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Changes in muscle performance among older adults with myeloid malignancies engaging in a mobile health (mHealth) exercise intervention: a single arm pilot study

BMC Geriatrics volume 25, Article number: 22 (2025) Cite this article

Abstract

Background

Older adults with cancer are vulnerable to declines in muscle performance (e.g., strength, speed, duration of muscular contraction), which are associated with worse cancer-related outcomes. Exercise-based interventions can mitigate these declines, but evidence of their effect among older adults with myeloid malignancies receiving outpatient treatment is limited. We explore change in muscle performance among patients in a single arm pilot study of a mobile health (mHealth) exercise intervention.

Methods

Patients ≥ 60 years old with myeloid malignancies receiving outpatient chemotherapy completed a home-based resistance band and walking exercise program [EXercise for Cancer Patients (EXCAP)©®] delivered via a mobile application with symptom monitoring [(Geriatric Oncology-EXCAP (GO-EXCAP)] lasting 2 cycles of chemotherapy (approximately 8–12 weeks). Clinical exercise physiologists provided instruction and ongoing support. Upper and lower extremity peak torque (maximum force, newton-meters, Nm), total work (force over entire movement, Nm), and average power (speed of force, watts, W) were assessed using the BIODEX System 4 isokinetic dynamometer. Muscle activation (motor recruitment, millivolts, mV) was captured using the BTS FREEEMG 1000. We report descriptive statistics and within-patient differences from baseline to post-intervention using Wilcoxon signed rank tests (α = 0.10) and effect size (ES, Cohen’s d, 0.20 ≤ small < 0.50, large ≥ 0.80), and explore differences by exercise level (resistance exercise, daily steps).

Results

A total of 25 patients completed baseline assessments, 23 with muscle performance data at baseline, 16 at post-intervention. Of these, most were male (n = 10, 62.5%) and had acute myeloid leukemia (n = 9, 56.3%). From baseline to post-intervention there were improvements in left shoulder peak torque [mean change = 2.45 (Standard Deviation = 2.41), p = 0.004] and average power [2.29 (3.05), p = 0.033]. Muscle activation increased for left rectus femoris [0.04 (0.04), p = 0.074], right and left biceps brachii [0.03 (0.04), p = 0.012; 0.03 (0.05), p = 0.098, respectively], and left pectoralis major [0.02 (0.03), p = 0.064]. Several measures of peak torque/total work and all measures of muscle activation showed ES ≥ 0.20 for improvement. There were no statistically significant decreases from baseline to post-intervention.

Conclusions

Older adults with myeloid malignancies participating in a mHealth exercise intervention had stable to improved muscle performance. Further research is needed to establish the preliminary efficacy of this intervention for improving physical performance in this population at high risk for decline.

Trial registration

clinicaltrials.gov NCT04035499 (registered July 29th, 2019).

Peer Review reports

Background

Muscle mass and performance (e.g., strength, speed, duration of muscular contraction) decrease throughout the aging process, and declines are associated with negative health outcomes such as falls and frailty [1, 2]. Objective measures of muscle strength such as peak torque, or the force produced by the muscle during a movement, or total work, the ability to maintain that torque throughout the movement, have been linked to slower gait speed and some measures of balance [3, 4]. Similarly measures capturing the speed of force production during a muscle movement such as average power may be even more important for timed tasks such as gait speed and thirty-second sit to stand [5, 6]. Deficits in physical performance such as gait speed can ultimately lead to difficulty with functional status, not only in gait-related activities, such as stair climbing, but also self-care tasks like bathing or dressing [7, 8]. Maintaining independence with functional status is critically important to older adults with complex health conditions [9].

Older adults with cancer are susceptible to accelerated musculoskeletal aging due to both their disease and its treatments [10]. Among all older adults with cancer, loss of muscle strength is an important prognostic indicator and associated with poor physical performance (e.g., gait speed), decreased treatment tolerability, and increased risk for mortality [11,12,13]. Impairments in physical performance are also connected to declines in functional status, just as they are in older adults in the general population [14]. Older adults with myeloid malignancies [e.g., acute myeloid leukemias (AML), myelodysplastic syndromes] commonly exhibit loss of muscle strength and impairments in physical performance and functional status, which can worsen during treatment [15,16,17]. Promoting muscle strength may prevent declines in physical performance and functional status for this high risk group.

