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Breathing exercises in ALS

Breathing exercises in ALS

Amyotrophic Lateral Sclerosis (ALS) is a progressive neuromuscular disease that attacks motor nerve cells in the brain (upper motor neurons) and spinal cord (lower motor neurons). 

In its initial stages, ALS causes loss of motor control. As the disease advances, it leads to motor impairment.

ALS is also known as Lou Gehrig’s disease, named after the American baseball player who was diagnosed with it.

One of the earliest signs of ALS is troubled breathing, excessive coughing, sleeping on propped up pillows at night (to ease breathing), and other respiratory issues.

Through this article, let’s learn about the various breathing problems one may experience in ALS, the right kind of breathing techniques, as well as the best treatment for ALS in India.

How does ALS affect lung function?

Breathing in and out is a result of the contracting and relaxing of the diaphragm and other muscles in your chest. The diaphragm is a large dome-shaped muscle between your lungs and abdomen. Along with the diaphragm, the intercostal muscles (between the ribs) support the breathing process. ALS weakens the diaphragm making it harder to inhale and exhale. As the patient’s breathing becomes more laboured, the shortness of breath leads to the body receiving less oxygen and expelling less carbon dioxide. 

In most cases, individuals do not notice respiratory symptoms until after an ALS diagnosis has been made. 

Early signs of respiratory issues

The weakening of the diaphragm leads to the following respiratory issues:

  • Fatigue
  • Shortness of breath during the day
  • Morning headaches
  • The need for frequent naps
  • Grogginess 
  • Trouble breathing while lying down

Maintaining respiratory strength and promoting airway clearance

Conserving energy

One of the first symptoms of ALS is the shortness of breath while performing physical activities. 

The best way to manage this is by simply taking breaks between tasks. Set up a schedule that takes into account the number of tasks you have to complete and the energy levels you’re running on. Activities like bathing, dressing, cooking, eating, etc. can take up a lot of your energy and time. Monitor your energy levels through the day. There may be days when you’re more energetic during the day. Some days you’ll find you’re better in the evenings. Let your schedule be flexible. 

Breathing techniques

Take 5-10 deep breaths that will allow the lungs to fully expand. This can be done several times during the day. Sit down in a comfortable chair or cross your legs and sit down on the floor (if possible). Declutter your thoughts and simply concentrate on your breathing. 

Breathing troubles at nighttime can be countered by raising the head of the bed (keep at incline). This hospital-style arrangement can be made at home as well. Just stack pillows under the head, neck, and back. You can also place a thick blanket or quilt under the head of the mattress. Remember to give adequate support to your neck and back when elevating the position of your head.

Coughing techniques

Coughing doesn’t necessarily mean there is infection. It is often a way to clear the lungs and airways of fluid, food particles, phlegm, or any other foreign particles that may have been inhaled. Coughing keeps the airways clean and reduces the risk of pneumonia.

However, ALS can make coughing difficult. Since the muscles in the chest are weak or are weakening, coughing may also be weak. This means the airways are not getting cleared well enough. A way to overcome this is breath stacking. Take a series of short breaths without exhaling. This leads to the ‘stacking’ of breaths in the lungs till they are full. Hold your breath for a few seconds and then exhale in one powerful gush!

Squeeze coughing or huffing involves taking two deep breaths and then pushing all the air out of your lungs in a series of huffs, with your mouth and vocal cords open. Repeat this several times to move the phlegm upwards in your lungs where it is easier to cough out. 

*Coughing equipment like resuscitator bags and ventilators may be used if breathing becomes very difficult and interferes with the oxygen levels in the lungs and body. 

**Yoga and meditation can also greatly support the diaphragm, and should ideally be a part of your daily exercise routine. 

Measuring respiratory efficiency

This is an important part of understanding how far the disease has advanced. Respiratory therapists will perform a variety of tests to measure respiratory efficiency. Some of these tests include:

  • Spirometer test 
  • Non Invasive Positive Pressure Ventilation (NIPPV)
  • Continuous Positive Airway Pressure (CPAP)
  • Bilevel Positive Airway Pressure (BiPAP)
  • Ventilation Positive Airway Pressure (VPAP)

Your doctor may also prescribe bronchodilators that open the airways and provide breathing respite.

