Exercise is an important component of care for children and adults with Duchenne muscular dystrophy (DMD) . The many benefits include minimizing the progressive loss of muscle strength and maintaining flexibility and mobility. Physical activity can also improve self-esteem and coping mechanisms, help you get better sleep, and reduce pain.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c6a911ad-1fc7-44cb-b058-98c3fa49468f But exercise needs to be individualized. Not all types are appropriate for everyone with DMD, and some can even be harmful. In healthy muscles, exercise causes microscopic tears in muscle fibers, which results in a “repair and growth” process that strengthens the muscles.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290a1179d4-515a-452e-a8fc-cfc14a12fabb This process doesn’t happen correctly when you have DMD, so you have to take care not to damage your muscles when you exercise.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295d834c22-85ad-41a4-ac0a-84d61b767074 Exercise for DMD commonly takes the form of physical therapy. Treatment guidelines also recommend regular, low-intensity aerobic activities like swimming and cycling, while recommending against high-intensity and high-resistance exercise.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e90ec871-05f9-4a52-a356-0db2868845f6 “Exercise with DMD is about preserving mobility, reducing stiffness, and supporting overall well-being, not building strength through overload,” says Matthew Cifelli, DPT , founder of Attain Physical Therapy with locations in New Jersey and Florida. “Parents are often understandably worried about how active their child can safely play,” says Cifelli. “The key message is that movement is important, but it must be gentle, paced, and non-damaging to tissue. The goal is to keep kids moving in ways that support mobility, joint health, and emotional well-being, without accelerating muscle damage.” There’s no one-size-fits-all approach to exercise when you have DMD. It’s important to speak with your doctor or a physical therapist before beginning an exercise program, so that they can help you create a personalized plan that balances healthy activity against the risk of damage.
How to Select and Start a Routine Getting Started Exercise with DMD needs to be personalized to fit you or your child’s abilities and interests. “People with more fatigue or contractures may need shorter, more frequent sessions,” says Cifelli. “Those with better mobility may tolerate slightly longer bouts of low-impact activity.” He points out that energy levels can fluctuate day to day, so it’s important to build in flexibility. As much as possible, movement should be incorporated into daily activity, and you should pick things you and your child have fun doing. “Some kids thrive socially, while others prefer quiet, predictable environments,” Cifelli says. “The best routine is one the child enjoys and can sustain without strain.” Speak with your healthcare provider or physical therapist before beginning an exercise program. Physical therapy is an essential component of DMD care, but it requires specific knowledge of the disorder in order to provide appropriate treatment. A qualified physical therapist can do an evaluation and then create a plan with exercises that are suitable for your stage of disease progression.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b1ac746b-414f-48e2-b1b4-f3f73f451547e60dc2a1-f33c-4a05-9b50-8e3e8e5976295e4df43f-57c9-42ed-950c-39ee4c481df6
Types of Exercise and Movement for Duchenne Muscular Dystrophy Types The types of exercise recommended for DMD provide maximum benefits with a low risk of damage to muscles. Stretching “In the early stages of a DMD diagnosis, the most important form of exercise is stretching, including lengthening of the posterior muscle chain, such as hamstrings, calves, glutes, and back mobility, as these are the primary muscle groups that become tight,” says Clarissa Aguirre, DPT , a board-certified pediatric physical therapist at Village Pediatric Therapy in Yorba Linda, California. When done as a regular practice, stretching will help your muscles stay flexible and help prevent your joints from becoming locked in one position (contractures). A stretching routine should begin at a young age and be done at least four to six times a week.e60dc2a1-f33c-4a05-9b50-8e3e8e59762909e9c621-ba89-49df-a4ae-d7b21ddbb2c7 Strengthening While people with DMD should not be lifting heavy weights, muscles can be maintained and strengthened with gentler activities. Stronger muscles improve movement, posture, and balance.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c3e3fd9b-9207-4896-93b8-2094589ee06c “It is important for patients with DMD to avoid high-resistance and eccentric strengthening [muscle contractions where muscles lengthen under tension], in addition to overexertion without sufficient rest breaks,” says Aguirre. Good options include using lighter weights and resistance bands, and doing exercises like yoga or tai chi. Aim for two or three times a week. Aerobic Exercise This is exercise that speeds up your heart rate and makes you breathe harder. It improves your heart and lung function and helps you maintain a healthy weight. But you need to stick to low-impact or non–weight bearing activities.