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Effects of a 12-week combined aerobic and strength training program in ambulatory patients with amyotrophic lateral sclerosis: a randomized controlled trial



To compare the effectiveness of a combined aerobic, strength, and flexibility training program with flexibility alone on disease-specific and health-related symptoms in ambulatory amyotrophic lateral sclerosis (ALS) patients.


Thirty-two ambulatory patients with ALS were equally randomized into a combined aerobic-strength intervention group or a stretching control group. The intervention period for both groups was identical, 12 consecutive weeks, two sessions per week. The combined intervention program consisted of aerobic training by recumbent cycling, flexibility achieved by stretching and passive exercises, and strength training via functional exercises. Patients in the control group performed basic stretching exercises of the upper and lower limb at home. Outcome measures included the ALS Functional Rating Scale-Revised (ALSFRS-R), respiratory function, mobility, fatigue, and quality of life and were collected 1-week prior to the intervention, after 6-weeks of training, and at the completion of the intervention.


Twenty-eight participants (17 males, 11 females); mean age (S.D.) = 58.5 (13.2) years; mean disease duration (S.D.) = 7.3 (12.0) years, completed the study. According to the group X time analysis, significant differences were found in respiratory function, mobility, and the ALSFRS-R in favor of the aerobic-strength group. These patients maintained their abilities, whereas, a significant decrease was observed in the flexibility training group. Scores of the SF-36 categories “physical functioning”, “energy fatigue” and “wellbeing” were higher following the intervention in the aerobic-strength group compared with the stretching control group.


A 12-week combined aerobic and strength training program is far superior to flexibility alone in improving respiratory function, mobility, and wellbeing in ambulatory ALS patients.

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We thank the staff of the Pulmonary Institute, Rabin Medical Center and the participating subjects for their cooperation.



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Authors and Affiliations



AK: conceptualization, methodology, formal analysis, visualization, writing original draft. IM: investigation, data curation, formal analysis, writing – review & editing. IW: methodology, investigation. DR: data curation. GRB: data curation. MH: data curation. MRK: writing – review and editing, supervision.

Corresponding author

Correspondence to Alon Kalron.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

The study was approved by the Rabin Institutional Review Board Ethics Committee (Ethics ref. 0287–17-RMC).

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Kalron, A., Mahameed, I., Weiss, I. et al. Effects of a 12-week combined aerobic and strength training program in ambulatory patients with amyotrophic lateral sclerosis: a randomized controlled trial. J Neurol 268, 1857–1866 (2021).

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  • Amyotrophic lateral sclerosis
  • Physical activity
  • Exercise
  • Aerobic
  • Strength
  • Neurological