Plexus Rehabilitation Program for ALS

ALS eventually impairs all most voluntary movements. So much so that day-to-day life is deeply impacted. It is important that both the patient and their caregivers are equipped with enough information about the disease as well as the available treatment options. Plexus’ regenerative rehabilitation for ALS is a holistic program that is aimed at boosting the health of the patient, while working through managing symptoms, slowing the rate of progression, and improving the patient’s overall quality of life.

Our comprehensive rehabilitation program consists of:

Stem cell therapy

Stem cell therapy is a type of regenerative treatment that puts the body’s natural healing mechanism into action to treat a number of conditions. Injected stem cells slow down the rate of neurodegeneration. They also possess the capacity to self-renew, regenerate cells, and repair damaged tissue. 

Plexus Neuro and Stem Cell Research Centre is India’s first ISO-certified stem cell research centre. Founded by Dr. Na’eem Sadiq, India’s foremost neurologist and acclaimed stem cell specialist, Plexus uses only autologous stem cells that have been taken from the patient’s own body. The procedure is performed by Dr. Sadiq, assisted by a team of highly-skilled and experienced stem cell specialists.


Exercise is the key to providing an extended lease on life to patients with motor neuron diseases like ALS. It helps improve posture and prevents joint immobility. As part of our rehabilitation program for ALS, our physiotherapists will draw up an exercise regime that is suited to your needs while also working to delay muscle weakness and atrophy as much as possible.

Occupational therapy

Do you find it difficult to perform daily activities like bathing or dressing up to meet friends? Because ALS interferes with motor function, mundane activities become more challenging. Occupational therapy can greatly improve the performance of these activities and allow the patient to lead an independent and confident life. Our occupational therapists will help you with exercises and activities that improve your fine motor skills and simultaneously address all sensory, cognitive, and physical challenges you may be facing.

Apart from the above, we also have speech-language pathologists and dietary nutritionists who help patients manage swallowing difficulties. ALS is a degenerative disease. As the muscles in the abdomen and chest weaken, the disease will impact breathing too. However, we can slow down the rate of progress (and therefore degeneration of muscles) through our rehabilitation program.

This program also comprises of:

  • Endurance training and fitness management
  • Functional stretching for relief from muscle stiffness
  • Hand function training
  • Functional splinting
  • Strengthening of muscles in the shoulder, neck, upper and lower limbs, and oral structures
  • Activities for daily living training
  • Energy conservation and work simplification training
  • Counseling and caregiver support 

Know more about our rehabilitation programs by calling us on

+91 89048 42087 | 080-2546 0886

080-2547 0886 | 080-2549 0886


Should ALS patients use oxygen?

Oxygen should be prescribed to ALS patients only as a palliative measure (when they are terminal). Oxygen can suppress respiratory drive which is basically channeled by carbon dioxide. The body intakes oxygen to produce carbon dioxide. Delivery of oxygen can increase the levels of carbon dioxide causing hypercapnia which can further lead to fatigue, headaches, respiratory failure, seizures, coma, etc.

What exercises are best for ALS patients?

Strengthening exercises with light weights, and aerobic exercises like walking, jogging, swimming, cycling, etc. are ideal for ALS patients. Group classes can also motivate them to stay committed to their exercise.

Why do people with ALS have breathing troubles?

ALS causes the degeneration of muscles in the chest and abdomen, specifically the diaphragm and intercostal muscles which are responsible for breathing. Because of the weakening of muscles, patients experience breathing troubles.

When does ALS affect breathing?

As the disease advances, ALS can severely impact breathing with many patients experiencing shortness of breath during the day (when they’re the most physically active).

What does ALS breathing feel like?

ALS patients experience shortness of breath. Along with their caregivers, patients must watch out for signs of respiratory distress and consult the doctor immediately if the breathing becomes laboured and difficult.

Does ALS cause phlegm?

Not a common symptom, but there are patients who develop thick secretions of phlegm in the back of the throat. This can interfere with swallowing too.

What helps with ALS cough?

Taking deep breaths, pacing yourself through the day, stacking of breath, and huffing can help with ALS cough.

Can you build muscle with ALS?

ALS is a degenerative disease. So as time passes, muscle degeneration and atrophy may be inevitable. Building muscles in the later stages is not possible. However, in the initial stages muscle-building may be possible. Having said that, exercise can help maintain/improve muscle tone, flexibility, and range of motion.


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