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c3e3fd9b-9207-4896-93b8-2094589ee06c “Exercises that minimize stress on deteriorating muscles, such as swimming or pool therapy, are recommended,” says Andrew Gorecki, DPT , owner of Superior Physical Therapy and MovementRx in Traverse City, Michigan. Walking, cycling, and even dancing can also be done safely. Try to do about 30 minutes a day, at least five days a week, broken up in shorter chunks if that’s easier for you. Balance Balance is important for maintaining independent mobility and quality of life. Exercises like yoga, martial arts, and fitness-focused virtual reality or video games can improve your balance to prevent falls, as well as make sitting and standing easier. Incorporate balance training into your workouts three or four times a week.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e08efd51-0af1-4f46-878b-e9244ff68eca Standing If you or your child uses a wheelchair, spending some time every day in a standing position can reduce or even prevent some of the complications that can happen when you’re no longer able to walk. Standing helps make it easier to stretch your legs, protects your bone health, and helps your digestion. Some insurance plans cover a supported standing device, like a standing wheelchair.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e08efd51-0af1-4f46-878b-e9244ff68ecae60dc2a1-f33c-4a05-9b50-8e3e8e5976292297146f-ac64-4ecc-bdcf-bd6043eb6fa8
The Takeaway Exercise and physical activity are an essential component of care in DMD, to maintain mobility, strengthen muscles, and enhance overall quality of life. Safe exercise with DMD should focus on low-intensity aerobic activity, gentle stretching, and muscle strengthening. Exercise with DMD is not “one size fits all,” and an individualized approach must be taken according to your age, muscle function, and preferences. Too much exercise can damage your muscles; it’s important to be aware of warning signs such as pain and cramping.
Resources We Trust Mayo Clinic: Muscular DystrophyCleveland Clinic: Duchenne Muscular Dystrophy (DMD)Muscular Dystrophy Association: Exercise Can Benefit Patients With Neuromuscular DiseaseUniversity of Minnesota: Exercise With Duchenne or Becker Muscular DystrophyParent Project Muscular Dystrophy: Care for Muscles
Modifications Modifications You can adapt just about any form of exercise to fit your abilities. If you have access to a pool, that can be especially helpful for working out with DMD. Buoyancy reduces stress on your muscles and joints as you get aerobic exercise, while the water provides mild resistance for strength training.e60dc2a1-f33c-4a05-9b50-8e3e8e597629faa736b3-9bca-4246-9579-1924969360d9 Beyond swimming, you can walk laps, do calf and hamstring stretches while sitting on the pool stairs, and make “snow angels” while you float on your back to work the full range of motion in your shoulders and hips. Stretch your lung capacity by blowing bubbles underwater. “Modifications are essential to keep exercise safe and accessible,” says Cifelli. “Avoid high-load movement patterns that require significant trunk or hip control. Use chairs or bolsters for seated or supported stretching and break up activities into short intervals to help prevent fatigue.” Just about any physical activity you can do standing you can also do sitting — and still get the benefits — including:e60dc2a1-f33c-4a05-9b50-8e3e8e59762914e94a70-89d8-4e10-b04b-5029c401611b Yoga Zumba Aerobics Resistance or weight training Wheelchair sports have become increasingly popular, and there are many to choose from, depending on your individual preference and ability. Popular types include wheelchair basketball, tennis, rugby, racing, fencing, and powerchair soccer. These sports provide aerobic benefits, and depending on the sport, strength training for the upper body.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294b41c73a-1209-41eb-83a6-39e14e196c9b
When to Push, When to Stop Limits While a regular exercise routine benefits both your physical and emotional health, you need to pay attention to signs you’re damaging your muscles. Pain, cramping, and weakness are signs to stop exercising immediately.e60dc2a1-f33c-4a05-9b50-8e3e8e5976299f0b3b00-699a-428b-9176-1655a164f23c “It’s okay to experience a mild sense of effort or a gentle stretch sensation,” says Cifelli. “Slight fatigue that resolves quickly with rest is what you should be looking for. Fatigue should never accumulate, and if you or your child looks or feels worse as the session goes on, it’s time to stop.” Other “red flag” signs that you have overdone your exercise are:e60dc2a1-f33c-4a05-9b50-8e3e8e59762977b3bfe4-9d09-4b6a-a038-b040a93b7da5 Dark or red urine (sign of an iron-containing protein from the breakdown of muscle cells) Trouble sleeping Shortness of breath that continues longer than a few minutes after stopping the exercise Fast heartbeat that lingers after your workout “Intensity needs to be adjusted if you feel fatigued beyond 24 hours following a workout that leaves you sore the next day,” says Gorecki. “You may need adjustments in accommodations, which can come with the progression of the condition.”
