Effects of Controlled Breathing Added to Therapeutic Exercise in Multiple Myeloma

Exclusion Criteria

• •Medical risk contraindicating exercise or breathing techniques:
• •+Clinically significant cardiovascular disease, including: decompensated heart failure, acute myocardial infarction within the past 3 months, clinically uncontrolled arrhythmias, unstable angina, acute-phase deep vein thrombosis or pulmonary embolism, pacemakers or cardiac devices whose monitoring parameters contraindicate supervised exercise according to cardiology.
• •* Severe decompensated respiratory disease, such as acute exacerbation of COPD, severe respiratory insufficiency, or persistently low resting oxygen saturation \< 90% (not correctable).
• •High musculoskeletal or bone risk:
• •* Extensive lytic bone lesions, high risk of pathological fracture, or unstable vertebral fracture, documented by imaging or based on the assessment of the Hematology/Traumatology specialist.
• •* Uncontrolled pain that prevents safe participation in an exercise program.
• •Hematologic or systemic conditions contraindicating exercise:
• •* Severe anemia: hemoglobin \< 9 g/dL in women or \< 8 g/dL in men (latest laboratory test ≤ 14 days).
• •* Active systemic infection contraindicating exercise, fever ≥ 38 °C, or neutropenia \< 0.5 × 10⁹/L.
• •* Severe cytopenias that, in the opinion of the hematologist, preclude moderate exercise.
• •Functional or procedural limitations:
• •* Inability to remain in the supine position for ≥ 5 minutes, required for part of the breathing intervention.
• •* Confirmed pregnancy or reasonable suspicion of pregnancy.
• •* Severe cognitive impairment, major psychiatric disorders, or neurological diseases that limit understanding of the procedures or safe participation.
• •* Significant difficulty understanding the language (spoken or written) that prevents following essential instructions or completing validated questionnaires.