Exercises for spinocerebellar ataxia (SCA) — graduated aerobic + balance reduces SARA (Miyai 2012 + Bauman 2018)

Klockgether 2019 + Schöls 2004 + Bauman 2018 meta-analysis + Miyai 2012 RCT framework. Spinocerebellar ataxias are a family of >48 genetic subtypes (SCA1-SCA48+), mostly autosomal-dominant CAG repeat expansions in trinucleotide-repeat genes. SCA1, SCA2, SCA3 (Machado-Joseph), SCA6, and SCA7 account for the majority of clinical cases globally. The clinical picture: progressive cerebellar ataxia (gait, then trunk + limb + speech) + dysarthria + nystagmus + variable subtype-specific features. SCA2 and SCA3 often have parkinsonism or dystonia overlap; SCA7 has retinal degeneration. No disease-modifying therapy exists yet; riluzole showed modest benefit in Romano 2015. The exercise framework — Miyai 2012 RCT + Bauman 2018 meta-analysis + Synofzik 2014 review — establishes that graduated aerobic + balance training + light progressive resistance reduces the SARA ataxia score and improves quality of life and functional capacity. Balance training is the CORE intervention, parallel to the FRDA framework: vestibular + visual + somatosensory exercises in a safe environment with progressive challenge. Heel-to-toe walking + tandem stance + single-leg stance are foundational. AVOID falls (cerebellar gait + lower-extremity weakness = high fall risk); use assistive devices appropriately.

Volya's catalogue carries the foundation moves: supported-glute-bridge for posterior chain + bone-loading within balance limits, scapular-retraction for posture, cat-cow for spinal mobility, supine-knee-to-chest for low-back release, diaphragmatic-breathing for parasympathetic + breath control + dysarthria respiratory support, single-leg-stance as the balance progression entry point, tandem-stance for balance progression, heel-to-toe-walk for gait-specific cerebellar retraining, sit-to-stand for functional + bone-loading. The AI coach also knows the nutrition side — Mediterranean backbone, dysphagia progression SLP eval EARLY + texture modifications + chin-tuck swallow training + sit upright 30+ min post-meal + aspiration vigilance, protein 1.2-1.4 g/kg, calcium 1000-1200 + vit D + weight-bearing within balance limits, omega-3 1-3 g/day, CoQ10 100-300 mg/day modest benefit in SCA2/SCA6/SCA7 per Mancuso 2010 + Cooper 2014, vit E + B12 + folate, AVOID alcohol excess (ataxia + falls + dysphagia compound), SCA7 retinal lutein + zeaxanthin (food-first leafy greens) + omega-3 + Mediterranean, SCA2/SCA3 parkinsonism timing of Mediterranean + protein around levodopa (LAT1 competition), diabetes screening (some subtypes elevated risk + metabolic comorbidity). CRITICAL: National Ataxia Foundation + Ataxia UK + euroSCA + FARA cross-resources + MDA + neurology (ataxia-experienced) + PT/OT (balance-focused) + SLP if dysphagia + ophthalmology if SCA7 + cardiology if subtype-specific + genetic counselling + dietitian. This is NEVER a replacement for ataxia-experienced multidisciplinary care.