ALS and exercise
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Exercise can be beneficial for people with amyotrophic lateral sclerosis (ALS), helping to preserve muscle strength and mobility for as long as possible, and enhancing overall quality of life.
ALS is caused by the progressive loss of motor neurons — the nerve cells that control muscle movement. Without these nerve cells, muscles weaken in patients, who may gradually lose their ability to move, speak, and swallow. Eventually, ALS may affect their ability to breathe.
For people living with ALS, exercise can support cardiovascular and respiratory health, promote better sleep, and boost mental health. It may also enable a person to live more independently for longer.
Before beginning any exercise program, people with ALS and their caregivers should speak with a healthcare professional to assess their individual needs, limitations, and safety concerns. ALS disease progression and symptoms can vary widely for each individual, and a physical therapist (PT) will be able to recommend the type, intensity, and duration of exercises that best suit each person, and adapt exercise plans as needs and limitations change over the course of the disease.
Gentle, low-impact exercises, such as stretching, resistance training, and mobility exercises, are believed to be beneficial as part of an ALS treatment program.
Benefits of exercise for people with ALS
The hallmark symptom of ALS is muscle weakness, which is often an early symptom that can lead to an ALS diagnosis.
Initially, this muscle weakness generally starts off subtly and affects one part of the body. However, as the disease progresses, weakness may become more severe and spread to other areas of the body.
ALS exercises can increase a person’s range of motion, overall strength, and cardiovascular health, according to Amiram Griver, PhD, a physical therapist in Tucson, Arizona.
“A strong heart and lungs will help keep a person with ALS independent and healthy for longer,” he says. “Exercise even helps regulate the GI (gastrointestinal) system and your skin health.”
People with ALS should keep in mind that inactivity can lead to muscles becoming weaker faster, he adds.
Exercise is also a mood booster, helping to reduce stress by alleviating symptoms of anxiety and depression.
“Most importantly, find an activity or exercise that you will enjoy and stick to it,” Griver says. “Yard work, cooking, playing pool, and even cleaning are a type of activity that can contribute to strength and cardiovascular endurance.”
Exercises usually recommended for people with ALS fall into the following categories:
- stretching
- strengthening
- cardiovascular.
Strength training might include light resistance exercises to maintain muscle function.
“With ALS in mind, it’s important to avoid overexertion, which may lead to pain, slower muscle recovery time, and possibly damage the nerves’ connections to the muscles,” Griver says. “It should be tailored to each person by a skilled PT, but the overall idea is to focus on increased repetitions rather than high resistance.”
Range-of-motion exercises try to maintain joint flexibility and prevent shortening of muscles and tendons (contractures). It can include gentle stretching, which usually involves positioning a joint or muscle in a gentle elongated position and holding it for 30 to 60 seconds.
“It’s important not to have pain with stretches, and to repeat the stretch several times,” Griver says. “For ALS patients, it will help with comfort, maintaining safe mobility, and making ease of care for more advanced patients who may need caregiver assistance.”
Cardiovascular exercises are designed to increase the strength and capacity of the heart and lungs.
“It should be mentioned that before cardiovascular exercises are initiated, one should get cleared by their physician for any issues that might need to be taken into consideration,” Griver says.
In addition, functional mobility exercises, such as sit-to-stand, standing transfers, and assisted walking, can improve a person’s ability to move and perform daily tasks.
Breathing exercises also can help maintain lung capacity and improve respiratory function, as respiratory weakness is a common issue for people with ALS.
As a columnist for ALS News Today, Dagmar Munn talked about how exercise has changed for her since she was diagnosed in 2010 and her symptoms started affecting her strength and balance. At one point, she noticed she could no longer easily open peanut butter jars.
Her first response was to look for ways to conserve her energy. Her second was to consider exercising. She decided not to follow traditional strength training exercises, like squeezing a rubber ball, which tired her hands.
“I did find success and relief from doing gentle stretches and range-of-motion movements. Those keep my muscles, tendons, and joints supple,” says Munn, who is a former yoga and dance teacher. “Plus, they’re relaxing.”
Helpful exercises for people with ALS
Exercises that can be adapted for people with ALS include gentle stretches, breathing exercises, aquatic therapy, and strength training.
Griver prefers to train his patients in his clinic, and model how they can safely do exercises at home. He also includes handouts that show how to do exercises properly.
“Often, there is no need for a home gym,” he says. “A physical therapist will provide the training and education for use of body weight or exercise bands to use at home.”
Some people with ALS, however, may find they need a partner to help them exercise safely or they prefer going to a gym.
