Hello,
I’m hoping to receive some advice on strength programming for neurodegenerative conditions. I’m a kinesiologist working with patients with ALS. I’d love to give them solid programing that can meaningfully improve their symptoms and ideally educate them enough so that they can leave our care centre with the tools they need to carry on without us.
Their physicians recommend avoiding taxing their bodies, as this will exacerbate the decline. I was theorizing that heavy resustance work would be beneficial, as this would be more likely to cause neural adaptations. As well, higher repetition work may be more damaging to muscle tisue than heavier “max lifts”, due to the greater metabolic demand. Obviously, still gradually progressing, and likely using machines for safety in implementing heavier lifts, as for many, balace and postural control can be an issue.
Do you have any thoughts that could help me to make the best of my time with these patients? This is not to disobey direct medical directives from their physicians, but rather, to suggest to the physicians and patients as a viable plan with research that can support it.
I’m not sure that exercise is likely to improve their symptoms per se’, though anything is possible. There is scant literature on exercise interventions in individuals with ALS, mostly showing that people tolerate it well and early improvement in function. Most research groups haven’t shown any change in fatigue levels.
If it were me, I probably wouldn’t change my exercise prescription approach much. I would ask if someone is open to exercising, as it is likely to improve how they feel and move about the world. Then, I’d ask how they’d prefer to exercise, adding my 0.02 as needed to make sure they’re doing some resistance training and conditioning. When it comes to specifics however, I wouldn’t avoid “heavy” resistance training or higher repetition work. I do not think either are uniquely risky or damaging. Like others, I would have them do a variety of exercises to train all the major muscle groups, using a variety of rep range and relative intensities. I would also use autoregulation to guide weight and volume prescription.
Medical decisions should be shared between the patient and provider. If a patient has ALS and is open to exercise, that should be discussed with the physician.