Written by Pablo Izquierdo
6 min read
The Consensus: Exercise May Help Prevent ALS but Certain Sports May Carry Greater Risk
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Amyotrophic lateral sclerosis (ALS), often known as motor neuron disease (MND), is a neuromuscular disorder leading to paralysis and muscle atrophy. Exercise could help against the disease and does no damage to patients, but head traumas increase the risk of developing it. This consensus is based on 4 experts answers from this question: Is exercise a risk factor for A.L.S?
Amyotrophic lateral sclerosis (ALS), a type of motor neuron disease (MND), is a disorder where motor neurons degenerate and eventually die. This leads to paralysis and can cause death of the patients, often due to respiratory problems. While some patients live with it for a long time (like the famous case of Stephen Hawking), most die within a few years of getting the first symptoms.
ALS links to athletic performance?
ALS leads to muscle degeneration, so many thought that being physically active could have a therapeutic benefit against muscle atrophy. However, the media reported several cases of top athletes getting the disease in the past few years, which prompted concern about the possibility that exercise could actually be ‘giving’ them ALS.
Early research seemed to suggest that more physically active people had a higher risk of ALS than the general population, according to neurology expert Luc Dupuis from the Inserm Institute in France. However, he explains, this could well be a mere correlation, whereby some people were more likely (because of other factors not taken into account) to become athletes and – separately – also develop ALS, rather than one event causing the other.
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Exercise can help protect against ALS
In any case, more recent evidence radically changed the way we think about this. A 2014 study led by Elisabetta Pupillo from the Mario Negri Institute in Italy looked at hundreds of people with and without ALS over the course of 4 years, and figured out how much exercise they did in their day-to-day lives. People with a higher level of physical activity, who played sports or indeed whose work involved physical exercise, were found less likely to get ALS. In other words, the study concluded that exercise is not a risk factor for ALS but – quite the contrary – may protect against it.
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Why do football players get ALS more often then?
There is a particular event though that does seem to increase your risk of getting ALS: hits to the head. According to Antonio Musaro, a neuroscience expert from Sapienza University in Rome, evidence suggests that more cases of ALS do happen among professional American football and soccer players. Sportspeople like American baseball legend Lou Lehrig suffered the disorder. Perhaps this explains why some people thought it was being physically active that was to blame.
A similar study in 2014 found that American football or soccer may indeed be a possible risk factor for developing ALS. It has also been found that soccer players not only have a higher risk of getting the disease but also develop it earlier on. More recently, Pupillo and colleagues ran a European-wide study with about 1,700 subjects from five different countries and concluded that traumatic events are in fact risk factors for ALS.
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So what to make of the ALS sports link?
Okay, so it is head traumas and not sport per se that increases your odds of developing ALS. The question then becomes whether exercise could help in therapy. As a patient with ALS, being physically active through tailored training could perhaps make up for the progressive degeneration of muscles that occurs in the disease. Expert Francesca Lanfranconifrom the University of Milan has been involved in research testing this idea. They recruited a group of sixteen ALS patients and sent half of them to the local gym while the other half continued with just their usual care. While the small scale of the study makes it difficult to draw conclusions, doing cycling and strength exercises improved fitness in those patients – and most of them were happy with the training plan. Adding to this, a recent review on the topic concluded that no damage has been found after bringing exercise into therapy.
ALS is a rare disease (affecting about 5 people in 100,000) so it makes sense that these studies are typically run using small groups of patients, which is in fact their main limitation. The effects of exercise can be mild and it remains unclear whether it delays the evolution of the disease in patients at all, but current evidence suggests that being physically active may be a good idea even for people that already have the disorder.
ALS, our experts agree, is a complex disease that affects a range of body systems. In most cases, the disorder does not have one specific trigger but many factors which combined can lead to it. Beyond head traumas, activities like smoking or drinking alcohol have been linked to increased risk of ALS by a recent study from China. Others, like education or indeed being physically active, seem to be protective. There is still no cure for ALS, so identifying which factors can prevent or delay it, or otherwise improve symptoms in patients – and then making changes in lifestyle and treatment plans – would be a big step forward.
Takeaway
Exercise is not going to give you ALS (it could actually help) but be careful with contact sports and keep your head safe from hits!
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