Top 10 ALS Strengthening Exercises to Improve Muscle Function

The Science Behind ALS Strengthening Exercises

Current Research on Muscle Strengthening in ALS

The latest research brings encouraging news for our ALS community. A comprehensive analysis of multiple studies reveals that thoughtfully designed exercise programs can significantly improve functional abilities and breathing capacity for people living with ALS^[1]. We’ve learned that resistance exercises tend to be most effective for maintaining overall function, while aerobic activities show particular promise for supporting lung capacity^[1].

A groundbreaking 2024 review found that exercise programs helped individuals with ALS walk farther and breathe more effectively, specifically improving their ability to exhale forcefully^[1]. While exercise didn’t significantly impact all measured outcomes, the improvements in mobility and breathing represent meaningful gains in daily quality of life.

Understanding the balance is crucial – while intense physical activity may pose risks for those with genetic predispositions^[2], moderate, carefully monitored exercise programs offer real benefits. Swimming-based protocols have shown especially promising results in research settings, supporting motor function while reducing inflammation^[2]. These water-based exercises appear to help muscles use energy more efficiently, favoring glucose over fat metabolism^[2].

At ALS United Greater Chicago, we stay current with emerging research to ensure our community has access to the most effective, evidence-based approaches. Learn more about the

How Strengthening Exercises Support Unaffected Muscles

When ALS affects certain muscle groups, strengthening the muscles that remain unaffected becomes essential for maintaining independence and quality of life. While some muscles may weaken due to the disease, others often retain their strength for extended periods. By focusing on these preserved muscle groups, we can help compensate for areas of weakness and maintain functional abilities longer.

Think of your body as a team – when some team members need extra support, the stronger members can step up to help carry the load. Targeted strengthening exercises for unaffected muscles can:

• Improve compensation strategies – Strong shoulder muscles can help when hand weakness makes lifting difficult
• Maintain postural support – Core muscles that remain strong help prevent falls and maintain sitting balance
• Preserve functional movements – Strengthening hip muscles can support walking even when ankle muscles weaken
• Reduce overall fatigue – When stronger muscles efficiently handle daily tasks, you conserve energy for what matters most

The key is working with your care team to identify which muscle groups remain strong and designing exercises that challenge them appropriately without causing overwork. This personalized approach ensures you’re making the most of your body’s capabilities while respecting its changing needs.

Preparation and Safety Guidelines

Required Medical Assessments Before Starting

Starting an exercise program is an important step in your ALS journey, and we’re here to support you every step of the way. Begin by connecting with your neurologist and physical therapist for a comprehensive medical assessment. This evaluation includes essential tests like forced vital capacity (FVC) to measure breathing strength, manual muscle testing (MMT) to assess individual muscle groups, and functional mobility screening. Your healthcare team at one of our partnered ALS Clinics and Centers will establish baseline measurements and identify which muscle groups can safely participate in strengthening activities. Together, you’ll determine appropriate exercise intensity levels based on your current abilities and unique needs. Plan for reassessments every 3-6 months to ensure your program evolves with you.

Monitoring Your Body’s Response to Exercise

Listening to your body is one of the most important skills you’ll develop in your exercise journey. We encourage you to monitor key signals that help keep you safe and progressing appropriately. The 30-minute rule is your guide: if fatigue lasts longer than half an hour after exercise, it’s time to adjust your program. Watch for muscle pain, soreness, or increased twitching as your body’s way of saying “let’s take it easier.” Your exercise should energize rather than exhaust you, allowing you to enjoy daily activities without interference.

Pay special attention to your breathing patterns during exercise, especially with new movements. For walking exercises, be mindful of balance changes, as ALS can affect your body’s natural adjustments during turns and direction changes. If a fall occurs, reach out to your care team immediately for program modifications – your safety is our priority. Many in our community find that tracking energy levels throughout the day helps identify their optimal exercise windows, turning this practice into a powerful tool for maintaining independence and quality of life.

Signs That Indicate When to Modify or Stop

Recognizing when to modify or stop exercise is crucial for your safety and long-term success. Stop exercising immediately if you experience: sudden breathing difficulties, chest pain or pressure, severe muscle cramping, dizziness or lightheadedness, or any new weakness that feels different from typical fatigue. These signals deserve immediate attention from your healthcare team.

Consider modifying your program when you notice persistent soreness lasting more than 48 hours, difficulty completing exercises you previously managed, increased falls or near-falls, or changes in speech or swallowing during or after exercise. Remember, modifying isn’t giving up – it’s adapting intelligently to keep you active and engaged. Your exercise program should grow and change with you, always supporting your goals while respecting your body’s current abilities. When in doubt, consult with your care team; they’re your partners in maintaining the best possible quality of life throughout your journey.

