Övningar för inklusionskroppsmyosit (IBM) — graderad aerob + lätt styrka SÄKRA + FÖRBÄTTRAR funktion (Spector 2018) — höjer INTE CK

Greenberg 2019 + Rose 2013 ENMC + Lloyd 2014 + Naddaf 2018 framework. Inclusion body myositis is the most common acquired myopathy in adults over 50 years old (overall prevalence likely under-counted because it's frequently misdiagnosed as polymyositis or treatment-resistant myositis). The presentation is distinctive: very SLOW asymmetric weakness over years with a characteristic anatomical distribution — FINGER FLEXORS (difficulty turning keys, holding pens, opening jars; preserved finger extension — diagnostic clue) + KNEE EXTENSORS / quadriceps (falls + difficulty standing from chair) — plus dysphagia in 50%+ (often the most disabling axis), facial sparing typically, mild CK elevation (not as high as PM/DM). Muscle biopsy shows rimmed vacuoles + intramuscular amyloid deposition + endomysial inflammation — pathology mixes degenerative + inflammatory features. CRITICAL: IBM is REFRACTORY to immunosuppression — it does NOT respond to corticosteroids, methotrexate, azathioprine, IVIg, rituximab (in contrast to PM/DM); arimoclomol failed its Phase 3 trial in 2021. There is no disease-modifying treatment as of 2025-2026. Treatment is symptomatic + rehab-focused. Misdiagnosis as PM/DM exposes patients to immunosuppression harms (infection + steroid bone/glucose/skin) WITHOUT benefit — accurate IBM diagnosis itself is high-stakes. Exercise framework per Spector 2018 + Johnson 2009 + Alexanderson 2014: graded aerobic + light-to-moderate strength IS safe + IMPROVES function + DOES NOT worsen CK or inflammation — overturned the cautious 'avoid exercise to preserve muscle' framing.

Volya's catalogue carries the foundation moves: supported-glute-bridge for posterior chain low-intensity (knee-extensor + gluteal weakness pattern), wall-push-up for upper-body push at low load (finger-flexor weakness makes traditional push-up disabling early), 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 + dysphagia training, seated-march for cardio without joint impact + falls-safer than treadmill, sit-to-stand for functional + bone-loading + the SPECIFIC IBM knee-extensor weakness target (most important functional move + falls prevention), chin-tuck for cervical posture + dysphagia swallow training. The AI coach also knows the nutrition side — protein-forward 1.4-1.6 g/kg/day + leucine 2.5-3 g per meal (elderly anabolic resistance + IBM-specific wasting), anti-inflammatory Mediterranean + omega-3 1-2 g + colourful polyphenols, dysphagia ~50%+ → SLP EARLY + soft moist textures + chin-tuck swallow + small bites + sit upright 30+ min + AVOID dry crackers/tough meats/nuts when impaired + PEG when severe, vit D + Ca + weight-bearing within knee-extensor limits + DEXA (falls + reduced mobility), creatine 3-5 g modest benefit (Chung 2007), caloric balance per activity + age, AVOID ultra-processed + SSBs + excess alcohol + restrictive fad diets. CRITICAL: The Myositis Association (TMA) + Myositis Support and Understanding + Cure IBM + Muscular Dystrophy UK + MDA + rheumatology + neurology (IBM-experienced — KEY because misdiagnosis exposes to immunosuppression harms without benefit) + SLP if dysphagia + PT/OT (falls prevention + AFO + knee bracing) + dietitian + GI if PEG. This is NEVER a replacement for IBM-experienced multidisciplinary care.