Exercise, breathing training may help ease myasthenia gravis symptoms

Physical activity and respiratory (breathing) muscle training may help people with myasthenia gravis (MG) reduce symptoms and improve daily functioning, especially when programs are adapted to their needs, according to a review study.

“Individualized exercise programs are essential to ensure safety and optimize adherence,” the researchers wrote.

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Review looks at exercise and breathing training in MG

The review study, “Physical and respiratory training in patients with myasthenia gravis: a systematic review with meta-analysis,” was published in Scientific Reports.

In MG, the immune system produces self-reactive antibodies that mistakenly attack proteins needed for proper communication between nerves and muscles. As this communication becomes disrupted, patients experience symptoms such as muscle weakness and fatigue, which can worsen with exertion — one reason the effects of exercise in MG have been debated.

In addition to medications, “non-pharmacological interventions, such as physical activity (PA), may play a valuable role in MG because it can help alleviate these symptoms of the disease, promote adequate muscle function, and improve key health outcomes, including quality of life and independence in basic activities of daily living,” the researchers wrote.

However, while some studies have reported that physical activity may help control symptoms and improve well-being, others have reported that it may trigger symptom recurrence, highlighting mixed evidence on its effects.

To clarify the effects of physical activity on MG, a team of researchers in Spain systematically reviewed studies published up to May 2025 on how training programs affect symptoms, daily functioning, quality of life, physical fitness, and lung function in people with mild to moderate MG.

Review includes 20 studies on training in MG

A total of 20 studies, involving 1,366 patients with mild to moderate MG, ages 16 to 75, were included in the qualitative analysis, with 10 studies used for meta-analysis, a method that combines data from multiple studies to better estimate effects.

Of the 20 studies, 14 focused on aerobic physical activity — including walking, cycling, and strength training — and six focused on respiratory muscle training. Seven studies were randomized controlled trials, while others reported data from observational studies and other types of trials.

Overall, patients who engaged in training programs tended to have fewer symptoms and better quality of life. There was also a trend toward improved ability to perform daily tasks such as walking, dressing, and eating.

Seven studies assessed changes in symptom severity using the validated Myasthenia Gravis Composite (MGC), which combines different symptoms into a single score. In one randomized controlled trial, the average MGC score was reduced from 5.4 to 2.4 points after training, meaning symptoms eased. The control group, which did not train, showed no such improvement.

Another tool used was the Quantitative Myasthenia Gravis (QMG) score, which measures muscle weakness. Pooled data from three studies showed that training resulted in an average reduction of 1.6 points in the QMG score, indicating less severe muscle weakness. Studies using the Besinger score, another tool to measure symptom severity, also favored training, although results varied widely between studies.

Training may improve quality of life in MG

Quality of life was evaluated in six studies using the Myasthenia Gravis Quality of Life 15-Item (MG-QOL-15) questionnaire. In one randomized controlled trial, all patients in the training group and 68.5% of those in the control group improved their quality of life by at least 50%. Pooled data showed a mean MG-QOL-15 score reduction of 5.63 points, indicating better quality of life with training compared with no training.

Daily functioning was assessed in four studies using the Myasthenia Gravis Activities of Daily Living score, which looks at daily tasks such as walking, dressing, and eating. Combined results showed a trend toward improvement with training.

Based on these findings, healthcare professionals may consider implementing PA and respiratory training as part of the therapeutic approach for this patient population.

Training programs were associated with significant improvements in muscle strength and endurance in one randomized controlled trial and a 10.8% increase in muscle strength in another study. Training was also associated with better walking performance, and better performance was linked to fewer symptoms and better quality of life.

Data from six studies evaluating lung function showed that respiratory muscle training was associated with significantly improved respiratory endurance, meaning patients could breathe better for longer periods. Measures of muscle strength during inhales and exhales also showed improvements with training.

Some patients dropped out of the training programs. Reasons included difficulty adhering to the routine, lack of time, or personal issues. Others dropped out due to myasthenic crises — a potentially life-threatening medical emergency that may require hospitalization and breathing support — or other health conditions reported during the studies, such as cancer.

“Based on these findings, healthcare professionals may consider implementing PA and respiratory training as part of the therapeutic approach for this patient population,” the researchers wrote. “However, the individual clinical status and personal characteristics of each patient with MG must be carefully evaluated, as these factors can pose challenges to the application of such interventions.”