A recent study involving a step-based physical activity program for patients with multiple myeloma (MM) after high-dose chemotherapy and autologous hematopoietic cell transplantation (HCT) showed feasibility and acceptability to patients. Results of the study were published in the journal Cancer Nursing.

The study was a pilot randomized clinical trial in which participants were assigned to either a physical activity intervention group (STEPS) or a usual care group. The STEPS program had a goal of increasing steps by 10% per week. The intervention involved a structured educational program started during hospitalization, followed by a 6-week phase of comprehensive physical activity based on daily step tracking, with weekly goal setting and individualized coaching.

Participants in the STEPS group had a choice regarding type of activity tracker they could use to monitor physical activity, including a low-tech pedometer, a high-tech device worn on the wrist, or a high-tech device clipped onto clothing. Participants in the usual care group were given advice regarding exercise, physical activity, and rest. Assessments were performed prior to HCT and at 7 weeks after hospital discharge, and analyses were based on quality-of-life questionnaires, functional performance, and activity data collected from wrist-worn accelerometers.

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The mean age of patients in this study was 62.78 years (standard deviation [SD], 7.46). A total of 15 patients were allocated to usual care, and 17 patients were allocated to the STEPS intervention. Two patients in the STEPS intervention group did not participate but were included in analyses.

Regarding acceptability of the exercise program, 65.7% of patients in the STEPS intervention group considered the physical activity tracker to be a motivator compelling them to increase physical activity. Reportedly, none of the patients receiving the STEPS intervention considered the physical activity tracker to interfere with their lives, and more than half (58.8%) considered monitoring physical activity to involve no extra work or effort. Willingness to participate in another study of physical activity was reported in 88.2%.

The STEPS program also demonstrated feasibility, with 76% of participants in the STEPS group wearing the physical activity tracker on more than 90% of the days of the program. Step goals were achieved by participants for an average of 18.65 (SD, 9.41) of 35 days. Average daily step counts for the STEPS group were 826 steps during week 1 and 3301 steps at week 6.

Participants in the STEPS group reportedly experienced more diarrhea (P =.045) and showed a trend of more appetite loss (P =.054) than the usual care group did. Based on self-reports of fatigue, patients in the usual care group showed a 15% improvement over baseline on the EORTC QLQ-C30 fatigue subscale, whereas those in the STEPS group showed fatigue worsened by 10%. The PROMIS fatigue subscale showed 8% improvement with usual care and 2% improvement for the STEPS group.

While both groups experienced some declines over the course of the study, the researchers performing the study concluded the STEPS program was acceptable, feasible, and provided useful information about HCT recovery in this population.


Hacker ED, Richards RL, Abu Zaid M, Chung SY, Perkins S, Farag SS. STEPS to enhance physical activity after hematopoietic cell transplantation for multiple myeloma. Cancer Nurs. Published online September 23, 2021. doi:10.1097/NCC.0000000000001006