Exercise and Activity Training
for Patients with CMT:
Application of the “Exercise is Medicine” Model
1- 855 - HELPCMT
www.hnf-cure.org
Robert D. Chetlin, PhD, CSCS, CHFS; West Virginia University School of Medicine
Morgantown, WV; [email protected]
In 2010, the American College of Sports Medicine hosted the First World Congress for the “Exercise
Is Medicine” (EIM) initiative in Baltimore, Maryland. The EIM enterprise is dedicated to improving health, wellness, and quality-of-life through regular physical activity and healthy behaviors.
Together with the recommendations provided by the Physical Activity Guidelines for Americans,
published by the US Department of Health and Human Services, EIM actively promotes the scientifically-based physical activity guidelines to facilitate the important health benefits of exercise
and activity for all Americans, including persons with chronic disabilities. The clinical aim of EIM
is to incorporate activity assessment and exercise prescription, when appropriate, as standard
clinical operating procedure in the prevention and treatment of disease. The described objectives, undoubtedly, are inclusive of patients with Charcot-Marie-Tooth (CMT) Disease.
There exists an ever-increasing body of clinical and
scientific information that exercise and activity, where
not contraindicated, is safe and effective for children
and adults with chronic disease, such as CMT. In fact,
organizations such as the American Medical Association, the American College of Sports Medicine,
the United States Department of Health and Human
Services, and the Office of the United States Surgeon
General, all agree that children and adults with chronic disease and disability, whom are capable, should
engage in regular forms of activity and exercise.
Following are some frequently-asked-questions (FAQs)
about physical exercise/activity for patients with CMT:
1. Who should exercise?
●::Children and adults, whom are able to, should
participate in regular physical activity and exercise.
2.How much exercise/activity and what
types of exercise/activity?
a.Children with CMT should participate in aerobic,
muscle-strengthening, bone-strengthening, and
balance exercises and activities.
:● :Collectively, this should amount to about one
hour of exercise/activity per day. This should in-
clude at least three days of moderately-vigorous
variable activity that is fun, age-appropriate,
and not contraindicated for the individual child’s
medical circumstances.
:● :Since CMT is both a motor and sensory neuropathy, it is important to recognize the individual limitations in order to minimize exposure to injury. In most
cases, motor control and sensory awareness of the
ankle and foot are impaired. Under these circumstances, activities involving running and jumping
– or other activities where the feet intermittently or
continuously leave the ground – may not be safe.
:● :Alternative exercises and activities should be
considered, for example:
i.bicycle riding (particularly tandem riding, with
the child at the front of the bike and parent/
adult at the back of the bike)
ii. games of catching and throwing
iii.swimming
iv.resistance exercises (using the child’s own
body weight, exercise bands, machines, and
hand-held weights;
v.“exer-games” (video exercise/activity games
on Wii, Playstation, or Xbox), and
vi.certain martial arts (like tai chi)
●
::Additionally, children with CMT should be encouraged – as all children should – to participate in
appropriate forms of play. If children have been
prescribed orthopedic braces, these should be
worn during exercise and activity where possible.
b.Adults with CMT should also participate in various
forms of aerobic, muscle-strengthening, bone
strengthening, and appropriate balance training.
● ::Ideally, it is recommended that adults with CMT
should perform about 150 minutes of total aerobic exercise and activity per week. Such activity
should be performed in moderate to moderately
vigorous bouts of at least 10 minutes duration,
spread throughout the week.
● ::Muscle and bone-strengthening exercises/activities – especially those involving simultaneous use
of all major muscle groups – should be done at
least two days per week. In cases where significant motor and sensory impairment of the ankle
and foot are present, exercises and activities
where the feet leave the ground, either intermittently or continuously, should not be performed.
● ::Some examples of less impactful exercise/activities include:
i.riding or rowing exercise (stationary bike,
tandem bike, recumbent bike, elliptical machines, rowing machines)
ii. swimming
iii.water aerobics
iv.vigorous gardening (with components like digging and lifting)
v.household chores (for example, sweeping,
laundry, and putting groceries away)
vi.resistance exercises (with bands, machines,
dumbbells, and/or bodyweight resistance)
vii. yoga, and
viii. tai chi
● ::Though 150 minutes of total weekly exercise/activity is recommended, adult CMT patients should
avoid inactivity; therefore, some physical activity
is always better than none. Prescribed orthopedic braces should be worn during exercise and
activity where possible.
3.Why are exercise and activity important
and what are the potential benefits of a
reasonably active lifestyle for CMT patients?
●
●
::For children with CMT, regular activity, including
play, contributes to normal, healthy physical and
psychosocial development. Certain clinical evidence indicates that early intervention may attenuate the disease process, possibly contributing to higher levels of function and quality-of-life
into adulthood. Additionally, children who adopt
an active lifestyle are less likely to be exposed
to the eventual dangers of inactivity, including
obesity, heart disease, and type-2 diabetes.
::For adults with CMT, regular exercise and activity, may improve, or at least maintain, functional
ability, independence, and higher quality-of-life.
Like all older adults, an active lifestyle helps to
maintain muscle mass and bone health, as well
as reducing incidence of falling and avoiding
diseases associated with inactivity.
4.Who else should be involved in the process of exercise and activity participation?
●
●
::●In all cases, health-care providers and appropriately-trained and credentialed exercise professionals should be consulted regarding individualized exercise and activity prescription for CMT
patients, including assessment, evaluation, and
program formulation/implementation.
::With regard to children with CMT, teachers and
administrators within the educational system,
should make reasonable accommodations to
promote the described benefits of regular exercise and activity participation. Parents should insist that school systems adhere to the Americans
With Disabilities Act and provide CMT children
with the opportunity to engage in the process of
normal, healthy development.
The EIM model has been endorsed by multiple, worldwide medical and healthcare agencies. Many of the
tenets of this movement should be applied to patients
with CMT. For more information, please visit the EIM
website: www.ExerciseIsMedicine.org.
This publication was supported by Cooperative Agreement 1U38DD000713-01 from the Centers for Disease Control and
Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the
Centers for Disease Control and Prevention.