Exercise and physical activity for adults with muscle wasting conditions

Physical activities are less structured movements that you might do as part of your daily routine, this could be through carrying out personal care, completing housework or commuting to work. Exercise is a type of structured activity, such as swimming, cycling, or Pilates.

There is no evidence yet that shows the ideal amount or type of physical activity or exercise for people living with muscle wasting conditions. The type of exercise or physical activity you do will be specific to you and how your condition changes over time. Doing what you can, even if it’s a small amount will be more helpful than not at all.

Speak to your healthcare team before starting a new type of exercise. They can help you find activities that are safe and suitable for you.

Any kind of physical activity is good for your health and wellbeing.

Being active can:

• Improve or maintain your ability to perform everyday tasks
• Reduce more weakness from not using your muscles
• Help to keep or improve movement in your joints
• Support heart and lung health
• Lower the chance of having other health problems, such as type 2 diabetes and high blood pressure
• Improve bone density
• Help to reduce pain
• Improve your mood
• Improve sleep quality
• Help you stay a healthy weight

Exercising daily

Try to do some exercise or physical activity every day. Even small amounts or gentle movements are helpful.

The UK government recommends at least 150 minutes of moderate activity each week. This includes any activity where you’re comfortably out of breath but still able to talk. They also advise doing some strength and balance exercises at least twice a week.

You may feel too tired to exercise sometimes and that’s okay. It’s important to pace yourself and rest when you need to. But try to avoid long periods of inactivity. This can lead to muscle weakness and a decline in your physical function which can make it even harder to exercise.

Getting advice

It’s safe for people with muscle wasting conditions to exercise. But in some cases, strenuous exercise is not recommended.

Speak to your doctor or physiotherapist before starting any new exercise. This is particularly important if you’ve not had a diagnosis yet. If your condition is linked to heart problems, speak to your heart specialist (cardiologist) first.

Saving energy and safety

Spreading activities out through the week can help you have enough energy for daily life. Little and often is best.

To avoid muscle damage or fatigue, it’s important to:

• Warm up before exercising and cool down afterwards
• Start with short sessions and slowly build up
• Rest when you need to
• Stop if you get any pain, shortness of breath, or sore muscles
• Avoid heavy strength training
• Avoid repeated exercises that lengthen the muscle, such as squats

A very small number of people with some muscle wasting conditions may get dark-coloured urine after exercising. Go to A&E if your urine is the colour of black tea or cola. This could be a symptom of a condition called myoglobinuria.

You may find it easier to exercise if you choose activities that fit easily into your daily life. Try to find activities that you enjoy and are safe for you to do. Exercising with friends can help make it more fun.

Your physiotherapy team may recommend aerobic, strength, and stretching exercises. Aim to do a mix of these throughout the week to give your muscles time to rest. For example, if you’ve been for a walk, you could do some arm stretches next time.

Aerobic exercises

Aerobic exercises help to make your heart, circulation, and lungs work better. They help to improve your overall fitness and health. Doing small amounts of aerobic exercise can also help to make your day-to-day tasks feel easier.

Aerobic exercises make you breathe faster, and make your heart and muscles work harder. They use large groups of muscles, such as legs and arms and once you start, you should be able to comfortably carry on with the exercise for a few minutes.

Low to moderate impact exercises are best because they do not put much stress on the joints. Examples include:

• Walking
• Doing housework
• Gardening
• Using a manual wheelchair
• Swimming
• Dancing
• Using an exercise bike
• Wheelchair sports such as football or basketball
• Boccia (a seated ball game similar to bowls)

How often you should do aerobic exercise

Doing aerobic exercise for 30 minutes, more than once a week is advised. You do not have to do 30 minutes all in one go. You could try to break it down into shorter exercises, doing between 5 to 10 minutes at a time.

It’s important to remember to pace, plan, and prioritise exercise as part of your regular activity. If you can, you should try to make being active a part of your daily routine, planning for aerobic exercise on most days.

How much time you should spend doing aerobic exercise

How much time you spend doing aerobic exercise will depend on what you’re used to. If you’ve done little exercise, you will need to start off slowly, doing a couple of minutes and then adding on more time as you get used to the activity.

How much effort aerobic exercise should take

You should exercise at a moderate or medium rate. You should feel warmer, start to sweat a little, and take deeper breaths. You should still be able to talk comfortably whilst doing the exercises.

You should not exercise to the point that you become very tired or fatigued.

Strength exercises

Strength exercises can help prevent or slow the loss of muscle strength. It’s best to use lighter weights or resistance. As you get used to the exercises, you could do more repetitions.

Include exercises that strengthen the muscles in your arms, legs, and core (your stomach area and back). Improved core strength can help improve your posture and balance, which can reduce the risk of falling and help with day-to-day activities. Examples include:

• Using exercise bands or small weights
• Tai Chi
• Pilates or yoga

How often you should be doing strengthening exercises

Try to do strength exercises at least twice a week, with a day or more off in between.

How much strengthening exercises you should do

You should aim to do one round of repeated movements between 8 to 12 times, for each muscle group you’re working on. You can start to slowly increase to three rounds, once you feel able to. Only use low weights to do strengthening exercises, even as you start to repeat more of the movements.

How to take care when doing strengthening exercises

Remember to take care to protect your back, neck, and posture when you’re doing any lifting. You should try not to rely on other muscles when doing strengthening exercises.

Your muscles may ache a bit after doing strength exercises. This should wear off after a couple of days. If your muscles are very sore, you may need to reduce the amount you’re doing or speak to your healthcare team.

Stretching exercises

Stretching exercises help to keep you mobile, with a good range of movement.

If you have tight muscles or joints, your physiotherapy team may give you stretches to do. These may be active stretches you do yourself, or passive stretches with the help of someone else.

Examples of stretching exercises include:

• Lying, seated, or standing stretches – gently stretch and hold for 20-30 seconds at a time without bouncing and repeat two to four times
• Pilates or yoga
• Tai Chi

It’s easier and safer to stretch your muscles when they’re warm from doing other types of exercise. Be careful not to overstretch, particularly if you have nerve problems, very weak muscles, or poor balance.

You can build stretches into your daily routine or do them at least two or three times a week.

Pilates

Pilates is a form of exercise that can be beneficial as it strengthens core muscles.

These videos have been created by neuromuscular physiotherapists or Pilates instructors specifically for people with muscle wasting conditions:

• Neuromuscular Pilates in standing and kneeling 
• Neuromuscular Pilates in standing
• Neuromuscular Pilates in lying and side lying
• Neuromuscular Pilates in lying
• Neuromuscular Pilates in prone
• Neuromuscular Pilates in sitting
• Neuromuscular Pilates in sitting
• Neuromuscular Pilates with support

Activity and stretching

The Scottish Muscle Network has videos for stretching exercises in the standing, sitting and lying positions.

There are also videos that demonstrate passive movements for the arms and legs.

Physiotherapy sessions at home

Neuromuscular physiotherapist Marina Di Marco demonstrates a seated physio session that you can do safely at home as well as a standing physio session.