Exercícios para distrofia muscular da cintura (LGMD) — 30+ subtipos, vigilância cardíaca/respiratória por subtipo, aeróbico moderado + força leve SEGUROS

Narayanaswami 2014 AAN/ANEM + Straub 2018 + LGMD Awareness Foundation + Mercuri 2019. Limb-girdle muscular dystrophy is not one disease but a heterogeneous group of 30+ genetic subtypes, differing dramatically in cardiac risk, respiratory risk, age of onset, and prognosis. Major split: autosomal recessive (LGMD2/R, most common globally) vs autosomal dominant (LGMD1/D). The most common AR subtypes include LGMD2A (calpainopathy, most common globally, typically cardiac-spared), LGMD2B (dysferlinopathy, very late-onset, distal involvement, exercise-triggered acute rhabdomyolysis caution), LGMD2C-2F (sarcoglycanopathies, CHILDHOOD onset DMD-like, HIGH cardiac risk), LGMD2I (FKRP, variable severity, cardiac + respiratory risk). The most common AD subtypes include LGMD1B (LMNA laminopathy — VERY HIGH arrhythmia + sudden cardiac death risk, ICD threshold lowered per Anselme 2008). GENETIC CONFIRMATION IS MANDATORY — without it cardiac surveillance plan is guesswork. Cardiac risk subtypes need annual echo + ECG + Holter from diagnosis; LGMD1B/LMNA needs surveillance starting BEFORE skeletal symptoms because sudden death may precede weakness. Respiratory: LGMD2I + LGMD2A + others may develop respiratory failure later; spirometry baseline + serial. Exercise per Olsen 2005 + van der Kooi 2007 + Sveen 2007: moderate aerobic + light strength IS safe and IMPROVES function across LGMD subtypes; AVOID exhaustion + AVOID eccentric peak loading; LGMD2B (dysferlinopathy) specifically — AVOID maximal exertion (rhabdomyolysis risk).

Volya's catalogue carries the foundation moves: supported-glute-bridge for posterior chain low-intensity (proximal pelvic-girdle weakness is the LGMD presentation), wall-push-up for upper-body push at low load (shoulder-girdle weakness common), scapular-retraction for upper-back posture + scapular stabilisation, cat-cow for spinal mobility, supine-knee-to-chest for low-back release + hip flexor stretch, diaphragmatic-breathing for respiratory training (subtype-specific need), seated-march for cardio without joint impact, ankle-pump for circulation + distal ROM + DVT prevention, sit-to-stand for functional + bone-loading within ability + balance. The AI coach also knows the nutrition side — protein 1.2-1.5 g/kg + leucine 2.5-3 g per meal anabolic threshold, cardiac-protective Mediterranean + omega-3 + low-sodium for at-risk subtypes (LGMD1B/LMNA + 2C-F sarcoglycanopathies + 2I FKRP), Ca + vit D + weight-bearing + DEXA for bone, individualised caloric per subtype + mobility status, AVOID ultra-processed + alcohol excess (cardiac), creatine 3-5 g/day modest benefit (Walter 2002 + Tarnopolsky 2004), consider CoQ10 100-200 mg if statin-prescribed (mitochondrial component). CRITICAL: LGMD Awareness Foundation + Coalition to Cure Calpain 3 (LGMD2A) + Jain Foundation (LGMD2B/dysferlinopathy) + Sarcoglycanopathy CARE + Speak Foundation (LGMD2I) + Cure CMD + MDA + neurology (LGMD-experienced) + GENETIC CONFIRMATION + cardiology (subtype-specific from diagnosis if at-risk) + pulmonology if respiratory subtype + PT/OT + dietitian + family genetic counselling. This is NEVER a replacement for LGMD-experienced multidisciplinary care.