Exercise, Physical Therapy, and Nutrition

Exercise is important to children’s mental and physical health. Children with Duchenne and Becker muscular dystrophy should limit their level of activity and participate in safer exercise, like swimming. Healthcare providers should talk to families about balancing the child’s need for exercise with the health of the muscle.

Usually, younger children should stay active doing activities that all kids enjoy, like swimming, riding bikes, and playing ball. Older children are usually encouraged to walk and swim. Children should not exercise or walk so much that they feel very tired. If they have sore muscles or cramping in the 24 hours after an activity, the activity was probably too difficult. Some children are very good at self-limiting their own activity, but others will need to have parents tell them to have rest breaks.

In general, children with muscular dystrophy should not do strengthening exercises using weights and resistance. Some activities, called eccentric exercises, are especially damaging to dystrophic muscle. Eccentric exercises happen when muscles are stretched while they are trying to contract (that is, the muscles are being used as a brake). Examples are going down steps, running or walking downhill, or landing from a jump. People with Duchenne and Becker muscular dystrophy should avoid these exercises as much as possible.

Physical therapy

Physical therapy (PT) is a key part of keeping muscle function and preventing joint problems, and all people with Duchenne and Becker muscular dystrophy should get PT. The goals of PT are to keep people with muscular dystrophy as strong, flexible, and symmetric as possible. This is done with exercise, stretching, orthoses (supports that prevent contractures), and proper standing and seating. Usually children have a PT evaluation soon after diagnosis and have regular evaluations once or twice a year to help them keep up their best function. Physical therapy is still important when a person with muscular dystrophy goes into a wheelchair, and in fact PTs are good resources to give advice about wheelchair choice and timing. 

Nutrition and weight management

For some people with muscular dystrophy low weight is an issue, and for others too much weight is an issue (especially those who take steroids). Nutritional needs may change over time, and what a young child needs may be different than what an older child or adult might need. Nutritionists/dietitians and PTs can help people with muscular dystrophy keep to a healthy weight over time, and all healthcare providers should check height and body weight. Healthcare providers should also check for swallowing problems, which can affect nutrition.

To learn more:

  • Read PPMD's Fact Sheet on muscle health.
  • Read PPMD's Fact Sheet on the GI system and nutrition.
  • “Rehabilitation” section of the TREAT-NMD recommendations
  • “GI-Nutrition” section of the TREAT-NMD recommendations
  • “Orthopedics” section of the TREAT-NMD recommendations
  • Case, Laura. Physical therapy management of dystrophinopathies. Presented at PPMD annual conference 2006 http://www.parentprojectmd.org/site/DocServer/PT_handout-parent_project_mtg-2006-L__Case.pdf?docID=4121.
  • Posselt, Helen, “Physical therapy: Who does what? Why do it? How often and how much? ” PPMD 2007 Conference Abstract.
  • Posselt, Helen and Denny, Bev. “Aquatic physiotherapy.” Montrose Access, Brisbane Australia.