What is ALS?
Amyotrophic lateral sclerosis (ALS), also known as Lou Gherig’s Disease, is a neurodegenerative disorder characterized by progressive muscle atrophy. For this reason, some specialists are reluctant to recommend exercise as a treatment option, hoping to avoid muscle damage through overwork. However, recent scientific studies support that moderate exercise may help maintain muscle strength, temporarily improve function, and enhance quality of life for those with ALS without significant adverse effects.
How to Exercise Safely With ALS:
Below are general tips to support a safe and effective exercise routine for people with ALS who have been cleared by their doctor to perform physical activity:
Establish a Routine
Adults with ALS should aim for 150 minutes (2.5 hours) of exercise per week, consistent with the US Department of Health and Human Services physical activity recommendations. Whether achieved over a few days or many, it's important to break exercise into manageable amounts and to perform it consistently to maintain strength as long as possible. Using a calendar, planning exercise around therapy sessions, or enlisting the help of a friend or family member to reinforce physical activity are all ways to create a lasting routine.
Monitor Heart Rate
People with ALS are advised to stick to moderate-intensity exercise, as high-intensity exercise can cause lasting muscle damage and fatigue. By contrast, too little exercise can promote muscle atrophy and contracture formation faster than what would occur with natural disease progression.
Exercise intensity is based off of a person’s heart rate, with moderate-intensity physical activity defined as 50 - 70% of maximum heart rate (MHR). MHR is calculated by subtracting your age from 220 beats per minute. The following formula can be used to calculate a minimum to maximum range of beats per minute that would be considered moderate-intensity exercise:
MHR x 0.5 = THR minimum
MHR x 0.7 = THR maximum
Do the math yourself or use a heart rate calculator to define an ideal heart rate range. Consider investing in a wearable heart rate monitor to easily check in on your heartbeat during a workout. If it's difficult to figure out what type of physical activity you can do within your moderate range, consult your medical or therapy team.
If your exercise routine leaves you tired the next day, even after staying within your target heart rate range, it is a sign that you have overworked your muscles. It's important to pace yourself during exercise and take rest breaks as needed to avoid lingering fatigue that prevents you from participating in necessary tasks later.
One way to measure fatigue is to perform a “talk test” during exercise. Pick a familiar saying and recite it while performing physical activity. During moderate exercise, you should be able to say a few words up to a short sentence. If you can finish multiple, full sentences, you can pick up the pace of your exercise. If it's hard to get any words out, slow down the pace or take a break.
Alternate Stretching and Strengthening
Another way to avoid lasting fatigue is to vary the days you perform certain types of exercise. You may choose to perform strengthening, stretching, aerobic, and coordination exercises on different days of the week to engage different muscle groups while letting others recover.
“No pain, no gain” should never be the motto driving an individual with ALS’ exercise routine. When engaging in exercise, it is important to avoid activities that cause pain during or after performance. Modify activities so that they can be performed in pain-free ranges. Avoid applying additional weight to perform strengthening exercise if doing so causes lasting pain or fatigue. Isometric exercise can help maintain muscle strength using only the resistance from your own body.
Although more research is needed to better understand the effects of physical activity on disease progression, therapeutic exercise may be a valuable option for some individuals to increase feelings of comfort and capability surrounding their journey with ALS.
Bello-Haas, V. D., & Florence, J. M. (2013). Therapeutic exercise for people with amyotrophic lateral sclerosis or motor neuron disease. Cochrane Database of Systematic Reviews. doi: 10.1002/14651858.cd005229.pub3
*Exercise intensity: How to measure it. *(2019, August 6). Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/exercise-intensity/art-20046887
HHS Office & Council on Sports. (2019, February 1). Physical Activity Guidelines for Americans. US Department of Health & Human Services. https://www.hhs.gov/fitness/be-active/physical-activity-guidelines-for-americans/index.html
Miller, R., & McDade, S. (2015). Exercise: Helpful or Harmful in ALS? ALS Worldwide. https://alsworldwide.org/care-and-support/article/exercise-helpful-or-harmful-in-als
Tsitkanou, S., Gatta, P. D., Foletta, V., & Russell, A. (2019). The Role of Exercise as a Non-pharmacological Therapeutic Approach for Amyotrophic Lateral Sclerosis: Beneficial or Detrimental? Frontiers in Neurology, 10. doi: 10.3389/fneur.2019.00783
Waehner, P. (2019, January 14). How to Use the Talk Test to Monitor Your Exercise Intensity. Verywell Fit. https://www.verywellfit.com/talk-test-fitness-term-1231121
All content provided on this blog is for informational purposes only and 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.
- Alison Scarpa, OTR/L, CSRSAlison is an occupational therapist and medical device specialist dedicated to helping patients and healthcare providers identify high-tech solutions that optimize performance.