Exercises for People Living with ALS

Amyotrophic lateral sclerosis (ALS) is a disease that impacts the nerve cells that control movement in the body. It’s a progressive disease, meaning symptoms continue to get worse over time. Also known as Lou Gehrig’s disease, ALS can affect how people move, think, talk, and function day-to-day.

Katey Burke, PT, DPT, a Mass General Brigham Neuroscience Institute neurologic clinical specialist and physical therapist, shares the best exercises for people with ALS and how exercise can help improve symptoms and quality of life.

Dr. Burke treats patients with ALS at Massachusetts General Hospital.

The benefits of exercise for ALS

“Experts used to think exercise wasn’t a good idea for people with ALS, since the disease makes muscles weaker over time,” Dr. Burke says. While their muscles won’t get stronger, people with ALS can and should exercise with the guidance of their care team. The current advice is that exercise can help people with ALS manage symptoms and reduce pain.

“Our bodies naturally crave movement,” says Dr. Burke. “Research shows many benefits of mild to moderate exercise for people living with ALS.”

While it’s true that your muscles affected by ALS won’t get stronger with exercise due to the condition, there are other benefits to various forms of exercise.

• Prevent stiff joints and pain
• Keep muscles not affected by ALS healthy and strong to better support the weakened muscles
• Maintain heart and lung health as much as possible
• Possibly slow muscle loss and weakness
• Reduce muscle spasms and stiffness (also known as spasticity)

The physical benefits of exercise for people living with ALS help make everyday life easier. An exercise program tailored to your needs can help you with eating, dressing, bathing, and fall prevention.

The mental and emotional benefits of exercise can help you feel good. It’s common for people living with ALS to have anxiety and depression. Exercise—especially if you’re able to get outside or chat with a caregiver or a friend while doing it—can be a great mood booster.

While ALS symptoms may limit what you can do, your care team can create an exercise plan that works for you.

“Any amount of movement can help your overall health and can help manage symptoms of ALS,” says Dr. Burke.

The best types of exercises for people with ALS

There are five kinds of exercises that are helpful for people living with ALS. Each exercise type helps with different ALS problems. Talk to your physical therapist about creating the right exercise plan for you and your ALS symptoms.

1. Stretching exercises

“Gentle stretching keeps your body limber and flexible,” Dr. Burke says. “It eases tightness in your muscles and joints and can make it easier to move.”

Stretching is a good way to move your body even if you’re tired or have limited movement.

Try a shoulder stretching exercise:

• Slowly lift your arm up and over your head as far as it’s comfortable or until your arm is pointing straight overhead.
• Hold that position for 30 to 60 seconds.
• Slowly lower your arm.
• Repeat the exercise one to three times per arm.

If needed, a caregiver can support the weight of your arm for this exercise by holding it under the elbow. This stretch can even be done in bed, allowing you to get some movement and the benefits it brings.

“To get the most benefit, you should stretch daily,” says Dr. Burke. Your physical therapist can give you a set of stretches for your symptoms and abilities, so you get the most out of your exercise time.

2. Aerobic exercise

Aerobic exercise—also known as cardiovascular exercise or simply cardio—is good for people with ALS to help keep the lungs and heart healthy. Depending on your ability level, this could include walking, riding a stationary bike or using bike pedals, swimming, or pool therapy. You can try aquatic therapy with adaptive devices to help support your body in the water.

“Monitor your breathing during any aerobic exercise,” reminds Dr. Burke. “It’s okay to feel slightly short of breath, but you shouldn’t struggle to breathe.”

Try to do aerobic exercise 3 to 5 times per week. Pick something you enjoy doing so it’s fun and motivating.

3. Resistance exercises

Resistance exercises use your own body weight, stretchy elastic bands, or weighted gym equipment like dumbbells, machines, or barbells to work your muscles.

ALS weakens muscles over time. Resistance exercises can’t strengthen the muscles or prevent the disease from getting worse, but they can help support your current strength. You can also strengthen muscles not affected by ALS to better support weaker ones.

A great body weight exercise for people with ALS is the sit-to-stand exercise. Here’s how to do it:

• Start out seated in a chair with your back supported and feet flat on the ground.
• Stand up and hold your balance for a few seconds.
• Slowly sit back down. Make sure you don’t plop back in the chair.
• Do this exercise five times.
• Don’t use your arms to help unless you need them.

Try doing resistance exercises 2 to 3 days a week to get the most benefit from them.

4. Balance exercises

As the muscles that support your body get weaker from ALS, you might have trouble with balance. This can lead to feeling unstable and can make you more likely to fall while standing or walking.

Balance exercises can reduce your fall risk by training your muscles. Falls can cause minor injuries like bumps and bruises but can also cause more serious injuries like broken bones or a concussion.

Work with your physical therapist to choose balance exercises that are safe for you, such as:

• Yoga
• Tai chi
• Side steps
• One-leg stand
• Balance ball or balance board exercises

“Practicing your balance can also help with daily activities like getting dressed or showering,” Dr. Burke points out.

5. Breathing exercises

ALS causes breathing problems as the muscles in the respiratory (breathing) system weaken. Exercises can’t reverse the weakness, but they can help you keep your strength for longer and help you feel more comfortable. The same muscles also help with swallowing and coughing.

Your health care provider may suggest exercises with or without resistance to help support your breathing.

Diaphragmatic breathing—also called belly breathing—is one example of an exercise without resistance. There are handheld devices called expiratory muscle strength training (EMST) devices that provide resistance as you breathe out through the device. Your team can help you decide what types of breathing exercises are appropriate for you.

Benefits of respiratory exercises may include:

• Relaxation and stress reduction
• Maintained or improved breathing efficiency
• Improved cough strength
• Improved ability to get mucus out
• Improved swallowing ability

Try belly breathing:

• Place your hand lightly on your stomach so you can feel the air making your belly rise.
• Breathe in slowly through your nose and pay attention to your belly moving out.
• Breathe out slowly through your mouth, making your exhale longer than your inhale.
• Repeat the process for a few minutes at a time.

You shouldn’t feel short of breath or lightheaded during this exercise. Try doing breathing exercises every day for the most benefit.

How to exercise safely with ALS

“One tip I share with all of my patients,” Dr. Burke says, “is to remember the importance of rest. After any exercise, be sure to take breaks and even naps to give your body time to recover.”

Plan your exercise sessions around your energy levels. If you have more energy first thing in the morning, for example, do more tiring exercises like resistance training and save something more relaxed like stretching for when your energy is lower.

Listen to your body and don’t overexert yourself. Dr. Burke notes that you should feel recovered within 30 to 60 minutes of completing your exercise session. “If you still feel fatigued after that, your body is telling you it was too much,” she says.

Your care team can find the best exercises for you and evolve the plan over time. For example, if you can’t move on your own, your caregiver can still help you with stretching exercises to reduce muscle contractions and pain. Working together, you can find the right exercises for your needs and abilities.

“Exercise can be empowering and help you feel good,” says Dr. Burke. “There are many adaptative exercise options to keep you moving even as your ability level changes.”