Exercise-based interventions incorporating resistance training have been shown to improve muscle performance among older adult survivors of cancer [18, 19]. The American College of Sports Medicine (ACSM) exercise guidelines for cancer survivors recommends 150 min of moderate intensity activity per week, incorporating two to three sessions of resistance exercise, and concludes that exercise is safe for adults with hematologic malignancies [20]. However, many adults with hematologic malignancies report being insufficiently active [21, 22]. Research to understand how exercise interventions influence muscle performance for older adults with cancer, especially those actively receiving chemotherapy, is needed to develop tailored interventions that benefit patients at greatest risk for decline.

Several exercise-based interventions have been tested to mitigate decline in physical performance for patients with myeloid malignancies by improving muscle strength [23,24,25,26]. In the inpatient setting, exercise has shown positive effects on physical performance for adults with hematologic malignancies who have undergone hematopoietic stem cell transplant [27, 28]. However, hemopoietic stem cell transplant is associated with an earlier, more rapid decline in physical performance early in the treatment course compared to outpatient treatment [29,30,31,32]. In addition, exercise interventions in the inpatient setting can be more directly supported by medical professionals [33, 34]. In contrast, patients receiving outpatient treatments for myeloid malignancies may have more gradual disease-related changes in physical performance and less access to supervised fitness interventions. However, a recent systematic review found no studies focusing specifically on older adults receiving exercise interventions in the outpatient setting [35]. Given that the majority of older adults with myeloid malignancies receive lower intensity treatments [e.g., hypomethylating agents, (HMAs), venetoclax] in the outpatient setting, there is a need to develop and test exercise interventions for the growing population of older adults with myeloid malignancies receiving less intensive treatments [36].

We previously adapted a mobile health (mHealth) exercise intervention which integrates a home-based exercise program [EXercise for Cancer Patients (EXCAP)©®] with a mobile application [(Geriatric Oncology-EXCAP (GO-EXCAP)] for older adults with myeloid malignancies [37,38,39]. We demonstrated that GO-EXCAP was feasible among older adults with myeloid malignancies receiving outpatient treatment in a single arm pilot study [40]. In the present analysis, we explore baseline and baseline to post-intervention (within-patient) change in muscle performance among patients who completed the GO-EXCAP intervention.

Methods

Study setting and participants

The GO-EXCAP single arm pilot study (clinicaltrials.gov NCT04035499) recruited patients age 60 or older with myeloid malignancies (e.g., AML, myeloproliferative neoplasm, myelodysplastic syndrome, and others) [16] who were planned for or receiving outpatient chemotherapy at the University of Rochester Medical Center Wilmot Cancer Institute. All patients had an Eastern Cooperative Oncology Group (ECOG) performance status of 0–2, were able to walk at least four meters, and had no medical contraindications for exercise per their oncologist. The study received ethical approval from the University of Rochester Research Subjects institutional Review Board (Study ID: STUDY00003945), and all patients provided informed consent.

Study intervention

The GO-EXCAP intervention integrated a home-based exercise intervention consisting of daily walking and resistance band exercises (EXCAP©®) with a mobile app which allowed patients to enter data related to daily exercise and symptoms [including daily steps, minutes of resistance exercise, and rating of perceived exertion (RPE) on the modified Borg Category-Ratio10 scale, where 0 = not tired at all and 10 = extremely tired] [41]. Patients wore Garmin Forerunner® 35 watch-style activity tracker throughout the study to monitor daily steps. An ACSM-certified clinical exercise physiologist provided initial exercise instruction and individualized walking and resistance exercise prescriptions as well as weekly monitoring and modification to exercise (communicated by study staff to the patient via phone or in person) throughout the intervention, which lasted for 2 cycles of chemotherapy (approximately 8–12 weeks, accounting for possible changes to cycle dates). All patients were instructed to do the same EXCAP program, but the exercise physiologist personalized exercise prescriptions (e.g., specific strength of resistance band for each exercise, daily steps goals) at baseline and weekly.

Measures

Demographic and clinical characteristics

Patients self-reported their demographics at baseline. Clinical characteristics were abstracted from the medical record by study staff.

