How to Exercise Safely With Myasthenia Gravis

“Exercise can absolutely benefit people with myasthenia gravis,” says Natalia Gonzalez, MD, a neurologist and chief of staff at Hawaiʻi Pacific Neuroscience. “Carefully managed exercise can improve muscle conditioning, reduce overall fatigue over time, and significantly enhance mood and mental well-being, which is especially important when living with a chronic condition.”

But exercising when you have MG comes with additional challenges, so it’s best to work with your healthcare provider and a physical therapist who is familiar with MG to exercise safely. They may even recommend you hold off on exercise if you’re newly diagnosed.

“Oftentimes early in the disease, I tell patients, ‘Let’s wait until we get your symptoms under control,’” says Benjamin Becker, MD, a neuromuscular neurologist at the University of Michigan Health in Ann Arbor. “Once that happens, actively pursuing exercise is good.”

Challenges of Exercising With Myasthenia Gravis

For people with MG, fatigue can fluctuate throughout the day because the signal going from the nerve to the muscle is impaired and weakens with repeated muscle use.

Called fatigable weakness, this key feature of MG is a major challenge for exercising because it means “the more we work in exercise, the more we get tired,” says Xinli Du, MD, PhD, a neurologist with the department of neurology at VCU Health in Richmond, Virginia.

Setting Realistic Expectations

“If we’re still adjusting your medications,” Dr. Becker says, “I might say that 150 minutes is a great goal to get to, but we need to be very cautious about how we titrate your level of exercise.”

Regardless, how you go about getting the exercise you need will differ from people without MG.

Since your muscles will get weaker the harder you push them, the mentality of no pain, no gain “cannot apply to patients with MG,” Du says. Consistent, steady effort over time is safer and more effective than intense bursts of physical activity.

“You have to be in tune with your body, to let your body guide the process,” Du says. “This is not a reflection of you being weak. It's just being smart, being adaptive to what your body needs."

Safe Exercise Selection and Modification

Aerobic, strength, balance, and respiratory training should all be a part of your exercise plan.

Stick to low- to moderate-intensity exercises. Avoiding actions that are too strenuous and repetitive is important, since your muscles need additional rest. “You can also rotate through the muscle groups that you're exercising,” Du says.

Balance and flexibility training, such as through yoga or tai chi, can improve overall stability and help prevent falls. Start slowly at first, focusing on seated movements, if necessary. Yoga poses that focus on stretching rather than balance is a great way to get your body moving even if you feel tired.

Exercise Timing and Energy Conservation

For people with MG, timing exercise can make all the difference, since your fatigue fluctuates and you have to manage a limited budget of energy.

“For patients who experience worsening fatigue later in the day, exercising earlier in the day and in cooler temperatures is often better tolerated,” Dr. Gonzalez says. “We do know that heat can worsen weakness in MG, so patients are generally advised to avoid exercising in hot environments or during periods of excessive heat exposure.”

Whatever the case, you should always do your exercises in short intervals followed by rest. “Do 10 to 15 minutes of exercise, then give yourself a break and let the muscle rest, let the nerve and neuromuscular junction resettle, and then repeat," Du says.

Safety Red Flags

Research suggests that exercising is safe for people with well-controlled MG. But make sure to pause exercising and rest if you experience ocular symptoms like double vision. “I haven’t seen them develop during exercise with patients or heard it could happen,” Becker says, “but it might.”

Similarly, if you feel short of breath during exercise, take a break and rest. “If you’re not getting relief with rest, you might have overdone it and might have to talk to your provider,” Becker says.

The Takeaway

• Exercise is safe and encouraged for people with mild to moderate myasthenia gravis; it can improve muscle strength, reduce fatigue, support mental health, and enhance quality of life.
• The mindset of no pain, no gain doesn’t apply to people with MG; short intervals of low- to moderate-intensity exercise followed by rest are key to exercising safely.
• Exercise when your energy is highest (such as earlier in the day), and stay cool.
• Because each person with MG is different, work with a neurologist and physical therapist familiar with the condition to build a personalized exercise plan.