Upper Body Strengthening Exercises

Exercise #1: Isometric Shoulder Strengthening

Isometric shoulder strengthening can be a powerful tool for maintaining your independence and daily function. When you perform these gentle contractions without moving the joint, research shows that muscles work together synergistically, helping preserve strength even as ALS progresses^[5].

To perform basic isometric shoulder exercises:

• Sit comfortably with your back supported
• Press your arm gently against a wall or doorframe for 5-10 seconds
• Focus on moderate pressure – you should feel muscle engagement without strain
• Rest between repetitions to prevent overworking

As discussed in the Preparation and Safety Guidelines section, watch for signs of overexertion. The beauty of isometric exercises is that they allow you to maintain strength while respecting your body’s changing needs^[6].

Exercise #2: Supported Arm Raises and Modifications

Supported arm raises offer a gentle way to maintain shoulder and arm function while honoring your energy levels. These exercises help you continue important daily activities like reaching for items, embracing loved ones, and maintaining personal care routines.

How to perform supported arm raises:

• Start seated or standing with your back against a wall for support
• Use a countertop, table, or lightweight

Exercise #3: Gentle Hand and Grip Exercises

Your hands connect you to the world – through touch, communication, and countless daily tasks. Preserving hand and grip strength helps maintain these vital connections for as long as possible^[7].

Simple exercises using everyday items:

• Coin stacking: Build small towers to work on precision and control
• Clothespin practice: Use different finger combinations (thumb-index is easiest, thumb-pinky most challenging)
• Tripod grip strengthening: Practice the functional grip used for writing by pinching thumb, index, and middle fingers together^[8]

For those experiencing increased weakness:

• Gently touch your thumb to each fingertip, opening your hand wide between touches
• Use your stronger hand to assist movements when needed
• Focus on maintaining flexibility rather than building strength

These exercises complement the respiratory and functional training discussed later, as hand strength supports activities like using communication devices and maintaining independence^[8]. Your care team can help determine the right intensity and progression for your unique situation.

Core and Lower Body Strengthening

Exercise #5: Seated Core Stabilization Techniques

Core stabilization forms the foundation for maintaining posture, balance, and overall mobility. Working with your care team, you can develop seated exercises that strengthen your trunk muscles while respecting your body’s current abilities. Simple movements like seated pelvic tilts, gentle trunk rotations, and supported breathing exercises can help maintain core strength. Start with just a few repetitions, focusing on quality of movement rather than quantity. Your physical therapist can guide you in finding the right seated position – whether in a standard chair, wheelchair, or with additional supports – that allows you to engage your core safely. Remember, even small movements make a difference in maintaining function and independence.

Exercise #7: Hip Strengthening for Mobility

Strong hip muscles are essential for walking, transferring, and maintaining balance throughout your daily activities. Working closely with your care team, you can develop a hip strengthening routine that matches your current abilities. Seated hip flexion, gentle marching in place while holding onto a stable surface, and supported hip abductions can help maintain strength without overexertion. For those using mobility aids, these exercises can be adapted to work within your comfort zone. As mentioned in the Monitoring Your Body’s Response section, watch for signs of excessive fatigue and adjust accordingly. Your physical therapist can help you find creative ways to incorporate hip strengthening into your daily routine, making exercise feel less like work and more like a natural part of your day.

Exercise #8: Ankle and Foot Strengthening Methods

Ankle and foot strengthening helps maintain stability, prevent falls, and support overall mobility in individuals with ALS. Focus on gentle exercises that target the muscles around the ankle joint without causing excessive fatigue. Start with seated ankle range of motion movements, moving your foot up, down, and side to side while keeping movements small and controlled^[9]. For those with adequate strength, try heel cord stretches with a bent knee to work the soleus muscle, which provides crucial ankle stability^[9]. Incorporate marble or towel gathering exercises with your toes to maintain foot muscle engagement and dexterity^[9]. As balance allows, practice supported single-leg standing while holding onto a stable surface, which strengthens ankle stabilizers and improves proprioception^[10]. As discussed in the monitoring guidelines above, pay attention to how your body responds to these exercises. Our ALS Care Services team can connect you with physical therapists who specialize in adapting ankle exercises to your changing needs, helping you maintain mobility and independence for as long as possible.

Functional and Respiratory Strengthening

Exercise #9: Respiratory Muscle Training

Breathing exercises can make a meaningful difference in maintaining respiratory function as ALS progresses. Respiratory muscle strength training (RMST) works by gently exercising your diaphragm and the muscles that help you breathe. Research shows this type of training is well-tolerated and can help preserve breathing strength when done consistently.

A typical RMST program involves using a breathing trainer device – often available through our

Exercise #10: Functional Movement Patterns

Functional movement patterns bring together different types of exercise to help you maintain independence in daily activities. Rather than focusing on just one type of exercise, combining gentle aerobic activities, light resistance work, and stretching creates a more complete approach that supports your overall function and well-being.

