Spinal muscle atrophy (SMA) is a genetic disease characterized by the loss of motor neurons, or nerve cells controlling the movement of voluntary muscles, that leads to muscle weakness or atrophy. Activities dependent on muscles — from walking and sitting to eating and breathing — can be affected.
SMA patients need to work with a physical or occupational therapist to establish a safe exercise program to ensure maximum mobility and improved quality of life. For some patients, orthotic braces or other adaptive aids may be necessary for support during exercise or daily activities.
In general, a likely exercise program will involve stretching to improve mobility and range of motion, aerobic exercise to build lung capacity and strength, and resistance training to build muscle strength.
The type and intensity of the exercise program will be tailored to the patients’ ability.
It is important not to overexercise, as muscle damage caused by exercise can increase muscle weakness and atrophy. Muscles in people with SMA do not heal from injury easily.
Research into exercise and SMA
Research conducted in a mouse model of SMA reported that long-term exercise can protect motor neurons.
A study published in Muscle & Nerve examined the feasibility, safety, and effect on strength and motor function of a home-based and supervised program of progressive resistance strength training in children with SMA types 2 and 3. Nine children completed the exercise program, carried out three times a week for 12 weeks and conducted with a physiotherapist. The researchers observed trend towards improved strength and motor function at the study’s end.
Results showed that the exercise program increased maximal oxygen uptake by 27 percent, but many participants complained of fatigue. One patient dropped out, three patients reported a need to sleep more, and two patients required changes in their training program. Researchers concluded that cycle exercise “improves” maximal oxygen update in type 3 patients “without causing muscle damage, but it also induces significant fatigue.”
The benefits and safety of a physiotherapeutic approach, based on exercise training in a swimming pool, is now the focus of a pilot study (NCT02061189) in children with type 2 and 3 SMA. Ten of 30 patients are doing pool exercises for six months intended to improve motor skills, with remaining 20 serve as a non-exercise control group. Changes in both patient groups will be assessed using the motor function measure (MFM, a series of tasks that measure a patient’s ability to control movement) and the Hammersmith scale (which tests functional motor abilities in SMA), among other measurements.
This study, taking place in France, is expected to finish in March 2020.
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