Duchenne muscular dystrophy causes progressive muscle degeneration and weakness, but physical exercise should still be part of a comprehensive treatment strategy.
Duchenne muscular dystrophy (DMD) is a genetic neuromuscular disease caused by a mutation in the DMD gene. Your DMD gene provides the instructions for making dystrophin, a protein essential to the strength and function of muscle fibers. In DMD, lack of dystrophin leads to progressive muscle degeneration and weakness which causes significant mobility challenges early in life.
Even though DMD can affect your mobility, regular exercise should still be part of your overall treatment plan. What exercises you can do and at what intensity will depend on your DMD diagnosis.
In 2018, a consensus committee released guidelines for the management of DMD. These are the most recent guidelines we have. In addition to assessing function, strength, and movement every 6 months, the paper’s rehabilitation recommendations focus on preventing overexertion, conserving energy, practicing fall prevention, and engaging in ability-appropriate exercise.
The consensus committee recommended regular, low intensity aerobic activities like swimming or cycling, with assistance if needed. Aerobic exercise helps your body maintain its overall fitness and plays an important role in maintaining cardiac and respiratory health.
High intensity and high resistance exercise was not recommended in the report, and clinicians were advised to actively monitor people during activity for overexertion and reduced cardiovascular capacity due to advanced DMD.
The DMD exercise guidelines also emphasized structured stretching and bracing to prevent contractures, a condition where muscles and connective tissues permanently shorten over a joint. Contractures in DMD can cause joint stiffness and structural changes over time.
DMD is a condition that can affect each person uniquely. When your neuromuscular specialist creates a personalized exercise program for you, they’ll start by assessing your baseline mobility, strength, and flexibility.
Not every exercise is appropriate for every person with DMD, and precautions should be taken when working out.
As a condition that affects the integrity of your muscle fibers, most exercise precautions in DMD focus on preventing overexertion or injury that compounds damage to your muscles and puts strain on your heart and lungs in the later stages of DMD.
“There still needs to be more research on exercise for muscular dystrophy,” explains Bryan Hathaway, a physical therapist certified in mechanical diagnosis and therapy and owner of Peak Performance Physical Therapy, Owego, New York. “The one thing we do know is that movement is medicine. Most of the data points to mild to moderate exercise, avoiding heavy resistance, plyometric, eccentric training, as well as sustained end-range stretching. It is a fine line encouraging function, maintaining strength or some improvement, without the breakdown of muscle tissue.”
General precautions you can take when exercising in DMD include:
- taking frequent breaks
- paying attention to signs of overexertion like trouble breathing, chest pain, or prolonged soreness
- avoiding high resistance or prolonged, high intensity exercises that could cause muscle damage
- prioritizing low impact activities and stretching exercises
- using assistive devices, like orthotics or braces, when needed
- avoiding movements or surfaces that increase your fall risk
- staying hydrated
- avoiding exercising in extreme temperatures
- following your exercise program as instructed
No one-size-fits-all exercise works for everyone with DMD. In fact, a systematic review and meta-analysis from 2021 was inconclusive in its findings on the most effective exercise training intervention for this condition.
The consensus committee specifically names swimming and cycling as examples of acceptable low impact exercises, but those activities can vary based on your individual needs, and there are many other low impact exercises that might make sense for you as well.
Hathaway says swimming, cycling, walking, and range-of-motion exercises are a good starting point for DMD patients.
Water exercises are often
“The challenge is that even though patients may have the same diagnosis, how they respond to exercise stresses can be different,” he cautions. “It is important for the patient and physical therapist to assess the aftereffects of exercise on the patient’s energy level and/or sustained soreness following.”
Exercise is good for your overall health and your muscles when you live with a neuromuscular condition like DMD. Hathaway notes that doctors recommend exercise in DMD for three reasons:
- to enhance the quality of life by functional strength gains and maintaining range of motion
- to optimize function for all systems, not just the musculoskeletal system
- to help preserve muscle function and delay complications associated with muscle weakness
“We can find some discrepancies on the ‘how’ to exercise, but most will agree that exercise in some fashion is vital for maintaining optimal function with the progression of the disease process,” he states, adding, “Movement is medicine.”
DMD is a severe genetic disorder that causes muscle degeneration and weakness. Many people with this condition find their mobility declines significantly at an early age.
Despite how DMD can negatively impact your function, exercise is a part of a comprehensive treatment plan. Low- to moderate-intensity aerobic workouts — depending on your ability level — support the health of your heart, lungs, and muscles in DMD.
While there’s no single exercise appropriate for all people with DMD, your neuromuscular specialist will work with you to develop a plan that’s right for you.