Exercise as it relates to Disease/The Role of Exercise in Managing Charcot Marie Tooth Disease

Charcot Marie Tooth (CMT) disease is a broad term describing any inherited peripheral nerve disorder. CMT can be broken down into different categories based on the pattern of inheritance, the gene(s) responsible and whether the nerve axons or the myelin surrounding them is affected. It is the most common disorder affecting peripheral nerves and is estimated to affect 1 in 2,500 people. As CMT occurs when the axons or myelin of nerves are damaged, the body’s ability to relay information between the brain and other parts of the body is negatively affected. The lower limbs, especially the feet are usually the first place affected by CMT.

Effects of CMT
The symptoms present can vary significantly between patients. However, some common symptoms include:
 * Sensory loss (e.g.- temperature, vibration, proprioception)
 * Impaired balance
 * Muscle weakness (especially in the distal portion of the limb)
 * Muscle atrophy (reduction in muscle size)
 * Abnormal gait
 * Cavus foot (high arched foot)
 * Fatigue
 * Hypo- or areflexia (diminished or absent reflexes)
 * Neuropathic pain

Treatment Options
Currently there is no cure for CMT, so treatment is based on managing symptoms and improving quality of life. Some common treatment strategies include:
 * Physiotherapy
 * Orthotics and leg braces
 * Surgery
 * Pain relief medication
 * Exercise

What Can Exercise Do?
Many of the symptoms mentioned earlier can be eased by exercise, especially in the early stages of the disease. Exercise can improve patient quality of life in the following ways:


 * Resistance exercise can improve muscular strength in CMT patients, allowing them to perform activities of daily living more efficiently.


 * Interval training in CMT patients has been shown to improve cardio-respiratory fitness, dynamic strength and walking speed (both on flat ground and stairs).


 * Continuous aerobic training increases cardiovascular fitness and day to day functioning of people suffering from neuromuscular diseases.

Considerations for Exercise Prescription
As balance is negatively affected by CMT, activities that require continuously moving the feet off the ground such as running and jumping may be dangerous. Alternatives to these activities include:
 * Exercise bike
 * Rowing machine
 * Swimming
 * Water aerobics