by Christina Medvescek and Margaret Wahl
If they’re undertaken with care and supervision, exercises
that strengthen and build muscle, and exercises that burn
calories, can help you lose weight — or at least enjoy
a little more food without gaining.
Limited research suggests that most people with slowly progressive
muscle diseases can do some exercise and gain muscle strength.
Careful exercise even may protect muscles against damage from
daily activities.
Exercise programs always should be developed under the supervision
of a doctor, physical therapist or other professional who
understands NMDs.
Strengthening Exercises
Slow, slow progress, carefully monitored at every step, is
the watchword here. Measurements should be taken of strength
gains and losses, and a physician should monitor blood levels
of creatine kinase (CK), an enzyme that leaks from damaged
muscle cells.
CK levels should be checked before you start an exercise
program, then about four days after the first few sessions.
Although CK will go up when you begin exercising, it should
gradually return to baseline or below over a period of weeks
to months.
A dramatic rise in CK (higher than 50 percent above
baseline) without a subsequent return to baseline is a signal
to decrease exercise intensity. Another sign of excessive
muscle damage is urine that darkens to a tea or cola color.
In a careful exercise program, the body will adapt and muscles
will actually gain some protection, says Mark Tarnopolsky,
associate professor of pediatrics and medicine at McMaster
University in Hamilton, Ontario.
Tarnopolsky recommends the following regime to strengthen
muscle:
- Warm up with gentle stretching
before exercising.
- Start with low weights or a resistance
to push/pull against, and 10 to 12 repetitions. In some
cases, simply moving a limb through a range of motion
with no added weight is a good starting point.
- Slowly increase to three sets of
repetitions, spaced about two minutes apart. Wait at least
48 hours before exercising the same muscle again to allow
for recovery.
- Gradually increase weight and/
or resistance force under the supervision of a physical
therapist or kinesiologist (movement specialist).
- In diseases in which the muscle
cell membrane is particularly fragile (such as Duchenne,
Becker and some limb-girdle MDs), be sure the weight isn’t
excessive. In FSH MD and other diseases in which, some
observers say, strength in the dominant arm deteriorates
faster, be even more cautious about exercising.
 |
 |
Proper
exercise, such as swimming or using a stationary bicycle,
can protect muscles and sometimes burn calories. |
Calorie-Burning
Exercises
Calories are burned through endurance
exercise, in which the heart rate increases to 120 to 150
beats per minute for at least 20 minutes.
For those who can do it, Tarnopolsky
recommends:
- Exercising at least 20 minutes,
five to seven times a week.
- Swimming, cycling on a stationary
bicycle, using a treadmill or hand cycle.
Endurance exercise can help shed pounds but it’s
not essential to weight loss, says Ted Abresch of UC Davis.
"Eighty percent of losing weight is diet, and 20 percent
is exercise,” he notes. “You can do it without
exercise, but it’s harder, and endurance exercise
appears to confer other health benefits.”
Metabolic Disorders
People with metabolic disorders need to understand which
types of activities will trigger a metabolic crisis. Those
with glycogen storage diseases like McArdle’s disease
(see "McArdle's Disease"
in this issue) or Tarui’s disease will notice exercise
intolerance with high-intensity strengthening activities,
while those with mitochondrial disorders or disorders of
lipid (fat) metabolism will have difficulty with endurance
activities.
However, almost anyone with a metabolic disease can adapt
to regular exercise, though the progression must be very
slow and dietary issues are critical. Given the complexities
of these conditions, consult a doctor or neurometabolic
specialist for advice.
Gentle stretching or passive exercise in which someone else
moves your muscles, and gentle movements in a swimming pool
don’t build muscle or burn calories. But these activities
can help you maintain flexibility and comfort, and may whet
your appetite for more strenuous exercise.
For more information, see:
“As
the Wheel Turns: Keep It Moving” (exercise cycles
for wheelchair users), Quest, November-December 2003
“The
Ins and Outs of Exercise,” Quest, June-July 2002
“No
Sweat Exercise: Aquatics,” Quest, July-August 2003
