serum reflect bone metabolism. An enzyme lactate dehydrogenase (LDH) is a marker of muscle damage, but its serum activity also has an important prognostic value in MM. Myoglobin (Mb) is a small protein present in muscles; its serum level increases when myocytes are damaged. Objectives: In this study, the impact of a 6-week Nordic walking (NW) exercise program on blood parameters related to calcium-phosphate metabolism and damage of skeletal muscles was assessed. Patients and methods: A total of 33 patients with MM in the remission stage, without cytostatic treatment, were allocated and randomly assigned to one of two groups: 17 in the training group (NW) and 16 in the control group (CG). All patients were supplemented per os with vitamin D3 and calcium carbonate daily and received zoledronic acid every 4 weeks (intravenous). Nordic walking training sessions took place 3 times a week for 6 weeks, 1 h each. Blood samples were drawn before and after the 6 weeks of training sessions to assess the serum concentrations of vitamin 25(OH)D3, P, Ca, Mb, and LDH. Results: Patients from the NW group showed a statistically significant decrease in mean serum myoglobin concentration (p = 0.018) and an increase in 25(OH)D3 (p < 0.001) and total Ca (p = 0.001) concentrations. There were no statistically significant changes in the results obtained in CG. Between groups, after 6 weeks, Mb serum concentration was significantly lower in NW (p = 0.041), and 25(OH)D3 was higher (p < 0.001) compared to CG. There was a correlation between the changes in myoglobin, phosphorus, 25(OH)D3, and Ca concentrations after 6 weeks. Conclusions: NW training is a safe and beneficial form of physical exercise for patients with MM without inducing muscle damage. NW performed outside improves serum vitamin 25(OH)D3 concentration.

The Impact of a 6-Week Nordic Walking Training Cycle and a 14-Hour Intermittent Fasting on Disease Activity Markers and Serum Levels of Wnt Pathway-Associated Proteins in Patients with Multiple Myeloma

“…On contrary, the proposed interventions improved the concentrations of some bone formation-related markers analyzed in this study. Previous publications on exercise interventions in patients with MM or pre mm conditions also did not show significant differences in weight and body composition [26][27][28].…”

The Influence of Therapeutic Exercise on Survival and the Quality of Life in Survivorship of Women with Ovarian Cancer

“…Both studies [ 20 , 26 ], individualised the frequency of exercise according to the duration of treatment the women under study were undergoing, specifically according to the duration of chemotherapy, and supervision of the subjects was carried out weekly in much the same way in the two studies, through telephone calls or face-to-face consultation with a specialist. This type of exercise has been used by other researchers with the same objective and has produced results along the same lines as ours [ 28 ].…”

“…There is a clear predominance of aerobic exercise with intensities ranging from low-moderate to moderate-vigorous in the interventions performed, concluding that the interventions with the best results are those performed at moderate intensity. Donnelly et al [ 9 ], in addition to aerobic intervention (mainly walking) [ 28 ], chose to add strengthening exercises. Others such as Mizrahi et al [ 21 ] or Zhang et al [ 23 ] incorporated resistance exercise, as current guidelines recommend the inclusion of resistance training [ 50 , 51 ].…”

Rheological properties of blood in multiple myeloma patients

“…The main groups of drugs used in treatment are alkylating agents, corticosteroids, immunomodulatory drugs and proteasome inhibitors 7 . The use of physiotherapy in patients with myeloma results in a reduction in perceived fatigue 8 as well as can affect patients’ functional ability 9 . In 2013, a study was conducted that found improvements in quality of life and strength after the intervention.…”

“…The therapy process included stretching, aerobic and resistance exercises and lasted for a total of 6 months 10 . Research by Czerwińska et al showed that for patients with MM, Nordic walking training is a safe form of physical activity, and could positively affect serum vitamin D concentration 9 , as well as disease-related blood parameters 11 .…”