Amyotrophic lateral sclerosis (ALS), also known as Lou Gherig’s Disease, is a neurodegenerative disorder that is characterized by progressive muscle atrophy. For this reason, some specialists are reluctant to recommend exercise as a treatment option for the condition, 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. (1,2)

Below are general tips to guide the development of a safe and effective exercise routine for individuals 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. (3) Whether this target time is achieved over a few days or several, it is 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 performance are all ways to create a lasting routine.

Set your target heart rate
Individuals 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 formula below can be used to calculate a minimum to maximum range of beats per minute that would constitute moderate-intensity exercise:

MHR x 0.5 = THR minimum
MHR x 0.7 = THR maximum

There are also many target heart rate calculators online.

It is important to use a heart rate monitor, smart watch, or take a manual pulse to keep track of heart rate when exercising with ALS. Consult your medical or therapy team if it is difficult to figure out what types of physical activity are within your moderate heart rate range. (4)

Monitor fatigue
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 is 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 that day or the next.

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 you can say few to no words, slow down the pace or take a break. (5)

exercise-ALS-stretching-NEOFECT

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.

Listen to your body
“No pain, no gain” should not 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. (6) Note that you do not have to apply additional weight to perform strengthening exercise if doing so causes lasting pain or fatigue. Isometric exercises 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 fight with ALS.

The NEOFECT line of Smart Rehabilitation Solutions can assist with maintaining strength, range of motion, and coordination for individuals with neurodegenerative disease. Our neurorehabilitation products include support from occupational therapists to maximize functional gains. Please call (866) 534-4989 or email contactus@neofect.com for further inquiry.

  1. 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

  2. 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

  3. HHS Office, & Council on Sports. (2019, February 1). Physical Activity Guidelines for Americans. Retrieved from https://www.hhs.gov/fitness/be-active/physical-activity-guidelines-for-americans/index.html

  4. Exercise intensity: How to measure it. (2019, August 6). Retrieved from https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/exercise-intensity/art-20046887

  5. Waehner, P. (2019, January 14). How to Use the Talk Test to Monitor Your Exercise Intensity. Retrieved from https://www.verywellfit.com/talk-test-fitness-term-1231121

  6. Miller, R., & McDade, S. (2015). Exercise: Helpful or Harmful in ALS? Retrieved from https://alsworldwide.org/care-and-support/article/exercise-helpful-or-harmful-in-als

For More Information on ALS & Exercise:
ALS News Today - ALS & Exercise
ALS News Today - 7 Tips for Starting an Exercise Program with ALS
ALS Worldwide - Exercise: Helpful or Harmful in ALS

Alison Scarpa
Clinical Manager / Occupational Therapist

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