Oefeningen bij Duchenne-spierdystrofie (DMD) — VERMIJD excentriek + submaximale aerobic IS veilig + multidisciplinaire kliniek

Bushby 2010 + Birnkrant 2018 DMD care considerations framework. Duchenne muscular dystrophy is an X-linked recessive disorder caused by DMD gene mutations resulting in absence of dystrophin protein, leading to progressive muscle fiber necrosis. Male predominance ~1:3500-5000 live male births. Clinical course: onset 2-5 years with proximal weakness, Gowers' maneuver (climbing up the legs to stand from floor), calf pseudohypertrophy (fatty replacement), loss of ambulation by 9-13 years (median ~11 years modern era), cardiomyopathy and respiratory weakness becoming leading mortality causes. Treatment: corticosteroids (deflazacort or prednisone) standard of care across all ambulatory + early non-ambulatory phases (delays loss of ambulation by 2-5 years); exon-skipping therapies for specific exon-amenable mutations (eteplirsen / golodirsen / casimersen / viltolarsen); gene therapy (Elevidys, FDA-approved 2023); ataluren in Europe for nonsense mutations. Exercise framework per Markert 2013 + Jansen 2010 + Voet 2019: AVOID eccentric loading (high-force lengthening contractions worsen the membrane damage in dystrophin-deficient fibers — heavy resistance is contraindicated), submaximal aerobic activity + low-impact training (swimming, stationary cycling, water-based) IS safe and supports function, daily stretching + range-of-motion + scoliosis prevention is non-negotiable. Multidisciplinary clinic care per Birnkrant 2018 reduces mortality and improves quality of life — referral to a designated DMD center at diagnosis is high-impact.

Volya's catalogue carries the foundation moves: supported-glute-bridge for posterior chain low-intensity activation (NOT max-effort), cat-cow for spinal mobility, supine-knee-to-chest for low-back release + hip flexor stretch, diaphragmatic-breathing as the central respiratory training (the diaphragm is the lethal vector — dedicated breath training preserves function longer), pursed-lip-breathing for dyspnea + respiratory muscle endurance, seated-march for cardio without joint impact (especially during ambulatory-to-non-ambulatory transition), ankle-pump for circulation + distal-muscle ROM + DVT prevention, supine-hip-abduction for hip-girdle balance + scoliosis-related compensatory work, chin-tuck for cervical posture (forward-head from chronic positioning). The AI coach also knows the nutrition side — caloric balance is the DMD-specific challenge (steroid + reduced mobility = weight gain risk → CV + ortho + transfer burden), individualised caloric intake aligned with actual activity per Davidson 2020 + Pessolano 2016, protein 1.2-1.5 g/kg + leucine 2.5-3 g per meal, calcium 1000-1200 + vit D + weight-bearing within Bethesda limits + DEXA per Birnkrant 2018 (very high fracture risk from steroid + immobility), cardiomyopathy modifier low-sodium <2 g/day + Mediterranean + omega-3 + cardiology team, steroid effects low-glycaemic Mediterranean + glucose monitoring, respiratory failure BiPAP + cough assist + adequate caloric/protein, dysphagia later stages SLP + texture modifications + PEG, creatine monohydrate 3-5 g/day modest benefit (Tarnopolsky 2004 + Banerjee 2010), AVOID ultra-processed + SSBs + under-feeding + over-feeding. CRITICAL: Muscular Dystrophy Association (MDA) + Parent Project Muscular Dystrophy (PPMD) + Duchenne UK + CureDuchenne + neurology (DMD-experienced, ideally certified care center) + cardiology + pulmonology + endocrinology + orthopedics + SLP + GI + dietitian + family genetic counselling + carrier sister screening. This is NEVER a replacement for DMD-center multidisciplinary care.