Benefits of Exercise: I think most will agree that exercise is a source of both physical and emotional well-being. From years of discussing the issue with other myasthenics, I can see that many myasthenics will cringe at the word "exercise"; they fear it is beyond their capabilities and might worsen their MG. A discussion of the issues should help to allay some of those fears. I am sure that even wheelchair-bound patients with various conditions are advised on how to exercise within their capabilities. That is my bottom line view: Exercise within your capabilities.

Why me? Am I an expert on exercise and MG? My MG came on slowly, starting perhaps as early as age 10 or 15. I was physically very active as a child and never slowed perceptibly. At age 42, when the MG had slowed me significantly, I was diagnosed. Having failed twice with exercise programs before my diagnosis, I tried again, this time with the help of Mestinon. This time it worked. While I am not an exercise expert, I have about 23 years of experience with exercise and MG together. Exercise did work for me as I know it has worked for many others. In my view, we should each take the responsibility of becoming his or her own exercise expert.

Discussion: How many here are currently involved with some type of exercise or exercise program?

Capabilities: Evaluate your capabilities. My upper body strength has always been limited, even as a teenager. However, my legs have been fine, especially after starting on Mestinon. I became aware that jogging and other aerobic exercise using my normal leg strength were my best capability. For those with leg weakness, the story would be different. I know that my ability to lift weights has always been limited, which is one reason I believe I had a limited form of MG as a child. I was fairly athletic but never could build up any arm strength. After my diagnosis, it was exceedingly clear that my arm strength was one of my biggest shortcomings caused by MG.

However, just because it worked for me does not mean it will work for others. We are all different. I had my doctor's approval and entered a supervised exercise program. I even had to take yearly "stress tests" in order to stay in the program.

My story is simple. It is also unique to me, so others should not make any assumption that it will be good for them. I do think it may help overcome some of the reluctance to exercise that is often reinforced by doctors. Some doctors may be reluctant to ask their patients to try something that may or may not produce additional weakness.

Doctor's Recommendations: A doctor's statement to "not overdo it" is often heard by the myasthenic but in my mind skirts the issue of a doctor specifying to a patient exactly what he/she should try. Even healthy people are told the same thing by their doctor, so of what use is it?? A doctor should evaluate a patient and provide specific guidelines. My humble opinion.

Discussion: How many here have discussed exercise with their doctor and been given recommendations? Are you satisfied with the doctor's advice?

Types of Exercise: I would break all exercise into one of two types: Aerobic and non-aerobic. Aerobic exercise concentrates on the cardiovascular system and non-aerobic on basic muscle tone and fitness. Each myasthenic should be evaluated by the doctor to judge which types of exercise are appropriate for him or her.

Many have opinions on the types of exercise that might be appropriate for the general population. I found an interesting article based on a press release from the Centers for Disease Control (CDC) in the U.S. Perhaps the list might provide some ideas of appropriate exercises for the myasthenic.

The CDC said it loosened the definition of exercise to obtain "a more comprehensive picture of Americans' daily lifestyles." A recent press release from the CDC is written up at

http://www.cdc.gov/od/oc/media/pressrel/r030814.htm

From the above article: "Moderate activities include walking at a brisk pace, ballroom dancing, playing in a marching band, shoveling snow, and moderate housework such as scrubbing floors, washing windows and vacuuming."

For those daunted by even moderate exercise, the CDC has a list of even
less intense activities it says would be at least a step in the right direction, including making photocopies, playing video games, coloring, sitting in a whirlpool bath, floating and "purposeless wandering."

The agency says an hour of such light activity is equal to 30 minutes of moderate activity, but light activity wasn't included in the latest survey. Light activity includes almost every activity that involves motion and some that don't: playing table tennis, miniature golf, darts or pool, shooting a pistol, yachting, fishing while seated, even light office work that includes movement of "little more than hands and fingers."

My emphasis: The above lists many different types of exercise that many may not even have considered exercise. The point is that they are exercise and should be used to the fullest extent possible within each person's capabilities - ALWAYS referring to specific approvals by your neurologist or other doctor.

Conclusion: Exercise is certainly something all of us should use everyday in whatever way we can without worsening our MG. A doctor's approval should always be obtained. Slow progress is very worthwhile. Reducing emotional stress is a side benefit that might be helpful in reducing MG symptoms. A supervised exercise program, such as at a health club or gymnasium, should be used during the beginning of attempts to increase levels significantly.

Discussion: I would open discussion by asking what types of exercise you have tried and found to be helpful? Do you find problems with some types of exercise??

My own exercise program includes: Jogging, bicycling, softball, volleyball, yard work, Tai Chi, and playing with the grandkids. Occasional sightseeing trips include lots of beneficial walking.