make comments -s there are many different research studies regarding the positive aspects of physical
activity and ALS, researchers have begun to test different exercise interventions to help patients
maintain quality of life. As mentioned in the previous sections, ALS causes weakness in the
lower limbs, resulting in limitations on movement, as well as fatigue and pain (Morioka et al.
2022). Recently, the hybrid assistive limb (HAL), was created as the “world’s first cyborg-type
wearable robot that supports gait training based on the wearer’s intended motion” (Morioka, et
al. 2022). This device detects bioelectrical signals on the skin’s surface and provides support for
the wearer’s intended motion (Morioka et al. 2022). This device is usually used for patients who
have suffered from a stroke, spinal injury, cerebral palsy, and other various diseases that cause a
walking disability (Morioka et al. 2022). In a study conducted by Morioka et al., they aimed to
assess the long-term effect of hybrid assistive limb (HAL) treatment on gait in patients with
ALS. Using HAL when training allows the subject to “walk repeatedly and intentionally in an
errorless pattern without causing fatigue or adverse effects” (Morioka et al. 2022). There were 3
courses in this study with a four- to five-week duration for each course, during which the
treatment was performed nine times with a rest period of at least two months between each
course (Morioka et al, 2022). Gait ability, ALS Functional Rating Scale-Revised, as well as
Respiratory function tests were performed before and after each course to observe improvements
(Morioka et al. 2022). In this study, they found that cadence for each patient significantly
improved in their 10-m walk test as well as improvements in their two-minute walk test
(Morioka et al. 2022). The subject’s Amyotrophic Lateral Sclerosis Functional Rating Scale-
Revised (ALSFRS-R) scores and percent FVC were generally maintained given the progression
of the disease (Morioka et al. 2022). They concluded that long-term repetitive gait training with
HAL can preserve gait function for about a year in patients with ALS (Morioka et al. 2022).
Briefly mentioned in the previous section, another exercise intervention for patients with
ALS is individualized aerobic exercise using the B-FIT program. The B-FIT training guide is
essentially a therapist and patient manual (Voorn et al. 2021). This manual consists of
background information for aerobic exercise, practical instructions and protocols, and other
various information to evaluate aerobic exercise for different types of neuromuscular diseases
(Voorn et al. 2021). In a study conducted at the University of Amsterdam, they used the B-FIT
program on fifteen different patients diagnosed with a neuromuscular disease. Utilizing the B-
FIT, they concluded that it is viable and has the potential to improve physical fitness in a wide
variety of progressive neuromuscular diseases (Voorn et al. 2021).
Fatigue and Disease Prevention
ALS is a terminal, progressive neurological condition without a cure. Fatigue is a
common symptom, which can be defined as “reversible motor weakness and whole-body
tiredness that is only partially relieved by rest” (Gibbons et al. 2018). It can be experienced as a
feeling of tiredness or lethargy. For people with ALS, fatigue can develop into objective motor
fatigue, which is unique to those with neuromuscular diseases and not normally within a person’s
experience (Gibbons et al. 2018). In Yu et al.’s study mentioned in a previous section, by
researching how the environment plays a role in one’s chance of being diagnosed with ALS, they
found that a majority of their randomly selected ALS patients in the study reported outside
exposures such as yard fertilizers and pesticides in the last 30 years (Yu et al. 2014). As ALS is
genetic and can be diagnosed due to environmental factors, it is not preventable