Übungen bei Myasthenia gravis (MG) — abgestufte niedrige Intensität IST sicher (Westerberg 2018), Hitze VERMEIDEN, Mittagsruhe

MGFA 2020 task force + Sanders 2016 ICER framework. Myasthenia gravis is an autoimmune disease of the neuromuscular junction — AChR antibodies ~85%, MuSK ~5%, LRP4, and seronegative subtypes. The cardinal feature is fluctuating muscle weakness that gets worse with use and better with rest (the metabolic signature of the diagnosis). Ocular involvement — ptosis + diplopia — is the first sign in 50-60% of patients; 80% generalise. Bulbar symptoms (dysphagia + dysarthria + chewing fatigue) and respiratory weakness (myasthenic crisis = ICU intubation) are the safety vectors. Treatment is multi-modal: pyridostigmine + corticosteroids + IVIG + plasmapheresis + immunosuppressants (azathioprine, mycophenolate) + biologics (rituximab, eculizumab, ravulizumab, efgartigimod) + thymectomy if AChR+ generalised. Westerberg 2018 + Birnbaum 2021 RCTs established that graded low-intensity aerobic + light resistance exercise IS safe in stable disease — this overturned the historic 'rest only' advice that left MG patients deconditioned and falling. Exercise priorities: graded low-intensity + frequent rest pacing + mid-day rest non-negotiable + AVOID heat (Lambert sign — heat compounds weakness in MG; cool down between sets, avoid hot yoga, summer mid-day exercise OUTSIDE), AVOID exhaustion (the cardinal worsening trigger).

Volya's catalogue carries the foundation moves: supported-glute-bridge for posterior chain low-intensity work, wall-push-up for scaled upper-body strength (NOT bench press to failure), scapular-retraction for posture, cat-cow for spinal mobility, supine-knee-to-chest for low-back release, diaphragmatic-breathing for parasympathetic + respiratory muscle training (the central MG skill — train the diaphragm because respiratory weakness is the lethal vector), standing-march for managed cardio, sit-to-stand for functional + balance, ankle-pump for circulation. The AI coach also knows the nutrition side — bulbar dysphagia modifier (if present) soft + moist textures + small bites + sit upright 30+ min post + chin-tuck swallow per SLP, AVOID quinine + tonic water + bitter aperitifs (unmask MG weakness), AVOID magnesium IV high-dose + magnesium-rich oral laxatives (neuromuscular blockade compound), Mediterranean anti-inflammatory backbone (Tasli 2024 + Hertel 2022), steroid-induced effects low-sodium + Ca + vit D + DEXA, AVOID alcohol excess (medication interactions + falls), vit D often low target 40-60 ng/mL, B-complex + folate (methotrexate folate depletion). CRITICAL medication-watch card: AVOID aminoglycosides + fluoroquinolones + non-depolarizing NMB + magnesium IV — keep written list with anesthesia/ED. CRITICAL: Myasthenia Gravis Foundation of America (MGFA) + Conquer MG + neurology + ophthalmology + SLP + pulmonology + thymectomy team + dental + emergency action plan. This is NEVER a replacement for neurology + multispecialty care.