About neuromuscular conditions
Neuromuscular conditions affect the muscles or the nerves that control them. They include Duchenne and Becker muscular dystrophy, facioscapulohumeral muscular dystrophy (FSHD), myotonic dystrophy, limb-girdle muscular dystrophy, spinal muscular atrophy, Charcot-Marie-Tooth disease and inflammatory myopathies. Most cause gradual weakness and many also affect the heart, breathing or joints.
Is exercise safe with muscular dystrophy?
For many years people with muscle disease were told to avoid exercise in case it damaged muscles. Research now paints a more balanced picture. A Cochrane review of strength and aerobic training across several muscle diseases found most trials reported no adverse events other than muscle soreness or joint complaints. Aerobic training showed promise for improving fitness in FSHD and combined training slightly improved strength and fitness in inflammatory myopathies. The overall evidence is still uncertain, so exercise must be carefully tailored.
In practice, the right program depends on the specific condition. For example, in Duchenne muscular dystrophy, high-resistance and heavy eccentric work (such as walking downhill or lowering heavy weights) are generally avoided, while gentle activity and swimming are encouraged.
How an exercise physiologist keeps exercise safe
- Reviewing heart and breathing involvement and getting medical clearance where needed
- Using submaximal effort: working well within limits rather than to fatigue
- Prioritising aerobic activity, gentle strengthening, balance and flexibility
- Monitoring warning signs such as muscle pain lasting more than 24 hours, unusual weakness after sessions or dark urine
- Using water-based exercise where it helps, since buoyancy supports weak muscles
- Adapting the program as function changes
The 24-hour rule: if you feel more weak or sore the day after exercise than before, the session was too hard. A good program leaves you feeling better, not wiped out.
What occupational therapy does
- Energy conservation: planning the day and simplifying tasks so energy goes to what you value most
- Equipment: mobility aids, wheelchairs, seating, arm supports and daily living aids
- Home modifications: step-free access, bathroom changes, rails and bed setup
- School, work and study: adjustments to workstations, desks and routines
- Hand function: splints and adaptive tools for writing, devices and self-care
- Driving: referral to an accredited OT driving assessor when driving safety or vehicle modifications need checking
Working together: EP
- Maintains strength, fitness and joint range
- Tracks changes in function session to session
- Keeps exercise within safe limits
Working together: OT
- Uses those changes to time equipment and home updates
- Reduces daily energy demands so there is energy left for exercise
- Makes sure the home supports safe movement
Example: A 28-year-old with FSHD is finding it harder to lift her arms to wash her hair and is tired by mid-afternoon. The EP starts a supervised cycling program and gentle shoulder-blade strengthening, keeping effort moderate. The OT recommends a handheld shower, a shower stool and a long-handled brush and restructures her work day with the employer. Within two months she reports more energy left for the gym and social activities.
Exercise that protects your muscles
Exercare comes to you across Melbourne: exercise physiology in the south-east and east and occupational therapy in the north-east, east and inner suburbs. One NDIS intake form covers both services.
NDIS funding
Most people with a progressive neuromuscular condition meet NDIS eligibility if they apply before 65. Both are usually funded from your Capacity Building budget, most often under Improved Daily Living Skills (Category 15). Exercise physiology can also be funded under Improved Health and Wellbeing (Category 12). Equipment and home modification recommendations from your OT are funded from your Capital budget. Exercare's exercise physiologist also offers hydrotherapy, which suits many people with neuromuscular weakness. Muscular Dystrophy Australia and MDA Victoria provide additional information and community support.
Evidence referenced in this article
- Voet NBM, et al. Strength training and aerobic exercise training for muscle disease. Cochrane Database of Systematic Reviews, 2019.
- Exercise training in Duchenne muscular dystrophy: a systematic review and meta-analysis. PMC.
Written by the Exercare allied health team. This article is general information only and is not a substitute for individual medical advice. Exercare provides mobile exercise physiology and NDIS occupational therapy across south-east and eastern Melbourne.
OT services mentioned in this article:
Assistive technology → · Home modifications →
Frequently asked questions
Can exercise damage muscles in muscular dystrophy?
Very hard or heavy eccentric exercise can be a problem in some conditions. Moderate, well-planned exercise appears safe for most people and research has reported few adverse effects. An exercise physiologist tailors the program to your specific condition.
What type of exercise is best for neuromuscular conditions?
Usually moderate aerobic activity such as cycling, walking or swimming, combined with gentle strengthening, balance and stretching. Water-based exercise is often very helpful.
How can an OT help with fatigue?
OTs teach energy conservation, simplify daily tasks, recommend equipment and adjust home, work or school setups so you have more energy for the things that matter.
Does the NDIS fund hydrotherapy?
Yes, hydrotherapy delivered by an exercise physiologist can be funded under Capacity Building when it links to your goals.