8/4/2014
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Define and Understand Types of Exercise and
benefits of exercise
Discuss the impact of exercise on those with
BMD
Discuss some ideas and parameters for
exercise
Discuss consideration for equipment
Leslie Nelson, PT, MPT, OCS
Exercise is muscle exertion (use), requiring the
expenditure of energy.
 Three major categories:
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 Aerobic Training
▪ helps maintain overall fitness, especially cardiac and respiratory health
 Resistance Training
▪ If muscles are intact and functioning, then resistance, or strengthening,
exercise helps increase muscle mass and the force muscles can
generate.
▪ Note, some muscle diseases severely limit the ability of muscles to
increase mass or force because they limit the regenerative capacity of
muscle tissue.
 Flexibility Training
▪ ability of your joints to move through a full range of motion
I really don’t think I need buns
of steel. I’d be happy with buns
of cinnamon.
~ Ellen DeGeneres
▪ Benefits of exercise
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General fitness
Cardiac and Respiratory Health
Preservation of bone density
Mood elevation
Offset the intake of dietary calories and may help keep weight in
check
Physical fitness is not only one of the most important keys to a
healthy body, it is the basis of dynamic and creative intellectual
activity.
~ John Fitzgerald Kennedy
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Limited Scientific Evidence
 Researchers have reported that exercise training
improves the fitness and strength of people with
Becker muscular dystrophy
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Clinical Evidence
If it weren’t for the fact that the TV set and the refrigerator are so
far apart, some of us wouldn’t get any exercise at all.
~ Joey Adams
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8/4/2014
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Signs of muscle damage or impending
muscle damage are:
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 shortness of breath
 chest pain
 very elevated heart rate (150 to 160 beats per minute)
 cramping in muscles (probably related to
insufficient energy supply for muscles)
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 pain in muscles
 weakness of exercised muscles
 dark urine that looks like cola, following exercise.
Seek medical care immediately if this occurs.
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Low-impact forms of aerobic exercise are best
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can talk while doing it. If you can’t talk, you’re doing something
too fast or for too long.
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How long should I exercise?
 20 min, four to six times a week. (20-40 min is
optimal)
▪ The American College of Sports Medicine, ACSM,
▪ If you have low endurance, start with five-minute
sessions or break up your workouts into several shorter
sessions spread throughout the day.
How hard should I exercise?
 Submaximal aerobic exercise
▪ maintains the heart rate at about 65 percent of its maximum.
▪ Maximum heart rate = (220 –AGE) x .65
▪ For example, the submaximal heart rate for a person who is 30 years
old is: 220 - 30 = 190; 190 x 0.65 = approximately 123 beats per minute.
 Another way of assessing aerobic exercise is to see whether you
with even moderate exercise
weakness
nausea
sweating
a gurgling sound in the chest with breathing
*Seek medical care immediately if these symptoms occur.
 Walking
 Swimming
 Biking on a flat surface.
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Signs of cardiac stress are*:
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The goal of aerobic training should be to
maintain and increase aerobic capacity and
decrease cardiac risk factors
Those who think they have not time for bodily exercise will sooner or later have to find time
for illness.
~Edward Stanley
How much and what type of resistance should I
use?
 Body weight resistance
 Weight lifting machines, Resistance bands,
dumbbells/free weights
 Based on recommended 1 rep max (1RM)
 Generally low resistance, higher repetitions
▪ start at a low (≈ 50%) percentage of individual 1RM
▪ Work with a weight or a position that you can perform
15 times without compensation
▪ At the end of that 15 reps you should report a RPE of
7-8
▪ RPE = rating of perceived exertion
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If you can perform 20-25 reps, pick a heavier
weight or more challenging position
 Full body push ups, bridges with arms crossed,
less slack in resistance band or higher resistance
band typically green or blue
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If you can only perform 8-10 times, pick a
lighter weight
 wall push ups, bridges with arms at sides for
stabilization, allow more slack in band or lighter
resistance band typically yellow or red
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How many repetitions should I do?
 Generally low resistance, higher repetitions
 15 repetitions, repeat 3 times (3 sets)
▪ If your second and third sets you are unable to perform 15
repetitions, pick a lighter weight!
 Gradually increase the amount of resistance or difficulty as
tolerated over a period of weeks to months.
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How many days a week should I do resistance
training?
 When creating a program, allow for at least 48 hours of
rest for a given muscle group
 Consider breaking your workouts up into lower extremity,
upper extremity, trunk/core
Physical fitness can neither be
achieved by wishful thinking nor
outright purchase.
~Joseph Pilates
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Is there anything I should avoid?
 Resistance or weight that you cannot lift without
compensation
 Eccentric strengthening
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Listen to your body!
 No Pain no Gain does NOT apply!
 decrease intensity if mild myalgias (muscle pains)
do not disappear after 36 to 48 hours or if muscles
cramp during an activity.
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Ask if you are not sure!
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Flexibility exercises should be performed
daily and held for about 20-30
seconds/stretch in order to increase range of
motion and prevent contractures
Consider longer duration positions/holds as
able
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 Long sitting
 Prone lying
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What do I do if I can’t lift a weight or an
extremity against gravity?
 goal should become to exercise through an
available range of motion
 Functional or activity-specific tasks can also be
included in a program (i.e., wheelchair propulsion)
to maintain and enhance proficiency in activities
of daily living.
▪ These activities should be performed daily as tolerated.
Lack of activity destroys the good
condition of every human being, while
movement and methodical physical
exercise save it and preserve it.
~ Plato
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Should I consider Orthoses (braces for the
feet)
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 Work situation
 Prevention of contractures also relies on resting
orthoses and joint positioning
 Resting ankle–foot orthoses (AFOs) used at night
can help to prevent or minimize progressive heel
cord contractures and are appropriate throughout
life
 AFOs should be fabricated for comfort and
optimum foot and ankle alignment.
Assess your needs
 Living situation
 Family situation/assistance
 Financial situation
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Discuss with your physician and medical team
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8/4/2014
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AFOs
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SMOs
 Hinged, Dorsiflexion Assist
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http://mdausa.org/
http://transitions.mda.org/
http://quest.mda.org/
http://www.accessmobilityequipment.com/
http://www.handiramp.com/
http://www.optp.com/
http://www.riseadaptivesports.org/wp/
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Leslie Nelson, PT
 [email protected]
Sveen ML, Jeppesen TD, Hauerslev S, Køber L, Krag TO, Vissing J. Endurance
training improves fitness and strength in patients with Becker muscular
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Simmonds, M. J., Ph.D., PT., MCSP., & Derghazarian, T. P. (2009). Muscular
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Grange, R.W., and Call J.A. Recommendations to define exercise prescription for
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McDonald CM: Physical activity, health impairments, and disability in
neuromuscular disease. Am J Phys Med Rehabil. 2002;81(Suppl):S108 –S120.
Jansen et al. Physical training in boys with Duchenne Muscular Dystrophy: the
protocol of the No Use is Disuse study. BMC Pediatrics. 2010;10:55.
Sveen ML, Andersen SP, Ingelsrud LH, etal. Resistance training in patients with
limb-girdle and becker muscular dystrophies. Muscle Nerve.2013;47:163–169.
Eagle M. Report on the Muscular Dystrophy Campaign workshop: Exercise in
neuromuscular diseases. Newcastle, January 2002. Neuromuscular Disorders
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