For most people with LEMS, the safest approach to exercise is one that emphasizes low-impact, functional movement, says Gingras. Examples include walking on level surfaces, recumbent cycling, and swimming, she says.
“These activities help maintain muscle function and mobility without placing excessive stress on the joints or neuromuscular system,” Gingras says.
Strength training can also be beneficial, particularly when it focuses on movements that translate to everyday activities. “This type of training promotes coordinated activation of multiple muscle groups for real-world tasks like standing, climbing, and lifting,” says Gingras.
“We typically recommend starting with body-weight resistance and gradually progressing to bands or light weights as tolerated,” she says. Your physical therapist will monitor you to make sure you’re not pushing muscles to the point of exhaustion.
“In strength-training sessions, people with LEMS should avoid exercising to the point of muscle burning. That sensation indicates excessive fatigue, which can increase recovery time and potentially worsen weakness,” says Gingras.
Eccentric loading, in which the muscle lengthens under tension, needs to be approached with caution, if at all. “It can place additional strain on the muscles and lead to faster fatigue or even microdamage,” says Gingras. She recommends avoiding this type of training unless specifically guided by a physical therapist.
Balance and flexibility work can play an important role in a safe exercise routine, particularly given the risk of fatigue-related instability in LEMS. Experts recommend focusing on gentle, low-intensity movements that improve stability and control, such as stretching, range-of-motion exercises, breathing work, and simple balance activities.
These slow, controlled movements can help maintain mobility and reduce fall risk when done within a comfortable intensity range and with rest as needed, says Gingras.
During your exercise session, build in brief rest periods (one to two minutes) between sets of strengthening exercises, as well as longer rest breaks after each four- to five-minute bout of aerobic activity, she says.
When planning your weekly exercise schedule, allow at least one day between strengthening or physical therapy sessions, says Gingras. “Nonstrengthening days can be used for gentle stretching and mobility, as well as breathing exercises,” she says.
Rest intervals should be built into every session rather than treated as an afterthought.
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