Doing the Impossible

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Neuromuscular diseases (NMD) represent a heterogeneous group of disorders, including motor neuron diseases, disorders of motor nerve roots or peripheral nerves, neuromuscular transmission disorders, and muscle disease.2 The progression of the NMDs varies considerably.2 While there are over 600 neuromuscular disorders, there is no consensus in regards to recommendation for physical therapy, training,or exercise for these disorders.1 The lack of exercise in NMD patients helps to contribute to deconditioning and creates a “vicious cycle” in which physical deconditioning discourages patients from exercising, which in turn worsens overall conditioning.1

Even though exercise is the most natural form of medicine, it is still doubted by many professionals. The human body has a way of healing itself naturally through proper nutrition and exercise, and while this is not a cure for neuromuscular diseases, if done correctly it may provide a positive outcome in quality of life. Exercise may help reverse the effects of muscle weakness, sensory loss, pain, and fatigue resulting in increased cardiac output and improved oxygen delivery.

Targeted exercise of specific muscles may be more effective than overall aerobic conditioning or strength training, as it addresses specific weakness in the various NMDs.1 For example, if gripping is an issue, target specific hand resistance training at least three times a week over a three month period.  Another example is respiratory muscle training, using breathing to expand the diaphragm resulting in improved lung function.

Low impact exercises, such as aquatic therapy and supported ambulation, helps to lessens the weight on joints where pain normally persists.  Other beneficial attributes associated with water physical therapy include, increased range of motion, improved balance and coordination, normalization of muscle tone, protection of joints during exercise, and reduction of stress.3

Patients should never start an exercise regime without consulting with a physician first. Collaboration and teamwork is the key on developing a plan that best fits the needs of the patient. Exercise should  gradually increase both intensity and frequency overtime.