Ejercicios para dermatomiositis — resistencia gradual ES segura (Alexanderson 2019), cribado de cáncer OBLIGATORIO

ACR/EULAR 2017 + 2023 IMACS criteria framework. Dermatomyositis is part of the idiopathic inflammatory myopathy (IIM) family alongside polymyositis, inclusion body myositis, and immune-mediated necrotising myopathy. DM is defined by proximal symmetric muscle weakness (shoulder + hip girdle) + the classic skin features: Gottron papules (over MCP/PIP/DIP joints), heliotrope rash (violaceous eyelid discoloration), shawl sign + V-sign (sun-exposed area photo-distribution), mechanic's hands. The single most important diagnostic discipline: cancer screening is MANDATORY at diagnosis and on ongoing surveillance — Hill 2001 meta-analysis showed ~25% of adult DM cases are associated with occult malignancy within 3 years. ILD is common, especially with anti-MDA5, anti-PL-7, anti-PL-12 myositis-specific antibodies. The exercise programming priority: Alexanderson 2019 + de Souza 2016 RCTs OVERTURNED the long-held 'don't exercise' advice — graded resistance + aerobic training IMPROVES strength + function + disease activity in DM WITHOUT worsening CK or muscle damage. Photosensitivity → indoor or UV-protected exercise (UPF-50 + SPF 50+); the photo-distribution of the rash means sun is a real trigger.

Volya's catalogue carries the foundation moves: supported-glute-bridge for posterior chain (DM hip-girdle weakness pattern), wall-push-up for scaled upper-body strength (DM shoulder-girdle), scapular-retraction for posture (proximal weakness affects shoulder positioning), cat-cow for spinal mobility, supine-knee-to-chest for low-back release, diaphragmatic-breathing for parasympathetic + ILD-aware (anti-MDA5 ILD risk), standing-march for managed cardio, sit-to-stand for proximal lower-body functional + bone-loading (steroid osteoporosis), calf-raise-rehab for posterior-chain + bone-loading. The AI coach also knows the nutrition side — Mediterranean anti-inflammatory backbone (Lundberg 2023), protein 1.4-1.6 g/kg/day for anabolic resistance from steroids + active disease, leucine threshold per meal 2.5-3 g (beans + lentils + tofu + tempeh + dairy + eggs + fish), creatine 3-5 g/day under rheumatology (Chung 2007: improves strength + function in DM/PM), vitamin D often low target 40-60 ng/mL, omega-3 1-3 g/day for muscle protein synthesis adjunct, swallowing weakness soft + moist textures + SLP eval if dysphagia (esophageal striated muscle in upper third + diaphragm), photosensitivity → indoor or UV-protected, ILD modifier omega-3 + pulmonary nutrition, steroid-induced glucose + bone + DEXA per ACR. CRITICAL: The Myositis Association (TMA) + Myositis Support and Understanding (MSU) + ACR + IMACS + rheumatology + dermatology + pulmonology if ILD + GI/SLP if dysphagia + oncology surveillance + dietitian familiar with IIM. This is NEVER a replacement for rheumatology + oncology surveillance.