The information provided here is for educational purposes only and does not substitute for professional medical advice. The content reflects the unique experiences of the author and is not necessarily the opinion, views, or recommendations of the MGFA. Please consult with your doctor and healthcare professionals for specific recommendations and advice pertaining to your healthcare/treatment.  

 

When I was diagnosed with myasthenia gravis, the doctors told me to be cautious about repetitive movements, such as exercises. My neurologist was under the impression that exercises would flare up the disease, and so I gave them up… momentarily.

 

After six continuous months of potent immunosuppressive therapy, my disease was under control. And then I began a regular but graded gym routine to make up for all the “lost” exercise time. And I was feeling better than ever.

 

While this won’t be everyone’s experience – and as a medical student, I always recommend following your doctor’s advice and guidance – getting back to exercise was an important part of my healing process. Not just physically, as I regained strength lost during my weakest periods, but mentally as well. Even limited movement has potent effects on your wellbeing that can improve your quality of life.

 

Exercise has many well-known benefits on health, but it remains understudied as a therapy for myasthenia gravis. Some in the medical community may point to medicine over alternative therapies. There are methodological difficulties, too, like the small sample size involved in any rare disease study and the fact that MG severity can differ so widely among patients. But just because studies in MG patients are limited, exercise should not be ignored as a potential therapy for this disease.

 

The limited research that does exist shows exercise is generally safe and effective for people living with myasthenia gravis. One 2017 study showed that exercise benefitted patients with mild MG during the activity.¹ Subsequent studies have confirmed this in patients with generalized weakness of MGFA classification II-IV.^2,3,4  The reason for this is not properly understood, but exercise has been shown to allow both heightened mind-muscle connection and nerve function, with a corresponding improvement in the synapses in the neuromuscular junction.^5,6 We can already see why this would be helpful in patients with MG, where the nicotinic acetylcholine receptors are blocked by autoantibodies in these synapses.

 

Exercise also has a slew of secondary effects not directly related to the pathogenesis of MG that may still help combat the symptoms of the disease and side effects of medication. For example, physical activity can help fight weight gain and muscle wasting from immunosuppressive medications such as prednisone. Strength-training can increase both muscle strength and muscle mass over time. Balance exercises can help you stay steady on your feet if you’re feeling weak.

 

Aerobic exercises can improve cardiorespiratory fitness in some patients, which may fight the respiratory weakness MG brings on. One study, for example, randomized MG patients into a training group (diaphragmatic breathing exercise) and a control group for a two-month intervention. The patients in the training group improved their respiratory muscle endurance and maximized inspiratory and expiratory pressures compared with the control group.⁷

 

Finally, physical exercise may lead to a positive immune response that may counter autoimmunity.⁸

 

Exercise gave me one additional, remarkable benefit as a person living with MG. After exercise, I experienced what I call “the endorphin orchestra,” where exercise elevated my mood.

 

To understand why this would be helpful, we first need to understand that fatigue is a product of both subjective and objective state. While people with MG may have normal or near-normal repetitive nerve stimulation tests, they are still afflicted with longstanding fatigue.⁹

 

A relatively large amount of research has shown the effects of exercise on mood, cognition, and fatigue. Physical exertion has an immediate, short-term boost in mood, which can persist up to 12 hours. The result is a compound effect on motivation that can power one through the day.

 

Don’t underestimate the power of a positive outlook and the impact of those endorphins on your mood and overall wellbeing. (See Dr. Rosenfeld’s presentation at the 2023 MGFA National Patient Conference!)

 

While exercise should be done carefully, and in a graded fashion, it can work wonders for helping you manage your MG symptoms in conjunction with your regular treatment plan.

 

For some gentle, low-impact exercises you can do at home, visit the Fitness Center in the MGFA Online Community. And stay tuned for more in 2024.

 

The author is a certified personal trainer and medical student who has lived with MG since 2015.

 

1. Rahbek MA, Mikkelsen EE, Overgaard K, Vinge L, Andersen H, Dalgas U. Exercise in myasthenia gravis: A feasibility study of aerobic and resistance training. Muscle Nerve. 2017;56(4):700-709. doi:10.1002/mus.25552
2. Westerberg E, Molin CJ, Spörndly Nees S, Widenfalk J, Punga AR. The impact of physical exercise on neuromuscular function in Myasthenia gravis patients: A single-subject design study. Medicine (Baltimore). 2018;97(31):e11510. doi:10.1097/MD.0000000000011510
3. Wong SH, Nitz JC, Williams K, Brauer SG. Effects of balance strategy training in myasthenia gravis: a case study series. Muscle Nerve. 2014;49(5):654-660. doi:10.1002/mus.24054
4. Lucia A, Maté-Muñoz JL, Pérez M, Foster C, Gutiérrez-Rivas E, Arenas J. Double trouble (McArdle's disease and myasthenia gravis): how can exercise help?. Muscle Nerve. 2007;35(1):125-128. doi:10.1002/mus.20645
5. Falk, Megan. “How a Strong Mind-Muscle Connection Can Take Your Workouts to the Next Level,” Shape. https://www.shape.com/mind-muscle-connection-6829315. Accessed Jan. 11, 2024.
6. Maugeri G, D'Agata V, Trovato B, et al. The role of exercise on peripheral nerve regeneration: from animal model to clinical application. Heliyon. 2021;7(11):e08281. Published 2021 Oct 29. doi:10.1016/j.heliyon.2021.e08281
7. Fregonezi GA, Resqueti VR, Güell R, Pradas J, Casan P. Effects of 8-week, interval-based inspiratory muscle training and breathing retraining in patients with generalized myasthenia gravis [published correction appears in Chest. 2005 Nov;128(5):3779]. Chest. 2005;128(3):1524-1530. doi:10.1378/chest.128.3.1524
8. Sharif K, Watad A, Bragazzi NL, Lichtbroun M, Amital H, Shoenfeld Y. Physical activity and autoimmune diseases: Get moving and manage the disease. Autoimmun Rev. 2018;17(1):53-72. doi:10.1016/j.autrev.2017.11.010
9. Symonette CJ, Watson BV, Koopman WJ, Nicolle MW, Doherty TJ. Muscle strength and fatigue in patients with generalized myasthenia gravis. Muscle Nerve. 2010;41(3):362-369. doi:10.1002/mus.21493