Examples of exercises for ALS patients include:
- wrist, ankle, and shoulder stretches and rolls to help maintain joint flexibility
- seated leg lifts, bicep curls, and passive strength training such as pushing against an object to engage various muscles
- gait training to help maintain stability and balance
- aquatic therapy exercises, such as walking in a swimming pool or gentle kicking, to improve mobility and flexibility
- diaphragmatic breathing to strengthen chest muscles
- gentle stretches for neck or leg muscles to improve flexibility.
In another column, Munn writes about her physical therapist recommending home exercises to strengthen a glute muscle that was causing a hitch when she walked. By regularly doing the exercises for several months, she finally felt the muscle was working properly, which made her very happy and appreciative.
Intense exercises are generally not recommended for people with ALS, as they may increase fatigue and further weaken muscles. Research has shown that certain vigorous physical activities are associated with a greater risk of ALS.
Exercising safely
A physical therapist should create an exercise plan that prevents injuries, maximizes benefits, and ensures proper form and technique. They can also adjust the plan as muscles weaken and ALS symptoms change.
ALS-related fatigue can severely affect a person’s quality of life, so it’s important to avoid high-impact or strenuous exercises that can worsen muscle fatigue. These types of exercise can also lead to increased difficulties in breathing and becoming overheated.
Not following the correct form when exercising can also strain muscles and joints, increasing the risk of pain and injury.
Having an exercise partner, or doing the exercises under the supervision of a PT, can reduce these risks, even for walking exercises, which carry a risk for falls, Griver says.
During exercise, it’s important for people to monitor breathing and heart rate, staying hydrated and at a comfortable temperature.
“Use of an assistive device may be needed as well, such as parallel bars or being held on to with a gait belt, for safety with more challenging activities,” Griver adds. “Training can be done when the need arises for fall recovery training or use of assistive devices like a walker or ankle foot orthosis.”
Exercise tips
Exercising regularly can be a challenge for anyone, so finding an activity that’s enjoyable will help with motivation. Many options are available, from yoga to swimming to walking.
Ways to maintain a consistent exercise program include:
- Set up a schedule: Build exercise into a daily or weekly schedule.
- Set achievable goals: Work with your physical therapist on goals you can work toward.
- Exercise with others: Join an exercise group or work out with friends or family.
- Choose several enjoyable options: Prevent boredom by alternating between different fun activities.
- Listen to music: Set an appropriate exercise pace with upbeat songs, which can help boost energy levels.
- Go outdoors: Lower stress levels and relax in the sunshine.
Muscle twitching after exercise
Muscle twitching is a common ALS symptom that can worsen with exercise.
Also known as fasciculations, muscle twitching can arise as a result of exercise-related fatigue. Fatigue can set in more quickly for people with ALS, and tired muscles may twitch as they struggle to maintain normal function.
Exercise places increased demands on the motor neurons that are functional. This heightened demand can also lead to twitching.
“Muscle twitching, or fasciculations, can sometimes be managed with stretches, if it’s not painful or limiting,” Griver says. “Others may require medications from their physician.”
Muscle twitching after exercise may be difficult to prevent entirely, but some strategies may help manage or reduce it, including:
- Supervision: A PT can create an exercise program that minimizes the risk of muscle fatigue. The therapist can modify an exercise routine to make it less intense, or shorten the duration, to match a person’s abilities.
- Warm-up and cool down: These routines can prepare muscles for the main exercises and reduce the risk of twitching due to sudden exertion.
- Diet: The body uses nutrients, such as protein and carbohydrates, from food to help build muscles and recover after an exercise session. Thus, patients can adapt their dietary habits to improve their recovery and increase the benefits of exercise. A diet designed for people with ALS includes foods high in antioxidants, protein, fiber, healthy fats, and vitamins and minerals, and cuts down on foods that are high in glutamate, along with beef, pork, and luncheon meats.
Physical therapy for people with ALS
ALS physical therapy can play a crucial role in helping patients to manage symptoms, such as muscle tightness and spasticity, maintain mobility, and keep up with daily activities.
A PT will start by assessing a person’s current level of mobility, and identify areas of concern. They will develop an exercise program that includes gentle range-of-motion exercises and stretches to preserve mobility and flexibility, along with light strength-building exercises.
Regular appointments allow the physical therapist to monitor a person’s condition and make adjustments to match their changing needs.
“As ALS is progressive, modifications may be needed as well. A skilled PT will take that into account when prescribing exercises for their clients, often offering modifications that the client can do for ‘good and bad days,’ ” Griver says. “Other times, whole new exercise programs are needed.”
For instance, when swimming is no longer an option, land-based exercises will be needed, he says. Making these changes should be done collaboratively and in person between the PT and the patient and, if needed, their caregivers.
A PT can recommend mobility aids and assistive devices, and offer advice on home modifications and adaptive equipment to make daily life more manageable.
Note: ALS News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of ALS News Today or its parent company, BioNews, and are intended to spark discussion about issues pertaining to ALS.
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