Muscle performance

All measures of muscle performance were captured at baseline and post-intervention by ACSM-certified clinical exercise physiologists in the PEAK Human Performance Clinical Research lab at the University of Rochester Medical Center. Muscles and movements reflecting upper and lower extremity performance were chosen based on those targeted by the intervention and clinical importance. We evaluated four measures of muscle performance: (1) Peak Torque – representing the greatest muscular force in newton meters (Nm) output during the full range of motion during a single instance (repetition) of the action, (2) Total work – measuring the muscle’s capacity to maintain torque in Nm throughout the entire instance of the action, (3) Average Power – calculated as total work divided by the time to complete that work (Watts/W), and representing how quickly a muscle can produce force, and (4) Muscle activation – capturing millivolts (MV) of muscle activity produced during voluntary contraction. Torque, total work, and average power were measured using standard protocols from the BIODEX System 4 Pro Isokinetic Dynamometer and Advantage BX Software 5.3X at an angular speed of 60 degrees/second. Muscle activation was measured using the BTS FREEEMG 1000 wireless surface EMG sensors attached to rectus femoris, biceps brachii, pectoralis major, and infraspinatus muscles while participants performed Biodex isokinetic testing. Patients completed all procedures a baseline and post-intervention in a set order during a single session, and were provided rest breaks as needed.

Change in exercise level

To evaluate whether the improvement in muscle performance is more likely among those with greater participation in the intervention exercises, we conducted two subgroup analyses stratifying patients by: (1) whether they reported performing greater than or equal to the median minutes of EXCAP resistance exercises per day at post-intervention for our sample, and, (2) whether they increased their daily steps by greater than or equal to the median change in our sample baseline to post-intervention. We chose median due to the small sample size to minimize impact of outlier values. Change values were based on the difference of one-week averages from baseline and post-intervention timepoints.

Statistical analysis

We report baseline values for all patients with data at baseline, and change values for all patients with post-intervention data. Patients who were missing data on daily steps or resistance exercise were excluded from the respective subgroup analyses. We used descriptive statistics to summarize muscle performance at baseline, post-intervention, and change. Due to the small sample size and non-normal distribution of within-patient change from baseline to post-intervention, we used Wilcoxon signed rank tests to evaluate whether that change was significantly different from 0. We also report effect size (ES) as Cohen’s D (small effect: 0.20 ≤ d < 0.50; moderate effect 0.50 ≤ d < 0.80; large effect: d ≥ 0.80) [42, 43]. Given the small sample size of this pilot study, hypothesis testing was performed at α = 0.10 (2-tailed) and we did not adjust for multiple comparisons. All analyses were completed using SAS v.9.4 (SAS Institute Inc., Cary, NC).

Results

Sample composition

We previously patient enrolment and reasons for refusal to consent and withdrawal for the primary study, which led to 25 patients completing baseline assessments [40]. Of those, 23 participated in muscle performance testing at baseline, 16 of whom also had muscle performance testing at post-intervention. Reasons for completely missing muscle performance testing included health decline (3/7 patients), logistical issues (scheduling, staff and equipment availability) (2/7 patients), and patient being lost to follow up (2/7 patients). Of the 16 patients with data at both timepoints, some were missing data for specific measures of muscle performance due to patient health status which may preclude testing a given muscle/action (e.g., joint pain, lines or ports that interfered with placement of testing equipment). As noted above, we report results from all patients with available data and include number of patients with data for each measure of muscle performance in all tables of results.

Demographic and clinical characteristics

Table 1 displays baseline characteristics for the 16 patients with muscle performance testing completed at both baseline and post-intervention. The majority were male (n = 10, 62.5%), married (n = 10, 62.5%), and had a diagnosis of AML (n = 9, 56.3%). At post-intervention, patients reported completing resistance band exercises 3.5 days/week [Standard Deviation (SD) 2.18], for an average of 26.6 (SD 10.7) minutes with an RPE of 3.4 (SD 1.22], indicating low intensity. They walked an average of 3305 (SD 1630) steps per day at baseline and 3758 (SD 2762) at post-intervention, representing an increase of 753 (SD 1596) steps on average.

Table 1 Demographic, clinical, and intervention characteristics for patients with data at baseline and post-intervention (N = 16)
Full size table

We also report baseline characteristics for the 23 patients who completed baseline fitness testing (including 7 missing post-intervention measures) in Supplemental Table 1. Those with missing data at post-intervention were similar in most baseline characteristics to those with data at both timepoints, however, they walked fewer steps per day at baseline 2695 (SD 3026). The subset with data on resistance exercise and steps at post-intervention (N = 5/7 and 3/7, respectively) reported fewer days per week of exercise and a decline in steps from baseline to post-intervention.

