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Medical professionals used to recommend that people living with ALS (also known as Lou Gehrig’s disease) avoid exercise. Today, however, there is a general consensus among many ALS professionals that moderate to low intensity exercise can be beneficial.
Moderate exercise can help people living with ALS maintain strength and flexibility, which can help extend independence. It can also help with circulation and other known benefits of exercise such as improved mood, mental health, and sleep. |
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Research on exercise and ALS is limited and still not conclusive, but studies and clinical observations suggest that the benefits outweigh the risks as long as exercise plans are supervised and adhere to general guidelines. Potential risks of exercising with ALS include overexertion, fatigue, falls, and weight loss.
Always consult with your medical team
The information on this page is educational and should not be used as medical advice. Before exercising, consult with your ALS clinic or medical team to determine what is safe and appropriate for you.
General Guidelines for Exercise and ALS
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When you’ve been diagnosed with ALS, you may need to approach exercise differently. The goal is not to build muscle and get stronger—the goal is to maintain your current levels of strength, fitness, and flexibility as much as possible. We don’t want you to lose any strength from not using your muscles.
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It is important to listen to your body and not push yourself too hard. An experienced physical therapist (PT) can help guide you, customize your exercise plan, and make modifications along the way. Here are some general guidelines for exercising when living with ALS:
- Assess Your Situation. Everyone is different. There is no one-size-fits-all exercise program for people living with ALS. There are a variety of factors that will affect how you approach exercise, including your current symptoms, level of fitness, prior exercise activities, daily routines, life obligations, respiratory status, and nutritional status. Early on, your exercise may be more active. Later, it may look more like stretching, range of motion exercises, and daily activities around the home.
- Stay Safe. When considering exercise, safety must always come first. It is important to avoid activities and situations that could result in falls and injuries. For example, if you can walk but have challenges with balance and strength, it is probably best to avoid treadmills and uneven surfaces. If you are unsteady riding a bike, you’re probably better off riding a recumbent stationary bike.
- Don’t Overexert Yourself. You should not exercise to the point where you feel fatigue, pain, or discomfort. Though there is no conclusive clinical evidence that overexerting your muscles can accelerate muscle deterioration, there is some anecdotal evidence that it could. Regardless, exercising so hard that your muscles become sore and fatigued could set you back a few days and prevent you from doing everyday activities until your muscles recover. It may also increase your risk for falls and injury. The goal is to have a quick recovery after any activity or exercise program.
- Modify and Adjust. ALS is a progressive disease, so your muscles will weaken over time. Try to be aware of changes such as decreased strength that may signal the need to modify your exercise routine. Keep in mind that there may also be day-to-day variations in your strength and energy levels. Work with your PT to adjust your exercise plan as needed.
Energy Conservation
When living with ALS, everyday activities can use a lot of energy. Modifying the way you do things and using assistive devices can help you conserve energy for the activities that are most important to you. Learn more
Types of Exercise
Walking, biking, lifting weights, range of motion exercises, and activities around the home can all be forms of exercise. When living with ALS, exercise is about feeling good, maintaining independence, and getting the benefits without pushing yourself too hard.
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Resistance Exercises
The “no pain, no gain” approach to lifting weights and breaking down muscle to build them up stronger is not appropriate for people living with ALS. Instead, the goal is to maintain your strength and find a happy medium where you can do resistance exercises—if appropriate—without getting overly fatigued. This may be done using bands, body weight, and possibly light weights. Instead of trying to lift the heaviest weight possible, it is better to do more repetitions with less weight and focus on stronger muscles that haven’t been impacted by the disease or muscles that have been minimally impacted and still have pretty good strength. It is also important to focus on having proper form with all exercises to minimize the risk of injury. |
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Aerobic Exercise
Activities like walking, biking, swimming, and aquatic therapy can be good for your respiratory system and circulation and provide other health benefits. If you experience shortness of breath in your daily life activities, you should be cautious about adding any aerobic activities and should probably avoid strenuous cardio exercise. You do not want to overly stress your breathing muscles.
Activities like walking, biking, swimming, and aquatic therapy can be good for your respiratory system and circulation and provide other health benefits. If you experience shortness of breath in your daily life activities, you should be cautious about adding any aerobic activities and should probably avoid strenuous cardio exercise. You do not want to overly stress your breathing muscles.
