Prehabilitation Exercise Training in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation: The PROTECT Trial

Inclusion Criteria: * Over 18 years old. * All patients will have a diagnosis of multiple myeloma, referral to DFCI transplant team, and assigned to the autologous transplantation waiting list for a first transplant. * Planning to receive autologous stem cell transplant after 8 weeks with or without concurrent neoadjuvant treatments at Dana-Farber Cancer Institute. * Medical clearance to perform moderate-vigorous intensity aerobic and resistance exercise intervention and fitness testing by their treating physician or a certified clinical exercise physiologist. * Speak English. * Currently participate in less than or equal to 60 minutes of structured moderate-vigorous intensity exercise/week. * Willing to travel to Dana-Farber Cancer Institute for necessary data collection. * Ability to understand and the willingness to sign a written informed consent document. * The effects of exercise on the developing fetus are unknown. For this reason, women of child-bearing potential must agree to undergo a pregnancy test and to use adequate contraception (hormonal or barrier method of birth control or abstinence) prior to study entry and for six months following duration of study participation. Should a woman become pregnant or suspect that she is pregnant while participating on the trial, she should inform her treating physician immediately. Exclusion Criteria: * History of unstable angina, abnormal resting ECG and/or unstable angina or a heart attack in the previous month to allow safe completion of the cardiopulmonary exercise test (CPET) or VO2peak test. * Patients with known spinal instability, spinal cord compression or neurological deficits or contraindications that preclude exercise. * Those who have had recent (within six weeks) spinal surgery or other intervention surgery for pathological fractures. * Those deemed unsuitable to partake by the transplant or study team. * Patients at high-risk of impending pathologic fracture of a weight-bearing bone (including spine, hip/femur and humerus) as determined by physician. * Unable or unwilling to undertake an exercise program on a regular basis. * Pre-existing musculoskeletal or cardiorespiratory disease, or metabolic diseases that could exacerbate with exercise, in addition to other conditions deemed unsafe by physician. * Patients with other active malignancies requiring active therapy. * Participate in more than 60 minutes of structured moderate to vigorous intensity exercise/week. * Unable to travel to Dana-Farber Cancer Institute for necessary data collection. * Subjects, who in the opinion of the investigator, may not be able to comply with the safety monitoring requirements of the study.