How to Select and Start a Routine Getting Started Exercise with DMD needs to be personalized to fit you or your child’s abilities and interests. “People with more fatigue or contractures may need shorter, more frequent sessions,” says Cifelli. “Those with better mobility may tolerate slightly longer bouts of low-impact activity.” He points out that energy levels can fluctuate day to day, so it’s important to build in flexibility. As much as possible, movement should be incorporated into daily activity, and you should pick things you and your child have fun doing. “Some kids thrive socially, while others prefer quiet, predictable environments,” Cifelli says. “The best routine is one the child enjoys and can sustain without strain.” Speak with your healthcare provider or physical therapist before beginning an exercise program. Physical therapy is an essential component of DMD care, but it requires specific knowledge of the disorder in order to provide appropriate treatment. A qualified physical therapist can do an evaluation and then create a plan with exercises that are suitable for your stage of disease progression.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b1ac746b-414f-48e2-b1b4-f3f73f451547e60dc2a1-f33c-4a05-9b50-8e3e8e5976295e4df43f-57c9-42ed-950c-39ee4c481df6
Types of Exercise and Movement for Duchenne Muscular Dystrophy Types The types of exercise recommended for DMD provide maximum benefits with a low risk of damage to muscles. Stretching “In the early stages of a DMD diagnosis, the most important form of exercise is stretching, including lengthening of the posterior muscle chain, such as hamstrings, calves, glutes, and back mobility, as these are the primary muscle groups that become tight,” says Clarissa Aguirre, DPT , a board-certified pediatric physical therapist at Village Pediatric Therapy in Yorba Linda, California. When done as a regular practice, stretching will help your muscles stay flexible and help prevent your joints from becoming locked in one position (contractures). A stretching routine should begin at a young age and be done at least four to six times a week.e60dc2a1-f33c-4a05-9b50-8e3e8e59762909e9c621-ba89-49df-a4ae-d7b21ddbb2c7 Strengthening While people with DMD should not be lifting heavy weights, muscles can be maintained and strengthened with gentler activities. Stronger muscles improve movement, posture, and balance.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c3e3fd9b-9207-4896-93b8-2094589ee06c “It is important for patients with DMD to avoid high-resistance and eccentric strengthening [muscle contractions where muscles lengthen under tension], in addition to overexertion without sufficient rest breaks,” says Aguirre. Good options include using lighter weights and resistance bands, and doing exercises like yoga or tai chi. Aim for two or three times a week. Aerobic Exercise This is exercise that speeds up your heart rate and makes you breathe harder. It improves your heart and lung function and helps you maintain a healthy weight. But you need to stick to low-impact or non–weight bearing activities.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c3e3fd9b-9207-4896-93b8-2094589ee06c “Exercises that minimize stress on deteriorating muscles, such as swimming or pool therapy, are recommended,” says Andrew Gorecki, DPT , owner of Superior Physical Therapy and MovementRx in Traverse City, Michigan. Walking, cycling, and even dancing can also be done safely. Try to do about 30 minutes a day, at least five days a week, broken up in shorter chunks if that’s easier for you. Balance Balance is important for maintaining independent mobility and quality of life. Exercises like yoga, martial arts, and fitness-focused virtual reality or video games can improve your balance to prevent falls, as well as make sitting and standing easier. Incorporate balance training into your workouts three or four times a week.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e08efd51-0af1-4f46-878b-e9244ff68eca Standing If you or your child uses a wheelchair, spending some time every day in a standing position can reduce or even prevent some of the complications that can happen when you’re no longer able to walk. Standing helps make it easier to stretch your legs, protects your bone health, and helps your digestion. Some insurance plans cover a supported standing device, like a standing wheelchair.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e08efd51-0af1-4f46-878b-e9244ff68ecae60dc2a1-f33c-4a05-9b50-8e3e8e5976292297146f-ac64-4ecc-bdcf-bd6043eb6fa8
The Takeaway Exercise and physical activity are an essential component of care in DMD, to maintain mobility, strengthen muscles, and enhance overall quality of life. Safe exercise with DMD should focus on low-intensity aerobic activity, gentle stretching, and muscle strengthening. Exercise with DMD is not “one size fits all,” and an individualized approach must be taken according to your age, muscle function, and preferences. Too much exercise can damage your muscles; it’s important to be aware of warning signs such as pain and cramping.
