Brandon Pollock PhD, ACSM-EP-C
Over the past year, the ice bucket challenge has drawn a great amount of attention towards amyotrophic lateral sclerosis, or ALS. Amyotrophic lateral sclerosis is a progressive neurological disease that attacks the nerve cells which control muscles. ALS results in difficulty speaking, swallowing, and breathing. The diagnosis of ALS is a process of elimination based on a person’s signs/symptoms, and the cause is not known in 90 – 95 percent of cases. The onset of ALS is often so subtle that symptoms are overlooked; many individuals are unaware they have the disease. Ever since the great Yankees Lou Gehrig died of ALS in 1941, many individuals have associated ALS with exercise. Research on exercise and ALS has been somewhat controversial.
Exercise and ALS?
Not too long ago it was thought that people who performed intense exercise were at higher risk of developing ALS, a notion which was undoubtedly amplified by the death of Lou Gehrig. Certain epidemiological studies of ALS patients in Europe found weak but measurable associations between regular exercise and heightened risk of ALS. This raised concerns that exercise might somehow induce ALS by affecting brain neurons or increasing stress levels. Given these reports linking exercise and ALS onset, it is understandable why avoiding exercise was thought beneficial. However, these studies were very small and had major methodological problems.
Recently, a more controlled research review was conducted on exercise and ALS that addressed the limitations of past studies. We now know that exercise does not increase people’s risk of developing ALS. Instead, exercise actually appears to offer some protection against the disease. The primary conclusion of the review was that “in the general population, physical activity is not a risk factor for A.L.S.,” said Dr. Benoit Marin, a neuroepidemiologist at the French Institute of Health and Medical Research in Paris.
Is exercise okay for individuals with ALS?
Yes, but unfortunately, current research on the role of exercise in ALS is limited. Exercise can provide a variety of health benefits for people with ALS, particularly in the early stages. Many people with ALS have found both physical/ psychological benefits from exercise. It isn’t known whether exercises are beneficial for increasing muscle strength for people with ALS. Only specific kinds of exercises are accepted among physicians and therapists for preventing the muscle tightening and spasticity common in ALS.
Studies suggest that moderate aerobic exercise such as stationary bicycling or treadmill walking have the potential to prolong the health of muscles and nerves in people with ALS by increasing levels of protective substances in the brain and spinal cord. Exercise might even help fight the disease by boosting energy supplies, removing damaged proteins and reducing inflammation. For some people, a moderate amount of daily walking in the early stages of ALS may be all that is recommended. Range of motion and stretching exercises will be beneficial as the disease progresses.
Exercise for people with ALS should involve multiple large muscle groups and contain these components:
- Range of motion exercises – yoga, tai chi
- Stretching – all joints, static
- Cardiovascular conditioning – walking, water aerobics, cycling
- Strengthening – based on physician discretion
Most patients with ALS want to do as much as possible to help themselves. The answer as to whether exercise is beneficial for people with ALS is unfortunately less clear than we would like. Studies done in patients with other neuromuscular disorders generally support the benefits of moderate exercise in patients with ALS, but more research is still needed on exercise and ALS.
*For examples of other variations/exercises look under Multimedia-VDF Exercise Tips
**Consult with a physician and/or medical healthcare provider before starting any exercise regimen
Bello-Haas VD, Florence JM, Kloos AD, Scheirbecker J, Lopate G, Hayes SM, Pioro EP, Mitsumoto H. A randomized controlled trial of resistance exercise in individuals with als. Neurology. 2007;68:2003-2007
Hamidou B, Couratier P, Besancon C, Nicol M, Preux PM, Marin B. Epidemiological evidence that physical activity is not a risk factor for als. European journal of epidemiology. 2014;29:459-475
http://well.blogs.nytimes.com/2014/09/03/can-exercise-cause-a-l-s/?_r=0 Can Exercise Cure A.L.S.? The New York Times. 9/3/2014. Retrieved 23 April 2015
http://www.ninds.nih.gov/disorders/amyotrophiclateralsclerosis/detail_als.htm Amyotrophic Lateral Sclerosis (ALS) Fact Sheet
Kelly, Evelyn B. (2013). Encyclopedia of human genetics and disease. Santa Barbara, CA: Greenwood. pp. 79–80.
Motor Neuron Diseases Fact Sheet: National Institute of Neurological Disorders and Stroke (NINDS). www.ninds.nih.gov. Retrieved 23 April 2015.
Pupillo E, Messina P, Giussani G, Logroscino G, Zoccolella S, Chio A, Calvo A, Corbo M, Lunetta C, Marin B, Mitchell D, Hardiman O, Rooney J, Stevic Z, Bandettini di Poggio M, Filosto M, Cotelli MS, Perini M, Riva N, Tremolizzo L, Vitelli E, Damiani D, Beghi E, Consortium E. Physical activity and amyotrophic lateral sclerosis: A european population-based case-control study. Annals of neurology. 2014;75:708-716
Turner MR, Wotton C, Talbot K, Goldacre MJ. Cardiovascular fitness as a risk factor for amyotrophic lateral sclerosis: Indirect evidence from record linkage study. Journal of neurology, neurosurgery, and psychiatry. 2012;83:395-398