Baseline muscle performance characteristics

Table 2 displays baseline measures of muscle performance for patients with muscle performance measured at both baseline and post-intervention. On average, knee extension peak torque was approximately 89 Nm [R(right) = 89.10(standard deviation = 22.96); L(left) = 88.28(31.15)], while knee flexion was close to 40 Nm [R = 40.71(14.33); L = 39.74(13.50)]. For the upper extremity, peak torque for shoulder flexion, adduction, and internal rotation (towards body) was approximately 40 Nm [R = 40.18(13.25); L = 39.40(17.03)]. Average power in W was the highest for knee extension [R = 50.61(13.99); L = 48.54(17.87)]. and lowest for shoulder extension, abduction, and external rotation [away from body; R = 16.30(6.62); L = 13.00(6.98)]. We also report baseline muscle performance for the 23 patients who completed baseline fitness testing (including 7 missing post-intervention measures) in Supplemental Table 2.

Table 2 Muscle performance at baseline for patients with data at baseline and post-intervention
Full size table

Change in muscle performance from baseline to post-intervention

Here we report mean within-patient changes from baseline to post-intervention in muscle performance by measure and muscle movement with p values from Wilcoxon signed rank tests. Full descriptive results including minimum and maximum values, median, inter-quartile range (IQR), and number of patients with each measure are shown in Table 3.

For lower body muscle performance patients showed statistically significant increases in average muscle activation of the left rectus femoris [0.02(0.04) mV, p = 0.074]. There were no statistically significant decreases in any lower extremity measures. However, peak torque for left knee flexion numerically decreased by 3.18 Nm on average with an ES of -0.21 (note the median change was much smaller at -0.68 Nm, suggesting influence of outliers). As with peak torque, total work showed a decrease of 16.72 Nm for the left knee during flexion with an ES of -0.22 (again the median was lower at -5.29 Nm). All other average changes in peak torque, total work, and average power were numerically positive for the lower extremity, with right and left knee extension showing ES ≥ 0.2 for improvement (range 0.20–0.46). Similarly, non-statistically significant increases were observed in muscle activation, with ES ranging from 0.35 to 0.75.

For upper body muscle performance patients showed statistically significant increases in left shoulder flexion, abduction, and external rotation (away from body) for peak torque [2.45 (2.41) Nm, p 0.004, ES 1.02] and average power [2.29 (3.05) Nm, p 0.033, ES 0.75]. Regarding muscle activation, there were significant increases in mV for the right and left biceps brachii [R = 0.03 (0.04) mV, p 0.012; L = 0.03 (0.05) mV, p 0.098], and left pectoralis major [0.02 (0.03) mV, p 0.064, ES 0.62]. There were no statistically significant decreases in upper extremity muscle performance, although left shoulder total work extension, adduction, internal rotation (toward body) showed a numeric decrease [-5.59 (79.77) Nm] with a very small ES of -0.07. Otherwise, all muscle movements demonstrated positive ES ranging from a low of 0.07 for left shoulder peak torque toward body to 0.75 for right biceps brachii activation.

Table 3 Baseline to post-intervention change in muscle performance, p values from Wilcoxon signed rank test
Full size table

Finally, we report change in muscle performance stratified by patients who reported greater than or equal to the median increase in number of daily minutes of daily resistance exercise (29.4, IQR 15.4), and daily steps (423.2, IQR 1631.6) compared to those who reported less than the median. Supplemental Table 3 presents these results for minutes of resistance exercise, and Supplemental Table 4 by change in daily steps. There were no systematic differences in change in muscle performance by minutes of resistance exercise. However, patients who increased their daily steps by the median value or more showed numerically positive changes for all measures of muscle performance (except left shoulder peak torque and infraspinatus activation), while those who increased by less than the median had decreases from baseline to post-intervention in over half of the measures.

Discussion

In our single arm pilot study of a mHealth exercise intervention, older adults with myeloid malignancies showed stable to improved muscle performance. Across eight muscle movements (four upper, four lower extremity), all statistically significant changes in peak torque, total work, average power, and muscle activation reflected increases. Further, ES ≥ 0.2 were associated with improvement for all muscle movements except left knee flexion. Finally, when stratifying by change in daily steps, those patients who were able to increase their steps to a greater degree during the intervention demonstrated more positive change in measures of muscle performance. These results suggest a home-based exercise program with daily walking and resistance band exercises delivered via mHealth intervention has potential to improve muscle performance among older adults with myeloid malignancies.

