Table 1.

Practical, empiric recommendations for exercise in ALS

Type of exercise	Potential benefits	Practical considerations
Flexibility	Prevention and management of contractures; might also help reduce pain and spasticity	Start early in the disease course and incorporate in gentle daily routine with caregiver participation as needed.
Strengthening	Potential role in maintaining muscle strength	Do not exercise muscles that do not have antigravity strength. Avoid high-resistance exercise. Avoid eccentric exercise. Progress as tolerated (“start low, go slow”).
Aerobic	Potential role in reducing deconditioning and improving mood, sleep, spasticity and quality of life	Perform at a moderate, sub-maximum level. If the patient cannot talk comfortably during exercise, the program is too vigorous. Progress as tolerated (“start low, go slow”). Consider community-based programs that encourage social interaction and participation such as adaptive sports program (e.g., adaptive golf).