CMT AND THE IMPORTANCE OF EXERCISE
A key element of managing CMT is frequent exercise. Done correctly, this can help prevent injury, and make challenging tasks easier over a period of time. However, understanding how CMT can impact a person regarding sport and fitness should be considered, in order to make the most of time spent exercising and to prevent injury.
WHERE DO I BEGIN?
ASSESSING YOUR CAPABILITY
Prior to starting any exercise program, you should always consult with a health professional who will be able to assess your personal capacity for exercise. If done incorrectly, exercise can cause injuries and therefore it is essential to know your limits before you begin. A qualified health professional should be able to assess where there may be any potential muscular or skeletal weaknesses, as well as provide other information such as excessively tight muscles, limitations in range of motion and provide exercise advice based on your overall health.
STARTING WITH CMT
For any exercise program to be effective, a basic understanding of how CMT impacts the body, as well as how the body works, is needed, otherwise hours can be spent with no positive outcome, or worse still, injuries can occur. Adopting the correct posture for any exercise, referred to as form, is essential for people to avoid injury, and more so in people with CMT due to lack of sensation hindering the physical sensation of pain.
UNDERSTANDING THE IMPACT OF CMT
CMT has a profound impact on muscle mass and strength, and the mechanical workings of the lower body. A person with CMT is likely to have reduced muscle mass in certain areas of the body, such as the lower legs and arms, as well as the feet and hands, caused by irreversible muscle loss. The irreversible muscle loss is the result of a process called fatty atrophy, where the nerves can no longer communicate with the muscle properly, resulting in muscle fibers turning to fat. While it is possible to increase the remaining muscle (via hypertrophy), fatty atrophy is currently irreversible, with potentially the only method of balancing it out being through increasing muscle fibers through muscle hyperplasia, although currently the mechanisms of this are not well understood. Muscular weakness can also result in muscle imbalances causing the body to use other, less efficient muscles in place of the regular muscle. This can lead to unknown muscular imbalances not seen prior to exercise, therefore any new exercise program should be adopted gradually. Also for the majority of people with CMT, due to high arched feet and other mechanical impairments, only low-impact sports and fitness routines should be considered.
START WITH THE BASICS
If you do not have a regular exercise program or have not exercised for a while, then it is best to start with the basics; light exercise in moderation. Start slowly over a few weeks to see how your body responds to exercise and adjust any exercise program appropriately.
CONSISTENCY IS KEY
For exercise to be effective, you will need to be consistent in how much you exercise. The UK National Health Service recommends adults to do at least 150 minutes of moderate intensity activity a week or 75 minutes of vigorous intensity activity a week. The US Department of Health and Human Services has similar guidelines for adults: at least 150 minutes to 300 minutes a week of moderate-intensity, or 75 minutes to 150 minutes a week of vigorous-intensity aerobic physical activity, preferably spread throughout the week. These guidelines can be typically reflected by exercising three times a week.
EATING CORRECTLY
To make the most of exercising, having a good diet is crucial, otherwise your goals may not be possible. Make sure to be eating healthy food in moderation. How much a person should eat depends on several factors: age, weight, height and exercise frequency. Basic guidelines from the NHS recommends eating 5 portions of fruit or vegetables a day and, where possible, limit intake of sugar, salt and saturated fats. The US HHS provides detailed advice on a healthy diet in the 2015-2020 Dietary Guidelines for Americans.
WHAT TO LOOK OUT FOR
CMT can lead to muscle weaknesses and other mechanical and physical issues that should be taken into consideration before exercising
Poor Balance
Most people with CMT have poor balance due to a combination of the shape of the foot (high-arched), lack of sensation in the feet, and tight muscles extending from the hips down to the feet. When exercising, it is important to choose a form of exercise that does not rely on good balance. Assisted exercises using weight machines within a gym to help ensure correct posture is one way of working around this issue.
Limited Foot Movement
The range of movement for the feet and lower leg can be severely limited by CMT, an example of which would be tight Achilles tendons preventing the knee from being able to extend over the foot. This means that any exercise that requires a good range of motion in the lower legs risks causing injury through poor posture and should not be attempted without compensating for this lack of movement e.g. using a solid platform to raise the heel when performing a squat.
Lack of Sensation in the Feet and Legs
The lack of sensation in the feet, legs and potentially hands of people with CMT must be taken into account when exercising. If injuries occur, they may be of a greater significance due to the delay in becoming aware of the injury. As someone with CMT, when exercising, be cautious with new exercises and when training new muscle groups. Always adhere to a good form when exercising.
Weak Forearms and Grip
In certain exercise programs, having weak forearms and a grip can limit yourself as to what can be done and can become a risk. Any sport or exercise that requires a firm grip should be treated carefully.
WHAT EXERCISE TO CHOOSE?
The key to choosing an exercise to help with your health and, where possible, minimise the impact of CMT on your daily life, is to choose one you are able to do frequently and enjoy, while also taking into the limitations of CMT, such as a fitness regime that has a low impact on joints, and does not require good balance. Below are several examples:
SWIMMING
Swimming is a great way to start exercising regardless of age or severity of CMT. Being a low impact sport, it will help minimise the chance of injuries and can help strengthen the body while improving cardiovascular health. If you are new to swimming, it may be prudent to have a trainer for a few sessions to ensure your technique is correct.
STRENGTH TRAINING
Strength training in a gym is a highly effective way of improving health and fitness while being able to target specific muscles with dedicated workouts. If you have not used a gym before, a gym instructor should introduce you to the different equipment available, which will vary gym to gym.
PILATES & YOGA
Pilate and Yoga can provide many benefits to people with CMT, from being a way of improving cardiovascular health to improving strength and ensuring that stretching, a fundamental necessity to limiting the impact of CMT, is undertaken. There are also the mental health benefits that both can provide, which some people may find beneficial.