Övningar för McArdles sjukdom (GSD V) — sackaros 37 g före träning + 'andra andning' + UNDVIK maximum + statiner (Vissing 2003 + Andersen 2008)

DiMauro 2007 + Lucia 2012 + Quinlivan 2014 + Santalla 2014 ACSM expert review framework. McArdle disease (glycogen storage disease type V, GSD V) is an autosomal recessive disorder caused by PYGM gene mutations leading to muscle glycogen phosphorylase deficiency — muscle glycogen cannot be mobilized to fuel ATP production during exercise. Classic presentation: lifelong exercise intolerance + early fatigue (the first 6-10 min of any activity is the hardest) + myalgia + cramps + exercise-induced myoglobinuria in ~50% of patients during lifetime, with risk of acute kidney injury from rhabdomyolysis. DIAGNOSTIC + UNIQUE: the SECOND-WIND PHENOMENON (Pearson 1961 first description + Vissing 2003 mechanism) — after 6-10 minutes of moderate aerobic activity, blood-borne fatty acid + glucose delivery rises, heart rate paradoxically drops, and symptoms improve dramatically. Patients can then exercise much further than the initial minutes suggested. CK is chronically elevated 1000-5000 U/L (vs normal <200). There is no cure and no enzyme replacement therapy yet (gene therapy in early trials). Management is entirely exercise framework + dietary + lifestyle: (1) AVOID maximal anaerobic effort + isometric / sustained contractions + heavy lifting — no rapid glycogen means no rapid ATP, so these are rhabdomyolysis triggers; (2) DO submaximal aerobic with WARM-UP / EASE-IN to trigger second wind; (3) sucrose 37 g pre-exercise per Vissing 2003 + Andersen 2008 RCT — 5-10× improvement in exercise capacity from a single dose; (4) regular aerobic training (4-6 sessions/week of moderate cycling/walking/swimming) INCREASES OXPHOS capacity + reduces symptom burden per Haller 2006 + Maté-Muñoz 2007 + Quinlivan 2014 — the most important non-pharmacologic intervention; (5) STATINS ARE ABSOLUTELY CONTRAINDICATED (rhabdomyolysis additive risk). Brown / cola-coloured urine = emergency room (myoglobinuria + AKI risk). MedicAlert bracelet + emergency action plan + family awareness non-negotiable.

Volya's catalogue carries the foundation moves: supported-glute-bridge for posterior chain low-intensity activation (NOT max-effort hip thrust), cat-cow for spinal mobility, supine-knee-to-chest for low-back release + hip flexor stretch, diaphragmatic-breathing for respiratory training + the 'breathing through the hard first 6 minutes' that's central to McArdle exercise, seated-march for cardio without joint impact + the IDEAL warm-up to trigger second wind (low-intensity sustained), wall-push-up for upper-body push at submaximal load only, ankle-pump for circulation + distal-muscle ROM + low-energy cost, calf-raise-rehab for distal-strength preservation at submaximal load, scapular-retraction for upper-back posture. The AI coach also knows the nutrition side — PRE-EXERCISE SUCROSE 37 g (Vissing 2003 + Andersen 2008 RCT — 5-10× improvement) about 30-40 min before activity, sport drinks + glucose tablets for ad-hoc activity, low-fat moderate-carb Mediterranean base (some protocols 60-65% carbs), regular aerobic INCREASES OXPHOS capacity (Haller 2006 + Maté-Muñoz 2007), protein 1.2-1.5 g/kg + leucine 2.5-3 g per meal, AVOID prolonged fasts (metabolic crisis), frequent small meals + bedtime snack, creatine 60-150 mg/kg modest benefit (Vorgerd 2000/2002), HYDRATION non-optional + BROWN URINE = ER, AVOID maximal anaerobic / isometric / sustained + pre-exercise high-protein + alcohol excess + ketogenic / low-carb (worsens substrate). CRITICAL: Association Internacional Pacientes McArdle + International Association for Muscle Glycogen Storage Disease (IAMGSD) + AMDA + MDA + neurology (McArdle-experienced) + cardiology (statin AVOID) + nephrology if recurrent myoglobinuria/AKI + dietitian familiar with metabolic myopathies + emergency MedicAlert + family genetic counselling. This is NEVER a replacement for McArdle-experienced multidisciplinary care.