Why is exercise important?
Along with helping to combat stress, proper exercise is important for preventing atrophy of muscles from disuse — a key to remaining mobile for as long as possible — and for keeping your cardiovascular system strong. The key to gaining these benefits is finding the most appropriate exercise for you.
Note: Discuss any type of planned exercise with your health care team, particularly your doctor and physical therapist (PT), to ensure that you don’t push weakened muscles to the point of doing further damage, or create a dangerous level of fatigue.
Don’t initiate any exercise program without clearance from a physician and guidance from a physical therapist.
Discontinue the activity if you experience any of the following signs of fatigue during exercise:
- shortness of breath
- excessive cramping
- unusually heavy sweating
To decrease the risk of harm, you should avoid:
- exercising with heavy weights
- exercising in extreme temperatures
- exercising when fatigued or ill
- moving a limb past the point of pain or significant resistance
It’s widely accepted among physicians and therapists that specific kinds of exercise help prevent the development of painful contractures (the permanent tightening of muscles) and can decrease the spasticity (muscle tightness or spasms) that’s common in ALS.
For some people, a moderate amount of daily walking in the early stages of ALS may be all that’s advisable. As the disease advances, you’ll benefit from doing range-of-motion and stretching under supervision of a physical therapist.
Never push yourself past the point of fatigue, or attempt to strengthen already weakened muscles. It isn’t clear whether muscles already weak from ALS can be strengthened, but PTs know that weak muscles can be further damaged when pushed too hard.
Generally, keep in mind that if you feel worse after an exercise activity, then you’ve done too much.
Stretching and range-of-motion exercises
Any area of weakness in your muscles is prone to tightness or contracture. Stretching increases joint mobility and improves or helps to maintain soft tissue extensibility.
All joints in the body need to be stretched. If there’s an area of weakness, such as your arms, legs or neck, you’ll need additional stretching there to maintain joint integrity and prevent pain.
In ALS, the shoulders are particularly prone to becoming “frozen,” a painful condition called adhesive capsulitis.
You should perform all of the stretching and range-of-motion movements on your own if you can, or with assistance of a physical therapy professional where needed. Your PT can train your caregiver in performing these stretches. It’s very important that you continue to move or have your limbs moved every day even if you’re too weak to do it on your own. When a caregiver is assisting you with the activities, continue to participate as fully as you can.
Note: Everyday Life with ALS contains more information on how to do range-of-motion and stretching exercises.
Walking speed, duration and terrain may be easily varied to suit your ability and strength. Even small amounts — as little as five minutes — of walking can be beneficial to your quality of life.
When you walk, go at a steady, comfortable, safe pace with your arms swinging, if possible. This will maximize the cardiovascular benefit.
You can also perform walking activities on a treadmill or an elliptical training machine. Again, your doctor or physical therapist can help you determine an appropriate duration for walking, and how to monitor the intensity of this type of exercise.
Water-based activity as a low-impact form of exercise can be very helpful. The buoyancy of water and resistance to movement decreases the risk of injury while allowing the benefits of exercise.
Simple water exercise — even as basic as walking around in the pool — or swimming laps can provide aerobic conditioning.
Spending time in the water can be extremely relaxing, but that in itself can increase the muscle weakness of ALS. If you reach the “wet noodle” stage, you may have difficulty getting out of the pool. For safety’s sake, a pool with supervision and a lift are recommended.
In later stages of ALS, doing aquatic exercises with the help of a PT can continue to provide cardiovascular benefits.
Both stationary and regular bicycling can be good for people with ALS, although stationary biking has certain advantages. You can do indoor biking in a climate-controlled environment where you can monitor your fatigue and take rest breaks with greater ease.
Contact your physician or PT for intensity and duration recommendations.
Exercise cycles, which are pedaling machines that you can use on any flat surface, are [an] option. Some of these cycles feature a passive/active component: An electronic motor assists in moving the user’s legs or arms and shoulders through the exercise motion, even when the user is entirely passive.
Restorators are another rehab tool that can simulate the motions of pedaling. This pedaling mechanism is mounted on an adjustable stand so it can be placed in front of a chair, and used for arm or leg exercises.
Arm ergometry (cycling with the arms) is a low-impact aerobic alternative to traditional bicycling. This type of cardiovascular exercise really challenges the heart, so be sure to do it with supervision and a doctor’s clearance.
Yoga, Pilates and tai chi are all low-impact activities that involve movement of the entire body and often include a mental component that can be meditative or stress relieving.
But remember that low-impact doesn’t mean low-intensity. Use caution to avoid fatigue and injury, and if you’re in a class, make the instructor aware of your medical condition before starting.
As with any exercise program, modification may be necessary over time. Please continue to update your health care team on what exercise regimen you’re involved in so they can make adjustments as needed to assist in maintaining your mobility and safety.
Editor’s note: The above is excerpted from the MDA publication Everyday Life with ALS: A Practical Guide. The guide is free to those registered with MDA. For more information, call (800) 572-1717.