Exerciții pentru Charcot-Marie-Tooth (CMT) — moderată ESTE sigură (Burns 2017), EVITAȚI excentrica + căldura extremă

Pareyson 2009 + Skre 1974 prevalence data + Burns 2017 + Sman 2015 + Wallace 2019 RCT framework. Charcot-Marie-Tooth (CMT) is the most common hereditary peripheral neuropathy — prevalence 1:2500, with autosomal dominant CMT1A (PMP22 duplication ~70% of cases), CMT2 (axonal subtypes), CMT4 (autosomal recessive), and CMTX (X-linked). The clinical picture: progressive distal weakness + muscle atrophy starting in the intrinsic foot muscles + lower legs (the inverted-champagne-bottle appearance), pes cavus deformity, hammer toes, foot drop, sensory loss in the same distal distribution + areflexia. The exercise framework was DEBUNKED in modern RCTs: Burns 2017 + Sman 2015 + Wallace 2019 established that moderate aerobic + light resistance training IS safe in stable CMT and IMPROVES function — overturning the historic 'overuse damages the failing motor units' advice that left generations of CMT patients deconditioned and falling. The current envelope: moderate-intensity aerobic + light progressive resistance + balance work; AVOID eccentric loading (which selectively damages denervated muscle), AVOID extreme heat (compounds neuropathic symptoms), AVOID bare-foot exercise (sensory loss in feet = unfelt injury risk — wear protective footwear always). AFO or custom orthotic for foot drop. Annual cardiology check if CMT2 cardiomyopathy variant.

Volya's catalogue carries the foundation moves: supported-glute-bridge for posterior chain + hip extensor strength (compensates distal weakness), wall-push-up for scaled upper-body, scapular-retraction for posture (chronic gait + crutch use → upper-trap compensatory), cat-cow for spinal mobility, supine-knee-to-chest for low-back release, diaphragmatic-breathing for parasympathetic regulation + respiratory muscle endurance (rare diaphragmatic CMT subset), seated-march for managed cardio without ankle/foot risk, ankle-pump for circulation + distal-muscle ROM, sit-to-stand for functional + bone-loading. The AI coach also knows the nutrition side — Mediterranean anti-inflammatory backbone (Hoyle 2024 modest neuropathic benefit), protein 1.2-1.4 g/kg/day for muscle preservation (distal atrophy is the disability driver), calcium 1000-1200 + vit D for bone density (CMT patients have reduced BMD from reduced weight-bearing), omega-3 1-3 g/day, B12 + B6 + folate (AVOID B6 mega-doses >200 mg/day — paradoxically NEURITIS-inducing), alpha-lipoic acid 600 mg/day (modest neuropathic benefit per Ziegler 2011), AVOID alcohol excess + AVOID vincristine/taxanes/platinum if cancer comorbid (worsen CMT severity), diabetes screening (CMT2/CMTX elevated risk), footwear + diabetic-style foot inspection daily. CRITICAL: CMT Association + Muscular Dystrophy Association (MDA) + Hereditary Neuropathy Foundation (HNF) + neurology + PT (CMT-experienced) + orthotist + podiatry + cardiology if CMT2 variant + dietitian. This is NEVER a replacement for neurology + multispecialty care.