This multi-faceted approach works on several levels. Light aerobic exercise, such as walking or stationary cycling at your own pace, helps reduce stress and supports your cardiovascular health. Resistance exercises maintain muscle strength for daily tasks, while flexibility work keeps your joints mobile. Research shows this combined approach has the greatest potential for improving quality of life and managing fatigue.

The beauty of functional movements is that they mirror real-life activities – reaching for items, getting up from chairs, or maintaining balance while walking. By practicing these patterns regularly, you’re directly supporting the movements you use every day. Your exercise specialist will help you find the right intensity level, as individuals with ALS may respond differently to exercise than expected. The key is finding activities that challenge you appropriately without causing lasting fatigue.

Combining Strengthening with Range of Motion

Pairing strengthening exercises with gentle stretching creates a balanced approach that supports both muscle health and joint flexibility. This combination is particularly important because maintaining range of motion helps you continue performing daily activities even as muscle strength changes.

Start each session with gentle range of motion exercises to warm up your joints and prepare your muscles. Follow this with your strengthening work, then finish with additional stretching to maintain flexibility. This sequence helps prevent stiffness while building functional strength. For example, you might begin with arm circles, move to supported arm raises (as discussed in Upper Body Strengthening Exercises), then finish with gentle shoulder stretches.

The key is listening to your body and adjusting the balance between strengthening and stretching based on how you feel each day. Some days you may focus more on maintaining flexibility, while others allow for more strengthening work. Your physical therapist can help you find the right combination that supports your current abilities without causing excessive fatigue. Remember, consistency matters more than intensity – regular, gentle practice yields the best results over time.

Adapting Exercises as ALS Progresses

Living with ALS means your exercise needs will change over time, and that’s okay. The goal isn’t to maintain the same exercise routine forever, but rather to adapt your activities to match your current abilities while staying as active as safely possible. Many individuals find that even as their physical capacity changes, modified exercises continue to provide meaningful benefits.

For breathing exercises, this might mean starting with higher resistance levels early on, then gradually reducing the intensity as needed. While some may begin training at 60% of their maximum capacity, others find 30% more appropriate – there’s no one-size-fits-all approach. Your healthcare team will guide these adjustments during regular check-ins.

As changes occur, especially if you experience weakness around your mouth, simple adaptations like using a specialized mouthpiece can help you continue respiratory exercises effectively. If swallowing or speaking becomes more challenging, focusing on exercises that strengthen your ability to exhale forcefully (like coughing) often provides the most practical benefit.

Remember, staying active doesn’t mean pushing through exhaustion. It means finding creative ways to keep moving within your comfort zone. Some days this might be modified exercises, other days it could be as simple as practicing deep breathing. Every bit of movement counts, and our community is here to support you through each adaptation. Together with your care team, you’ll find the right balance that honors both your determination and your body’s needs.

Implementing Your ALS Exercise Program

Tracking Progress and Measuring Success

Tracking your exercise journey with ALS requires a compassionate approach that honors your body’s unique needs while celebrating every achievement, no matter how small. Work closely with your care team to establish meaningful benchmarks that reflect your personal goals – whether that’s maintaining the ability to button a shirt, preserving breathing strength, or simply feeling more energized throughout the day.

Consider keeping a simple exercise journal to note daily energy levels, which activities feel manageable, and any changes in function. Many people find it helpful to rate their fatigue on a 1-10 scale before and after exercise sessions. This personal record becomes an invaluable tool during medical appointments, helping your team adjust your program based on real-world feedback rather than clinical assessments alone.

Remember that success looks different for everyone living with ALS. Some days, success might mean completing your full routine; other days, it might mean listening to your body and choosing rest. Both are equally valid responses that honor your journey. Our ALS Care Services team can provide additional support in developing personalized tracking methods that align with your specific needs and goals.

Integrating Exercises into Daily Activities

Making exercise a natural part of your daily routine helps maintain consistency without overwhelming your schedule or energy reserves. Simple movements can be woven into activities you’re already doing – practice quadriceps contractions while reading the morning news, or perform gentle sit-to-stands during TV commercial breaks^[17]. These brief exercise moments throughout the day often prove more sustainable than dedicated workout sessions.

Consider pairing exercises with regular daily activities to create helpful reminders. Morning coffee time might include ankle circles and toe points. Phone conversations become opportunities for supported arm raises. Waiting for meals to cook allows time for standing balance work near the kitchen counter. This approach transforms everyday moments into opportunities for maintaining strength and function.

As discussed in “Monitoring Your Body’s Response to Exercise,” always listen to your body’s signals about intensity and duration. The beauty of integrating exercises into daily life is the flexibility to adjust based on how you’re feeling each day. Some days you might complete multiple exercises; other days, focusing on just one or two movements is perfectly appropriate. This adaptable approach helps you stay active while respecting your body’s changing needs throughout your ALS journey.