The purpose of exercise for people with ALS is

• to maintain or improve the flexibility of muscles not affected by ALS;
• to maintain the flexibility of muscles that have been affected;
• to maintain the flexibility of joints in the neck, trunk and limbs.

It is important to realize that exercise will not strengthen muscles that have been weakened by ALS. Once the supply of motor neurons that control a particular muscle has degenerated, it cannot be regenerated by exercise or anything else. The right exercise program can minimize joint and muscle stiffness.

Range-of-Motion (ROM) Exercises
A person with ALS needs to move each affected joint through a series of range-of-motion (ROM) exercises every day to prevent joint stiffening. Exercise will help to keep your body as flexible as possible and your joints mobile. ROM exercises are usually done systematically, meaning that the joints of one limb are exercised in a particular order before the next limb is exercised and so on.

Each person with ALS needs a program of exercise tailored to his or her individual needs and abilities. Your doctor and therapist can prescribe the exercises that are right for you at any given time. Your physiotherapist can demonstrate the exercises and ensure that you are performing them correctly.

Moderation in Exercise
It is important that all exercise be performed in moderation. Fatigue will only increase your weakness and rob you of energy that you need for your daily routines and the activities you enjoy. If you find that your prescribed set of exercises tires you, talk to your therapist. Changes can be made that will eliminate the risk of fatigue.

Similarly, none of your exercises should cause you pain. If you do experience pain when exercising, stop that exercise and talk to your therapist. It may be that you are not doing the exercise correctly, or perhaps some modification to your exercise program must be made.

Recreational Exercise
If you enjoy such activities as walking, stationary bicycling and especially swimming, keep them up for as long as you can do them safely. If you experience cramping or fatigue, do not continue the exercise until you have consulted your doctor or therapist.

Active, Active-Assisted and Passive Exercises
The objective of ROM exercises is to move each affected joint through its full range of motion every day. Not every person with ALS can do a full set of active exercises.

An active exercise is one you do yourself without any assistance, when your muscles can perform the full movement.

Muscles that are able to move a joint only partially need active-assisted exercise. A helper may assist the muscle through the movement, or you may be shown a way to do a self-assisted range of motion.

Passive exercises are done completely by a helper when muscles can no longer perform any of the movement. The helper moves the joints through their range of motion by manipulating your limb. Passive exercises work the joints but not the muscles. Your therapist can train your caregiver(s) to do these exercises properly.

The transition from active to passive exercise is seldom abrupt. You may find that you can do some exercises actively, some with assistance and still others only passively.

Some Exercising Tips
Exercises should be done daily and should become a routine. You may wish to break up your exercise routine into parts to avoid fatigue. If you experience fatigue, consult your therapist for a change in your program.

Do as many active exercises as you can. It may be necessary to switch to active-assisted or passive exercises later. Your therapist can help you to make decisions about the correct limits of your exercise.

Ask your therapist which exercises are the most important ones to do if you have a busy day ahead of you.

Some exercises can be done while you either sit or lie down. Passive exercises are usually performed while you lie down. Your therapist can advise you on which exercise positions are best for you.

Stop doing any exercise that hurts, and consult your therapist if this happens.