Efficacy of Different Physical Therapy Regimen for Amyotrophic Lateral Sclerosis: A Systematic Review

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder characterised by the degeneration of upper and lower motor neurones, which results in progressive muscle weakness, functional decline, and ultimately respiratory failure. There is presently no cure for ALS; however, rehabilitation strategies have been investigated to enhance functional capacity and quality of life in affected individuals.
Objective: The objective of this narrative review is to evaluate the effectiveness of different exercise interventions and determine which forms of exercise are beneficial across the stages of amyotrophic lateral sclerosis.
Method: Articles were sourced from online databases including PubMed, Google Scholar, and Cochrane. The systematic review was conducted in accordance with the PRISMA 2020 Statement guidelines. All studies included in the review were randomised, controlled trials evaluating physiotherapy-based exercise programs, including aerobics, resistance, stretching, endurance, strengthening, and balance exercises. They were reviewed. Findings from the included studies were synthesised narratively to identify trends in exercise prescription and clinical outcomes.
Result: 30 articles were found; out of these, six randomised controlled trials examining interventions in individuals with ALS were included. The PEDro assessment indicated that the included studies demonstrated moderate methodological quality. Overall, moderate-intensity exercise programmes were reported as safe and beneficial for maintaining physical function, respiratory capacity, and quality of life in individuals with ALS.
Conclusion: Although ALS is a progressive neurodegenerative disease, evidence suggests that appropriately prescribed physiotherapy interventions may help maintain functional ability and improve quality of life. Moderate-intensity exercise appears to be beneficial across different stages of the disease when carefully monitored. However, larger randomized controlled trials are required to establish Standardised exercise guidelines should be established to determine the long-term safety and effectiveness of rehabilitation interventions in ALS.

Amyotrophic lateral sclerosis, physiotherapy, exercise therapy, rehabilitation, and quality of life.

1. Rowland, L. P., & Shneider, N. A. (2001). Amyotrophic lateral sclerosis. New England Journal of Medicine, 344(22), 1688-1700. [Google Scholar] [Crossref]

2. Simmons, Z. (2005). Management strategies for patients with amyotrophic lateral sclerosis from diagnosis through death. The neurologist, 11(5), 257-270. [Google Scholar] [Crossref]

3. Murphy, J. (2004). Communication strategies of people with ALS and their partners. Amyotrophic Lateral Sclerosis and Other Motor Neuron Disorders, 5(2), 121-126. [Google Scholar] [Crossref]

4. Bello-Haas, V. D. (2018). Physical therapy for individuals with amyotrophic lateral sclerosis: current insights. Degenerative neurological and neuromuscular disease, 45-54. [Google Scholar] [Crossref]

5. Ferri, A., Lanfranconi, F., Corna, G., Bonazzi, R., Marchese, S., Magnoni, A., & Tremolizzo, L. (2019). Tailored exercise training counteracts muscle disuse and attenuates reductions in physical function in individuals with amyotrophic lateral sclerosis. Frontiers in physiology, 10, 1537. [Google Scholar] [Crossref]

6. Zucchi, E., Vinceti, M., Malagoli, C., Fini, N., Gessani, A., Fasano, A., ... & Mandrioli, J. (2019). High‐frequency motor rehabilitation in amyotrophic lateral sclerosis: a randomized clinical trial. Annals of clinical and translational neurology, 6(5), 893-901. [Google Scholar] [Crossref]

7. Clawson, L. L., Cudkowicz, M., Krivickas, L., Brooks, B. R., Sanjak, M., Allred, P., ... & Maragakis, N. J. (2018). A randomized controlled trial of resistance and endurance exercise in amyotrophic lateral sclerosis. Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 19(3-4), 250-258. [Google Scholar] [Crossref]

8. Lunetta, C., Lizio, A., Sansone, V. A., Cellotto, N. M., Maestri, E., Bettinelli, M., ... & Corbo, M. (2016). Strictly monitored exercise programs reduce motor deterioration in ALS: preliminary results of a randomized controlled trial. Journal of neurology, 263(1), 52-60. [Google Scholar] [Crossref]

9. Braga, A. C. M., Pinto, A., Pinto, S., & De Carvalho, M. (2018). The role of moderate aerobic exercise as determined by cardiopulmonary exercise testing in ALS. Neurology research international, 2018(1), 8218697. [Google Scholar] [Crossref]

10. van Groenestijn, A. C., Schröder, C. D., van Eijk, R. P., Veldink, J. H., Kruitwagen-van Reenen, E. T., Groothuis, J. T., ... & van den Berg, L. H. (2019). Aerobic exercise therapy in ambulatory patients with ALS: a randomized controlled trial. Neurorehabilitation and neural repair, 33(2), 153-164. [Google Scholar] [Crossref]

11. Kalron, A., Mahameed, I., Weiss, I., Rosengarten, D., Balmor, G. R., Heching, M., & Kramer, M. R. (2021). Effects of a 12-week combined aerobic and strength training program in ambulatory patients with amyotrophic lateral sclerosis: a randomized controlled trial. Journal of neurology, 268(5), 1857-1866. [Google Scholar] [Crossref]

12. Meng, L., Li, X., Li, C., Tsang, R. C., Chen, Y., Ge, Y., & Gao, Q. (2020). Effects of exercise in patients with amyotrophic lateral sclerosis: a systematic review and meta-analysis. American Journal of Physical Medicine & Rehabilitation, 99(9), 801-810. [Google Scholar] [Crossref]

13. Ren, S., Che, X., Hu, S., Feng, X., Zhang, J., & Shi, P. (2025). The effect of exercise intervention on amyotrophic lateral sclerosis: a systematic review and meta-analysis. Frontiers in Neurology, 16, 1499407. [Google Scholar] [Crossref]

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