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Range of Motion Exercises and Stretching
You can reduce joint stiffness and maintain greater flexibility by stretching and performing regular range of motion (ROM) exercises. Stretching involves bringing your muscles to their end range and holding the stretch to hopefully increase muscle length. ROM exercises are slow movements where you move a joint through its available range of motion but don't necessarily hold it at the end range. You repeat the motion a few times to help keep the joint loose. Common areas that need focused stretching include calves, hamstrings, and hip flexors. While all joints benefit from regular ROM exercises, areas that tend to get tight for people living with ALS include ankles, knees, hips, and shoulders. Stretching and range of motion exercises can be done independently or with assistance. |
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Balance Exercises
If you develop leg, trunk, or arm weakness, this can impact your balance and increase your risk for falls. While assistive devices may be necessary to maintain safety, physical therapists can also work with you on your balance and your balance strategies. This can include both seated and standing exercises to help you develop strategies to decrease your risk for falls. It is often best to do these exercises under the supervision of a physical therapist.
If you develop leg, trunk, or arm weakness, this can impact your balance and increase your risk for falls. While assistive devices may be necessary to maintain safety, physical therapists can also work with you on your balance and your balance strategies. This can include both seated and standing exercises to help you develop strategies to decrease your risk for falls. It is often best to do these exercises under the supervision of a physical therapist.
Finding A Physical Therapist
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If you are interested in exercising, the best place to start is with a physical therapist who specializes in ALS, such as the PT at your ALS clinic. If you do not attend an ALS clinic, you can ask your medical team or local ALS organization for recommendations.
If you cannot find a physical therapist with ALS experience, try searching for a neurologic (or neuro) PT who specializes in neurological conditions. If that is not possible, search for an experienced physical therapist who is willing to learn about ALS and develop a customized program that meets your needs. The PT at your ALS clinic may not have enough time during your visit to develop a full exercise program. If this is the case, he or she may offer general guidance and refer you to a PT at either a local outpatient clinic or a local home care agency. |
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If you are unable to leave your home independently, you might qualify for home care. It is important to note that you cannot be active with outpatient therapy and home care at the same time.
Both outpatient and home health physical therapy services should be covered by insurance, though there may be an out-of-pocket payment. If cost is a concern, you can ask your PT to create an exercise routine, teach you correct form, and monitor you for a few sessions. Then, you can continue your routine on your own at home or at a gym and then schedule appointments whenever you have a concern or need to adjust your routine.
When doing your exercises, remember to listen to your body. Start slow, focus on correct form, and see how it feels before increasing intensity, reps, and duration. Stop if you feel pain, discomfort, or fatigue. If you experience any concerning symptoms related to exercise, pause your routine and contact your medical team.
Both outpatient and home health physical therapy services should be covered by insurance, though there may be an out-of-pocket payment. If cost is a concern, you can ask your PT to create an exercise routine, teach you correct form, and monitor you for a few sessions. Then, you can continue your routine on your own at home or at a gym and then schedule appointments whenever you have a concern or need to adjust your routine.
When doing your exercises, remember to listen to your body. Start slow, focus on correct form, and see how it feels before increasing intensity, reps, and duration. Stop if you feel pain, discomfort, or fatigue. If you experience any concerning symptoms related to exercise, pause your routine and contact your medical team.
Working with Your Physical Therapist
If your physical therapist doesn’t specialize in ALS, you can help educate him or her about the disease, your symptoms, and your needs and preferences. Be sure to share any respiratory or nutritional challenges you may be experiencing. If you are struggling to maintain your current weight, for example, you will want to avoid burning too many calories through exercise.
It is important to communicate any concerns that arise. If you do not feel that the PT is listening to you, is pushing you too hard, or is not sensitive to your needs, you may want to look for another physical therapist.
We have developed the following two-sided downloadable PDF that you can email or hand to your physical therapist. It provides an overview of ALS and general guidelines for ALS physical therapy.
It is important to communicate any concerns that arise. If you do not feel that the PT is listening to you, is pushing you too hard, or is not sensitive to your needs, you may want to look for another physical therapist.
We have developed the following two-sided downloadable PDF that you can email or hand to your physical therapist. It provides an overview of ALS and general guidelines for ALS physical therapy.
We developed this page in collaboration with physical therapists Claire MacAdam, PT, NCS, Katey Burke, PT, DPT, NCS, and Amy Swartz Ellrodt, PT, DPT from the Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital and Sara Feldman, PT, DPT from the MDA/ALS Center of Hope at Temple University.
