Neuromuscular Disease & Exercise

Neuromuscular diseases (NMD) are a sub group of neurological diseases where the nerves that control movement are affected. They can be either acquired or genetic, with diagnosis often complex to establish particular strains of disease.

 

Neuromuscular disabilities including multiple sclerosis, post-polio syndrome, and Parkinson’s disease.

exercise right for condition_more_v23

Why it’s important to exercise

 

Exercise Right recommends resistance training modifications to improve motor function in persons with cerebral palsy, muscular dystrophy, spinal cord injury, and stroke.

 

Resistance and aerobic training improves physical fitness, strength and functional performance and capacity. Those with MS have shown to have increased walking mobility with combined resistance and aerobic training.

 

Regular flexibility training assists with reducing/preventing contractures in people with muscular dystrophy, spinal cord injury and stroke.

 

Neuromuscular diseases can be broken down into six general types depending how they affect the body, these are:

 

  • Muscular dystrophies (MD)
  • Motor neuron conditions
  • Metabolic muscle conditions
  • Conditions of the peripheral nerve
  • Conditions of the neuromuscular junction
  • Neuromuscular myopathies

 

Most NMD’s are incurable, however exercise in neuromuscular diseases is known to improve:

 

  • quality of life,
  • reduce degradation rate of muscle,
  • improve movement,
  • improve symptoms or co morbidities of the disease,
  • prolong independence
  • reduce risk of falls and injury and can prevent or limit disability.

 

Exercise not only improves movement and muscle control but also physiology including improved cardiovascular and respiratory function, (often the last phase of the condition) leading to increased longevity.

 

Exercise improves mental wellbeing with social interaction and accomplishment.

neuro2

Things to remember:

 

  • Avoid exercising alone or in abnormal conditions. With movement disorders the risk of falls is increased.
  • Conditions affecting the peripheral nerves can reduce pain symptoms, where pushing an exercise program too hard can result in an injury without receiving the neural feedback i.e. pain.
  • Allow 48 hours to recover from resistance training prior to the next session.
  • Foot and hand straps may be needed on bicycle and arm ergo machines to allow for adequate movement and control.
neuro3

Types of exercise recommended

 

If starting an exercise regime, Exercise Right recommends starting slowly. NMDs may be aggravated by fatigue so even a 2 minute seated exercise session is of greater benefit than exercising to fatigue.

 

Start with a low intensity exercise first. The intensity can always increase if things are too easy, but if exercise is begun with too much too soon, people with NMDs may experience multiple bad days in a row.

 

Always incorporate resistance training combined with flexibility training. The resistance training should target all the major muscle groups with low weight and high repetitions to begin with. Weight intensity should gradually be increased as fatigue and muscular endurance allows.

RIGHT PROFESSIONAL

 

Accredited Exercise Physiologist (AEP)

As an exercise specialist, an Accredited Exercise Physiologist (AEP) can assess and prescribe the appropriate exercise plan for your condition and symptoms. Given the complexity and stages of degeneration, an individualised program that meets your current needs, goals and symptoms is required.

 

An AEP will monitor the risk versus benefits of exercise including fatigue levels and movement/technique. This expert advice and monitoring can result in greater independence, improved energy levels and functional capacity and reduced risk of falls and injury.

 

An AEP can assist you to high levels of fitness and function despite conditions. The goal is still attainable, only the time-frame has changed.

 

RIGHT PLACE

 

Climate controlled environment, such as a gym or rehabilitation centre

For some NMD’s such as Multiple Sclerosis it is important you exercise in a cooler environment as exercise in heat can exacerbate conditions. With decreased thermoregulation your body’s ability to adapt to climate is reduced leading to an increased risk of heat stress.

 

Exercise may need to be completed in a rehabilitation gym to allow for modified and safe equipment and the required hand and foot straps for you to be able to complete all exercises comfortably and safely.

 

RIGHT TIME

 

Right time is medication dependent

Exercise Right recommends timing sessions so that medications can be in full effect (e.g. in PD you may experience an increase in symptoms just before the next medication dose is due). Work in conjunction with you doctor or specialist to find out about timings of medication dose and full effect.

 

At this time of day, levels of the hormone cortisol are higher, which lowers insulin action and keeps blood glucose levels from dropping, and circulating. Insulin is also lower (prior to any insulin taken for breakfast).

 

Exercise before bed is also not recommended given the risk of delayed post exercise hypoglycaemia.

 

When possible, scheduling similar timing of exercise into your daily routine maybe beneficial to minimize the risk of nocturnal hypoglycaemia.

 

A recent study published in the Journal of Diabetes Science and Technology early in 2015 found that overall, hypos occurred significantly less often following 7 AM exercise compared to 4 PM (5.6 vs. 10.7 hypos per person). That study compared blood glucose levels and the number of lows during and following moderate exercise for 36 hours.

 

Remember to always consult a professional before beginning any new exercise routine, and to find out what time may work best for you and your uniqueness.

Downloadable resources