Canadian Health Professionals Recommend Stretching More, But Science Remains Shaky, Survey Finds

Health professionals in Canada are more likely to recommend stretching than strength or aerobic exercises to people with amyotrophic lateral sclerosis (ALS), a recent survey found. However, this approach isn’t supported by currently available data.

The survey results were published in the journal BMC Neurology in a study titled, “Intentions of Canadian health professionals towards recommending exercise for people living with ALS.”

Whether exercise is beneficial for people living with ALS has been something of a controversial topic. While some studies have linked very strenuous exercise with a higher mortality risk, the most recent consensus is that moderate exercise probably is beneficial. Still, there aren’t enough published studies to say with certainty.

Meanwhile, people with ALS are likely to ask their healthcare providers about the benefits or risk of exercise. What are those healthcare providers saying?

To find out, researchers sent a survey to Canadian healthcare workers who see people with ALS; 25 physicians responded, as did 53 non-physician healthcare workers. Of those, 22 physicians and 23 non-physicians said that giving counseling on exercise was within the scope of their practice. Data for respondents who were in administration, research, or for whom exercise wasn’t a part of their practice, were not analyzed thoroughly.

Overall, the respondents’ attitudes toward recommending exercise to people with ALS were positive — on average, higher than five on a seven-point scale, with higher numbers indicating a greater likelihood of recommending exercise.

This was true for all three types of exercise the survey asked about — strength, aerobic, and flexibility. However, the average score for flexibility was about a full point higher than for either of the other two types, which is a statistically significant difference.

What’s interesting about this difference is that preferentially recommending flexibility training is not backed up by current data. In a systematic review published nearly a decade ago, “the best evidence at the time was that individuals with neurological conditions, received no clinical benefit from stretching when assessing joint mobility and spasticity,” researchers explained.

They added: “A recent update of that systematic review concluded that no further research is necessary since the evidence that stretch is ineffective is of a high quality, and additional studies are unlikely to change the findings.”

It should be noted that the review in question wasn’t looking at ALS specifically, because there aren’t any published studies directly addressing that question in ALS. But there’s no reason to think that stretching would be particularly beneficial in ALS when it’s not helpful in people with multiple sclerosis or spinal cord injuries, researchers explained.

So, why the difference in attitude? The researchers’ best guess is that stretching may be viewed as a less risky form of exercise: “It could be the lingering perception that flexibility exercise does no harm, whereas strengthening could make things worse or exacerbate spasticity,” they wrote. It’s also possible that individual healthcare providers are working off of their own observations, and the data just hasn’t caught up. But without further studies this is just speculation.

Summarizing their findings, the researchers wrote, “The current study provides empirical evidence that while intentions are high to provide exercise counsel for [people living with] ALS, there is a positive bias towards flexibility that does not originate from high-quality clinical trials.”