Упражнения при миотонической дистрофии (DM1/DM2) — умеренная аэробика + лёгкая сила БЕЗОПАСНА (Voet 2019) + кардио-наблюдение обязательно

Bird 1993/2021 + Thornton 2014 + IDMC 2018 consensus framework. Myotonic dystrophy is the most common adult-onset muscular dystrophy, prevalence ~1:8,000 (Type 1 + Type 2 combined). Type 1 (Steinert / DMPK CTG repeat expansion, autosomal dominant with anticipation — children may inherit larger expansion and more severe phenotype; congenital form possible from maternal genotype) is more severe than Type 2 (CNBP CCTG expansion, adult-onset, no congenital form). Both are multisystem: skeletal myotonia (sustained contraction with delayed relaxation — grip release delay, percussion myotonia) + weakness (distal Type 1 — face/forearm/foot drop; proximal Type 2 — thighs/hips), CARDIAC CONDUCTION abnormalities with sudden-death risk (annual ECG + Holter + Wahbi 2012 lower ICD threshold than general population — first-degree AV block + bifascicular block = consider ICD), insulin resistance ~30-40% (type 2 diabetes earlier-onset), iridescent posterior subcapsular cataracts (Christmas-tree colours), oropharyngeal + esophageal dysphagia, obstructive sleep apnea ~30-40%, executive dysfunction + apathy, frontal balding + testicular atrophy in Type 1 men. Exercise per Voet 2019 + Roussel 2019: moderate aerobic + light strength IS safe and reduces weakness + fatigue without raising CK — overturned the cautious 'avoid all exercise' framing.

Volya's catalogue carries the foundation moves: supported-glute-bridge for posterior chain low-intensity activation, wall-push-up for upper-body push at low load (proximal weakness more in Type 2 + distal-to-proximal progression Type 1), scapular-retraction for upper-back posture + shoulder weakness, cat-cow for spinal mobility, supine-knee-to-chest for low-back release + hip flexor stretch, diaphragmatic-breathing for respiratory training (OSA + respiratory weakness common), seated-march for cardio without joint impact + safe distal-weakness alternative (foot drop common Type 1), ankle-pump for circulation + distal ROM + foot drop counter, chin-tuck for cervical posture (neck flexor weakness common). The AI coach also knows the nutrition side — insulin resistance ~30-40% → low-glycaemic Mediterranean + protein + fibre at each meal, dysphagia → SLP eval EARLY + chin-tuck swallow + soft textures + sit upright 30+ min post-meal + AVOID dry crackers/tough meats/nuts when impaired, protein 1.2-1.5 g/kg spread 4-5 meals + leucine 2.5-3 g per meal for anabolic threshold, cardiac protective Mediterranean + omega-3 1-2 g + low-sodium <2 g + cardiology team annual (cardiac conduction THE leading mortality cause), OSA management + weight within healthy BMI + AVOID alcohol + late heavy meals, vit D + Ca for bone, ANAESTHESIA SURPRISE — succinylcholine + halothane + propofol may trigger prolonged apnea + arrhythmia + worsened myotonia per Mathieu 1997 — MedicAlert bracelet + anaesthesia consult MANDATORY before any surgery (including cataract), creatine 3-5 g modest benefit (Tarnopolsky 2004 + Walter 2002). CRITICAL: Myotonic Dystrophy Foundation (MDF) + MDA + Marigold Foundation + DM-CARE network + neurology (DM-experienced) + cardiology (annual ECG + Holter + ICD per Wahbi 2012) + endocrinology + ophthalmology + SLP + pulmonology + dietitian + family genetic counselling (autosomal dominant with anticipation). This is NEVER a replacement for DM-experienced multidisciplinary care.