To our knowledge, there are no normative values for measures of muscle performance for older adults with myeloid malignancies receiving outpatient treatments. Therefore, we contextualize our results in comparison to previous work among older adults without cancer. There is evidence to show aspects of peak torque for the knee joint such as rate of torque development and asymmetry by side of the body are associated with falls and physical performance [44,45,46]. A study comparing peak torque and power at the knee joint among active and inactive community-dwelling older adults reported higher values for all measures than patients in our study (e.g. average knee extension peak torque = 121.35 Nm for active and 110.16 Nm for inactive older adults vs. 92.86 Nm for our sample) [47]. Although we do not stratify our results by sex due to the small sample and exploratory nature of this analysis, it is notable that average peak torque values among our patients were lower than those of men over age 65 (148.7 Nm) [46]. Our patients performed more similarly to older women (98.9 Nm before and 105.2 Nm after exercise training), but somewhat better than older adults receiving care in a day-hospital setting (61.0 Nm before and 83.6 Nm after a 12 week exercise intervention) [48, 49]. This may reflect the vulnerable health status of older adults with myeloid malignancies relative to those without cancer.

Given the sparse literature on muscle performance response to exercise intervention among older adults with myeloid malignancies, it is helpful to compare our results to previously published results among older adults with other types of cancer, while considering differences in measurement. In a recent meta-analysis of sixteen clinical trials with muscle strength as an outcome, half used one repetition maximum, three used grip strength, two used maximum voluntary torque of knee extensors, and one used maximum isometric effort on a dynamometer [19]. Of these, the measure of maximum voluntary torque most closely approximates that used in our own study. A study of adults with advanced prostate cancer (mean age = 72) showed that a 12-week intervention composed of aerobic, resistance exercise and dietary advice led to a greater increase in maximum voluntary torque of knee extensors than usual care [50]. However, a smaller study of older adults (mean age = 69) with colon cancer found that a similar intervention improved timed sit to stand but not knee extensor torque or muscle activation (measured by electromyography) [51]. Patients in the second study were advised against lifting strenuous loads due to their post-operative status; therefore it is possible that lack of improvement in muscle performance was related to sub-therapeutic exercise. Although patients in our study also reported low RPE when engaging in resistance exercise, they demonstrated positive ES for change in knee extensor torque and activation. This may reflect that even low intensity exercise can have muscle performance benefits for older adults [52, 53]. These studies also differ from ours in that they also incorporated dietary advice and did not include symptom monitoring. However, taken together their findings support the potential for older adults with cancer to show gains in muscle performance given an appropriately dosed exercise intervention.

Our study has several important strengths. First, we focus on the growing population of older adults with myeloid malignancies receiving outpatient treatment, who are at high risk for declining physical performance and functional status. Second, our use of an mHealth home-based intervention with demonstrated feasibility has potential for scalability in this population. Finally, to our knowledge there are no studies which have evaluated how objective measures of muscle performance are influenced by exercise for this population. Therefore, while direct comparisons to the prior work are limited, our study makes a contribution by being the first to report detailed measures of change in muscle performance. Importantly, descriptive studies have shown muscle performance declines over longer time periods among older adults in the general population [54, 55], and those with cancer may experience accelerated loss of muscle mass, especially during systemic treatment [56, 57]. Therefore the absence of evidence of decline across the majority of our measures may also be clinically significant. Studies quantifying muscle performance in populations vulnerable to decline may help identify and refine exercise-based interventions to maximize gains in muscle performance and physical function.

There are several limitations to our findings. First, our small, single study site sample may have limited generalizability to the broader population of older adults with myeloid malignancies. We report change in muscle performance for patients who completed assessments at both timepoints, and health decline was a primary reason for missing data. Therefore, our results may represent a more robust subgroup of patients than is typically seen in clinical practice. At the same time, patients within our sample ranged in age, time since start of treatment, and other aspects of health status. Due to our small sample size and single arm study design, we were not able to employ statistical techniques to adjust for this potential bias. For instance, it is possible that patients who were able to improve their daily steps also had more favorable health status, which allowed them to improve their muscle performance. Similarly, while we did not observe differences in muscle performance by participation in resistance exercise, weekly average at post-intervention may not reflect cumulative adherence to exercise across all weeks of the study. While patients were encouraged to complete resistance exercise daily and to exert moderate effort, the average was 3.5 days per week with an RPE indicating low effort. Although we do not explore reasons for differences in adherence to the intervention, prior work suggests there are multiple factors which influence ability to improve muscle performance in response to exercise among older adults [58]. Based on patient feedback, future studies using the GO-EXCAP intervention will incorporate additional support from study staff (e.g., an open-text field for patients to report barriers, an integrated chat function and video calls for more frequent communication with the exercise physiologist) to address barriers to exercise [40]. Despite these limitations, our findings provide valuable preliminary data that can be used to inform development of more definitive studies of mHealth exercise interventions in this population.

