Exerciții pentru distrofia musculară Becker (BMD) — aerobic submaximal SIGUR + cardiomiopatie disproporționată față de slăbiciune (Birnkrant 2018)

Bushby 2010 + Birnkrant 2018 (DMD/BMD shared multidisciplinary care framework) + Hoffman 1988 (original DMD/BMD allelic delineation) + Connolly 2014 + Voet 2019. Becker muscular dystrophy is an X-linked recessive disorder caused by IN-FRAME mutations of the DMD gene, producing PARTIAL dystrophin protein (in contrast to DMD's near-null) — phenotype is milder, later-onset, and slower progression. Ambulation is typically retained to adulthood (in contrast to DMD's loss by 9-13 years). However, CARDIOMYOPATHY is DISPROPORTIONATE to skeletal weakness in BMD — it becomes the leading mortality cause, often manifesting before significant skeletal involvement and frequently in middle adulthood. Annual echocardiogram + ECG + Holter per Birnkrant 2018 are non-negotiable; cardiac MRI for early dilated cardiomyopathy detection per Connolly 2014; treatment per heart failure guidelines + ICD threshold lowered for sustained arrhythmia. Female carriers (mother/sister/daughter) also at cardiomyopathy risk — carrier echo screening per Birnkrant 2018. Exercise framework: submaximal aerobic + low-impact (swim, cycle, water-based) IS safe and supports function; AVOID eccentric overload (same dystrophinopathy vulnerability as DMD); daily ROM + scoliosis prevention helpful. Steroid use is OPTIONAL in BMD (less established benefit than DMD) — discussed case-by-case with neurology.

Volya's catalogue carries the foundation moves: supported-glute-bridge for posterior chain low-intensity (NOT max-effort), wall-push-up for upper-body push at low load, scapular-retraction for upper-back posture, cat-cow for spinal mobility, supine-knee-to-chest for low-back release + hip flexor stretch, diaphragmatic-breathing for respiratory training (less critical than DMD but foundational), seated-march for cardio without joint impact, ankle-pump for circulation + distal-muscle ROM + DVT prevention, calf-raise-rehab for distal-strength preservation. The AI coach also knows the nutrition side — cardiac-protective Mediterranean + omega-3 1-2 g/day + low-sodium <2 g/day + cardiology team (the cardiomyopathy axis is THE mortality driver), caloric balance per individual sustained-mobility profile (BMD typically near general population needs vs DMD's tightrope), protein 1.2-1.5 g/kg + leucine 2.5-3 g per meal, Ca 1000-1200 + vit D 1000-2000 IU + weight-bearing within ability + DEXA (bone density risk from reduced mobility + later-life falls + steroid IF prescribed), creatine 3-5 g/day modest benefit (Tarnopolsky 2004 + Banerjee 2010), AVOID ultra-processed + SSBs + excess alcohol (cardiac + bone). CRITICAL: MDA + PPMD (BMD included) + Duchenne UK + CureDuchenne + neurology (BMD-experienced) + cardiology (annual echo + ECG + Holter + early intervention) + pulmonology if symptomatic + dietitian + family genetic counselling + carrier sister/daughter cardiac screening. This is NEVER a replacement for BMD-experienced multidisciplinary care.