Resources We Trust Mayo Clinic: Muscular DystrophyCleveland Clinic: Duchenne Muscular Dystrophy (DMD)Muscular Dystrophy Association: Exercise Can Benefit Patients With Neuromuscular DiseaseUniversity of Minnesota: Exercise With Duchenne or Becker Muscular DystrophyParent Project Muscular Dystrophy: Care for Muscles
Modifications Modifications You can adapt just about any form of exercise to fit your abilities. If you have access to a pool, that can be especially helpful for working out with DMD. Buoyancy reduces stress on your muscles and joints as you get aerobic exercise, while the water provides mild resistance for strength training.e60dc2a1-f33c-4a05-9b50-8e3e8e597629faa736b3-9bca-4246-9579-1924969360d9 Beyond swimming, you can walk laps, do calf and hamstring stretches while sitting on the pool stairs, and make “snow angels” while you float on your back to work the full range of motion in your shoulders and hips. Stretch your lung capacity by blowing bubbles underwater. “Modifications are essential to keep exercise safe and accessible,” says Cifelli. “Avoid high-load movement patterns that require significant trunk or hip control. Use chairs or bolsters for seated or supported stretching and break up activities into short intervals to help prevent fatigue.” Just about any physical activity you can do standing you can also do sitting — and still get the benefits — including:e60dc2a1-f33c-4a05-9b50-8e3e8e59762914e94a70-89d8-4e10-b04b-5029c401611b Yoga Zumba Aerobics Resistance or weight training Wheelchair sports have become increasingly popular, and there are many to choose from, depending on your individual preference and ability. Popular types include wheelchair basketball, tennis, rugby, racing, fencing, and powerchair soccer. These sports provide aerobic benefits, and depending on the sport, strength training for the upper body.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294b41c73a-1209-41eb-83a6-39e14e196c9b
When to Push, When to Stop Limits While a regular exercise routine benefits both your physical and emotional health, you need to pay attention to signs you’re damaging your muscles. Pain, cramping, and weakness are signs to stop exercising immediately.e60dc2a1-f33c-4a05-9b50-8e3e8e5976299f0b3b00-699a-428b-9176-1655a164f23c “It’s okay to experience a mild sense of effort or a gentle stretch sensation,” says Cifelli. “Slight fatigue that resolves quickly with rest is what you should be looking for. Fatigue should never accumulate, and if you or your child looks or feels worse as the session goes on, it’s time to stop.” Other “red flag” signs that you have overdone your exercise are:e60dc2a1-f33c-4a05-9b50-8e3e8e59762977b3bfe4-9d09-4b6a-a038-b040a93b7da5 Dark or red urine (sign of an iron-containing protein from the breakdown of muscle cells) Trouble sleeping Shortness of breath that continues longer than a few minutes after stopping the exercise Fast heartbeat that lingers after your workout “Intensity needs to be adjusted if you feel fatigued beyond 24 hours following a workout that leaves you sore the next day,” says Gorecki. “You may need adjustments in accommodations, which can come with the progression of the condition.”
