The Ins and Outs of Exercise — Yes, You Can
I like long walks, especially when they are taken by people who annoy me.
— Fred A. Allen |
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by Christina Medvescek
For years, doctors have debated whether or not people with neuromuscular diseases (NMDs) should exercise. Would the benefits of exercise be offset by irreversible muscle damage and further weakening?
Although research hasn't come up with a conclusive answer, experts generally agree that moderate exercise won't hurt you. At a 2001 conference on the role of physical activity and exercise training in progressive NMDs, chaired by William M. Fowler Jr., professor emeritus at the University of California at Davis Department of Physical Medicine and Rehabilitation, a variety of studies showing no short-term negative impact on muscle from light exercise were cited.
And while exercise won't hurt, it sure might help. Here are a few benefits of exercise discussed at the conference:
It's Good for You
Strength: Several studies by David D. Kilmer of the UC Davis Medical Center in Sacramento suggest that when people with NMD do light-to-moderate strengthening exercises, they may maintain or slightly increase their strength. Interestingly, high-intensity strengthening exercises don't appear to offer more benefits, and in fact have a greater potential to cause muscle damage.
Studies confirm what excercisers already know: It just plain helps you feel good. |
One caveat: Some research implies that people with NMD should avoid "eccentric training," which focuses on moving slowly through the lowering portion of an exercise such as weightlifting or sit-ups. This approach may cause muscle damage.
Heart: Moderate aerobic exercise by people with slowly progressing NMD caused slight improvement in their aerobic (heart and lung) capacities, according to a 1996 UC Davis study.
Memory: Three studies presented at the 2001 Society for Neuroscience conference suggest that regular exercise enhances memory function, and can even counteract the fuzzy mental effects of a bad diet (high in fat and sucrose).
Stress: Stress lowers a brain protein (brain-derived neurotrophic factor, or BDNF) that nourishes neurons and helps them stay healthy. Exercise counteracts this brain-draining stress effect by increasing production of BDNF, even in people who find it stressful to exercise.
Osteoarthritis: Some studies suggest that exercise reduces pain and stabilizes joints.
Osteoporosis: Exercise slows the progression of this bone-weakening disease.
Back Pain: People who don't exercise regularly are at increased risk for low back pain.
Weight Control: It's hard to lose weight without it.
Cancer: A number of studies indicate that regular moderate exercise reduces the risk of colon cancer and other cancers related to obesity.
 Wet workout: Experts say pool exercise is best for people with neuromuscular disease. |
Gastrointestinal Tract: Moderate regular exercise may reduce the risk of some intestinal disorders, including ulcers, irritable bowel syndrome, indigestion and diverticulosis.
Psychological Benefits and Quality of Life: A variety of studies confirm what exercisers already know: It just plain helps you feel good.
Exercises for NMD
OK, now you're convinced you should exercise. But what exactly should you do?
Greg Carter, director of the MDA clinics in Olympia and Tacoma, Wash., is a strong advocate of pool aerobics "because it is safe and people with NMD can do more in the water than on dry land." In a recent MDA clinical-research Internet chat, Carter suggested a 20-to-30-minute session, preferably in a warm pool (85 to 90 degrees Fahrenheit).
For energy, he recommends taking 5 to 10 grams of creatine and 50 to 100 milligrams of coenzyme Q-10 one hour before exercise and drinking lots of water.
Strength training should be done under supervision, and the trainer should be told about your NMD. People with slowly progressing NMD should work at about 20 percent to 30 percent of their maximum strength, Carter advises. (There's no clear standard for people with rapidly progressing NMDs, who may be at greater risk for injury.)
A simple rule of thumb: If it hurts, stop. |
If you're working with weights, start your routine with the heavier weights and work down to lighter ones, advises Lee N. Burkett, professor in the Department of Exercise and Wellness at Arizona State University in Tempe. This reversal of the usual training method will ease the fatigue factor.
Burkett suggests doing no more than three workouts of one to three sets per week, with 15 to 20 repetitions per set. Be sure to use the proper lifting form at all times. One set may be enough, he says, noting that his latest research indicates that one set "gets you about 82 percent of the benefit you can get from three."
How Much Is Too Much?
A simple rule of thumb: If it hurts, stop. If you become fatigued, stop. Don't push yourself too hard. Symptoms of fatigue include shortness of breath, cramping, increased muscle twitching and a "heavy" sensation in your arms and legs.
Be sure to take regular rest breaks while exercising. Some people with extreme weakness exercise 2 minutes, then rest for 3 to 5 minutes. You decide what works for you.
"Submaximal" exercise is best for people with NMD — exercise that doesn't take your full muscle strength to perform. In other words, don't walk as fast as you can walk, cycle as hard as you can pedal or lift as much weight as you can lift. This protects against overwork while helping to maintain or minimally increase muscle strength.
If you're not back to normal 20 minutes after stopping your routine, you probably are exercising too hard, according to ALS: Maintaining Mobility."
Weakness the following day is another sign you need to slow down, Carter says, although it doesn't necessarily mean your muscles have been permanently damaged.
Do whatever level of exercise your ability allows. Even if you can't exercise independently, you still should do range-of-motion exercises, say the authors of ALS: Maintaining Mobility. Do the exercise to the point at which you need assistance, then let the assistant do the rest.
Even completely passive exercise can have benefits. Range-of-motion exercises performed by an assistant or a motorized system that moves the limbs can help keep the body loose, decrease pain, ease pressure points, stimulate circulation and bowel function, and just make you feel better.
Simply put, there's just no way you can avoid it — exercise is a good idea!
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