Exercise may have many benefits for ALS patients, including reducing depression and improving strength and stamina. But it must be performed carefully to be beneficial. Patients should work with a physical therapist to determine how best to exercise safely, as well as to ensure that they include stretching, strength-building, and range-of-motion exercises in their routine.
Regular and moderate exercise is better than excessive exercise. It is important for patients to avoid overworking their muscles. Aching muscles after exercise mean that they have been overstressed, and this may actually speed muscle loss. Patients should stop exercising when they get tired, rather than trying to push through the fatigue.1
Aerobic exercise can increase muscle efficiency and endurance by increasing heart rate, respiratory rate and overall cardiovascular fitness. Aerobic exercise examples are swimming, water walking, walking, cycling, rowing, …
Remember to exercise in moderation - exercising to the point of fatigue may actually result in increased muscle weakness.
May help decrease the frequency or intensity of muscle cramping. These should be done daily to prevent pain and stiffness.
Range of motion exercises (ROM)
Help move the joints through their full range of motion. These should be performed actively, if possible, or passively if muscle weakness limits movement. These should be done daily to prevent pain and stiffness.
Are not recommended. Working out with weights will not strengthen those muscles already weakened by ALS and could result in increased muscle weakness.2
2021 - Systematic Review of Therapeutic Physical Exercise in Patients with Amyotrophic Lateral Sclerosis over Time
Therapeutic interventions included a variety of physical exercises, such as aerobic exercise, moderate-to-high-intensity strength and endurance training, and stretching, and lasted from two weeks to six months.
Slight increases in ALSFRS-R scores — noting a gain in functional capacity — started to be seen in patients receiving therapeutic physical exercise as early as in the first month of treatment.
According to investigators, these beneficial short-term effects are important to consider, especially “since, when dealing with the rehabilitation of a degenerative disease, function is expected to be lost with the passage of time.”
After three months of treatment, differences in ALSFRS-R scores between patients on the therapeutic intervention and those who remained inactive became significant. Although ALSFRS-R scores decreased in both groups, indicating all patients were gradually losing their ability to perform certain tasks, this functional decline was more severe in those who were not engaging in physical exercise.
2019 - The Role of Exercise as a Non-pharmacological Therapeutic Approach for Amyotrophic Lateral Sclerosis: Beneficial or Detrimental?
Although previous evidence suggests a potential relationship between heavily active lifestyles and an increased incidence of ALS (30, 31, 109), recent studies support that physical activity is not necessarily a risk factor for ALS (42, 43, 110). There is now a large body of evidence suggesting physical activity as a potential therapeutic or even holistic approach for ALS.
The study found those who did moderate strengthening exercises had a 12-percent slower decrease in function and a 16-percent slower decline in quality of life over the six months than those who did the stretching exercises alone.