1. Exercise in the Adult Neuromuscular Patient Jacky Yirrell Clinical Specialist Physiotherapist.

2. “Advice is what we ask for when we already know the answer but wish we didn't” Erica Jong 1942

3. 10.000 Calories!!

4. Benefits of Exercise 1.Improves or maintains your ability to perform every day tasks 2.Reduces fatigue 3.Can improve bone density 4.Assist in controlling your weight 5.Improves your mood 6.Can improve your sleep.

5. 1.Activity over a week should add up to at least 150 minutes ( 21/2 hours) of moderate intensity activity. 5 times a week 30 minutes per session. OR 2. 75 minutes of vigorous activity spread across the week. 3. Adult should undertake physical activity to improve muscle strength on at least 2 days a week. 4. All Adults should minimise the length of time spent being sedentary for extended periods.

6. Difficulties encountered by our Patients 1. Loss of muscle bulk 2. Reduced stamina 3. Increased level of tiredness 4. Muscle and joint pain. 5.Weight gain 6. Tight muscles and joint deformity 7.Poor balance and falls 8. Lack of motivation.

7. Specific benefits of exercises to the Neuromuscular Patient 1.Delay Muscle wasting. 2.Keep unaffected muscle strong. 3.Improve heart and lung function 4.Maintain or improve stamina and endurance 5.Reduce pain in muscles and joints 6.Improve or maintain joint range of movement 7.Prolong ability to undertake functional activities e.g. Walking. Stairs etc.

8. How do we direct them to do the right sort of physical activity at the correct level to be beneficial?

9. The right sort of exercise. 1. Type of exercise 2. Frequency of exercise 3. Duration of the exercise session 4. Intensity of the session 5. Any precautions 6. Progression of the exercise.

10. Aerobic exercise

11. How often? How much? How hard? Can patients do too much?

12. “This is a scale that asks you to rate the difficulty of your breathing. It starts at number 0 where your breathing is causing you no difficulty at all and progresses through to number 10 where your breathing difficulty is maximal. How much difficulty is your breathing causing you right now?”

13. Strengthening exercise

14. Stretching exercises

16. How do we deliver these exercise options? Exercise programmes Increasing physical activity Group activities In the gym

17. Summary of exercise Discuss with the patient Check there are no underlying medical reasons Decide on the type of exercise Decide how that exercise should be delivered Decide how that exercise will be measured

18. Correction of dropped foot gait. Ankle support Dictus band Push Aquei Ankle support Posterior leaf spring supportMatrix

19. Shoulder supports

20. Thank you