Conclusion

There is strong evidence to support the overall positive effects of exercise-based interventions during cancer treatment, and guidelines from national organizations including the American Society of Clinical Oncology endorse exercise as a critical part of cancer care [59]. Our pilot study identified stable to improved muscle performance among older adults with myeloid malignancies participating in an exercise intervention. While such interventions appear to be safe and feasible for older adults with cancer, there is limited evidence to characterize their underlying mechanisms [60]. Previous analyses of data from our study showed changes in DNA methylation, a marker of biological age, and TNF alpha promotor methylation, a marker of systemic inflammation [61, 62]. Disease and treatment-related influences on important biomarkers such as these may influence the ability to improve muscle performance in response to exercise. In addition, aspects of the exercise intervention itself may benefit from modification to maximize gains in muscle performance across all muscle groups. Any pathway from exercise to improvement in muscle function is likely to depend on adherence to the intervention. An ongoing randomized clinical trial (clinicaltrials.gov NCT04981821) has incorporated lessons learned in administration of this intervention (such as increasing frequency and modes of communication with the exercise physiologist) and will further elucidate these complex relationships and establish the preliminary efficacy of the GO-EXCAP mHealth exercise intervention for improving physical performance in this population [63].

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

EMG:

Electromyography

GO-EXCAP:

Geriatric oncology- exercise for cancer patients

mHealth:

Mobile health

Nm:

Newton-meters

W:

Watts

Mv:

Millivolts

ES:

Effect size

AML:

Acute myeloid leukemia

ACSM:

American college of sports medicine

ECOG:

Eastern cooperative oncology group

IQR:

Inter-quartile range

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Acknowledgements

We thank Wilmot Cancer Institute Human Biophysiology Shared Resource (HBSR) PEAK Human Performance Clinical Research Lab for assistance with collecting this data. We acknowledge Susan Rosenthal, MD, for her editorial assistance.

Funding

National Cancer Institute UG1CA189961 to KM and R00CA237744 to KPL. The funder played no role in the design of the study, collection, analysis, and interpretation of data or in writing the manuscript.

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Authors and Affiliations

  1. James P. Wilmot Cancer Institute, Rochester, New York, USA

    Marielle Jensen-Battaglia, Po-Ju Lin, Chandrika Sanapala, Jason H. Mendler, Jane Liesveld, Ying Wang, Elisabeth Hayward, Marissa LoCastro, Soroush Mortaz, Richard F. Dunne, Karen Mustian & Kah Poh Loh

  2. Department of Public Health Sciences, University of Rochester Medical Center, Rochester, USA

    Marielle Jensen-Battaglia & Ying Wang

  3. Princeton University, New Jersey, United States

    Erin E. Watson

  4. Emory University, Atlanta, USA

    Elisabeth Hayward

  5. Department of Surgery, University of Rochester Medical Center, New York, USA

    Po-Ju Lin & Karen Mustian

  6. Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, James P. Wilmot Cancer Institute, 601 Elmwood Avenue, Box 704, Rochester, New York, 14642, USA

    Jason H. Mendler, Jane Liesveld, Richard F. Dunne & Kah Poh Loh

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  1. Marielle Jensen-Battaglia
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Contributions

MJB conducted data analysis, interpretation of results, manuscript drafting. PJL contributed to the study concept, interpretation of results, and manuscript edits. CS, EEW, JHM, and JL assisted with data collection, interpretation of results, and manuscript edits. YW assisted with data analysis, interpretation of results, and manuscript edits. EH, ML, SM, RFD, contributed to interpretation of results and manuscript edits. KM contributed to the study concept, interpretation of results and manuscript edits. KPL contributed to study design, concept, data collection, analysis, interpretation of results, manuscript edits, and provided funding. All authors reviewed the final manuscript and agree with it’s submission to BMC Geriatrics.

Corresponding authors

Correspondence to Marielle Jensen-Battaglia or Kah Poh Loh.

Ethics declarations

Ethics approval and consent to participate

The study received ethical approval from the University of Rochester Research Subjects institutional Review Board (STUDY00003945) on July 24, 2019, and all patients provided informed consent.

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Not applicable.

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The authors declare no competing interests.

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Jensen-Battaglia, M., Lin, PJ., Sanapala, C. et al. Changes in muscle performance among older adults with myeloid malignancies engaging in a mobile health (mHealth) exercise intervention: a single arm pilot study. BMC Geriatr 25, 22 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12877-024-05668-w

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BMC Geriatrics

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