Amyotrophic lateral sclerosis (ALS) is a neurological disorder characterized by the progressive loss of motor neurons or the nerve cells that control muscle movement. Without these nerve cells, muscles weaken and patients gradually lose the ability to move, speak, swallow, and, eventually, to breathe unaided.
Goals of exercise in ALS
Exercise may have many benefits for ALS patients, including reducing depression and improving strength and stamina. But it must be performed carefully to be beneficial. Patients should work with a physical therapist to determine how best to exercise safely, as well as to ensure that they include stretching, strength-building, and range-of-motion exercises in their routine.
Regular and moderate exercise is better than excessive exercise. It is important for patients to avoid overworking their muscles. Aching muscles after exercise mean that they have been overstressed, and this may actually speed muscle loss. Patients should stop exercising when they get tired, rather than trying to push through the fatigue.
Exercise research for ALS
A study examining the safety and tolerability of resistance and endurance exercise in ALS patients was published in the journal Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration in 2018. A total of 59 ALS patients were randomly assigned to groups performing different types of exercise: 21 patients did stretching exercises, 18 resistance exercises, and 20 endurance exercises.
Stretching was done passively with the help of a partner. Endurance exercises were carried out using a mini-cycle that could exercise both the legs and the arms. Resistance exercises used weights based on a participant’s capacity.
Exercises were carried out in the patients’ homes with individualized programs designed by a physical therapist.
Study results indicated that, at 12 weeks and 24 weeks, all three types of exercise were well-tolerated by patients, and no differences in disease progression — including disease worsening — were found among the groups.
The results of a clinical trial (NCT03326622) evaluating whether a tailored aerobic exercise program would improve outcomes in ALS patients were recently published in the journal Neurology Research International. For six months, 48 patients were assigned to either standard care (control group, 24 patients), or standard care plus moderate exercise twice a week (test group, 24 patients).
Changes in functional abilities between study start and end were measured using the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R). As a secondary measure, the researchers used Cardiopulmonary Exercise Tests (CPET) to examine changes in respiratory capacity. Improvements in ALSFRS-R were seen in the exercise group. Respiratory capacity did not change in the exercise group, but CPET scores were significantly worse in control group patients.
Researchers concluded that moderate exercise can be safe and beneficial for ALS patients.
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