Lakhasly

Physical activity and physical training of low to medium intensity is recommended, while physical activity of high intensity should be avoided in patients with MG because it increases muscular weakness[13].ptosis or diplopia) during exercise General aerobic exercise is also valuable, helping with respiratory function as well stamina.Individuals with MG should strive to strike a balance between physical activity and rest, finding the right level of each to optimise their health.It is not possible to cure the weakness by active physical training.

Physical activity and physical training of low to medium intensity is recommended, while physical activity of high intensity should be avoided in patients with MG because it increases muscular weakness[13]. Individuals with MG should strive to strike a balance between physical activity and rest, finding the right level of each to optimise their health. It is not possible to cure the weakness by active physical training. However, most MG patients are more passive than they need to be.

One study showed a clear benefit from a strength training exercise program for a group of patients with mild to moderate MG[14], concluding "physical training can be carried out safely in mild MG and provides some improvement of muscle force".

Aerobic exercise, respiratory muscle training, strength training, and progressive resistance exercises has been shown to be an effective approach in enhancing functional outcomes (including mobility, muscle strength, and aerobic capacity), reducing fatigue, improving physical performance, and enhancing overall quality of life for individuals with MG[15]. Previous studies have reported that exercise programs for MG patients should be supervised to ensure safety[16]. However, a recent randomised controlled trial was done to explore effects of home-based, unsupervised exercise therapy in MG[17]. This the first study to report that a 3-month unsupervised home-based exercise therapy program was well-tolerated by adults with stabilised MG and did not caused any exacerbations. The therapy program did not show significant evidences on improvement in quality of life. Further research is needed to investigate different dosages of exercise and their effects in people living with MG.

Balance strategy training maybe effective in improving balance, enhance the vestibular function through trgeting sensorimotor system to improve balance and decrease falling risk, moreover more research into this domain has to be done[18].
Gradual resisted training exercises.
Respiratory muscle training showed to be effective in management fatigable weakness and respiratory failure specially with moderate cases that hinder normal ADL. The benefits of respiratory training summarized in the following ( improvement in respiratory muscle strength and endurance, improvement in physical performance and reduce incidence of respiratory MG complications[19].
General advice for exercise programs for people with MG:

Aim to strengthen large muscle groups, particularly proximal muscles of shoulders and hips
Advise patient to do the exercises at their "best time of day" ie, when not feeling tired - for the majority of MG patients this will be morning
If a patient is taking pyridostigmine, exercise at peak dose ie, 1.5 to 2 hours after taking a dose
Moderate intensity of exercise only: the patient should not experience worsening of MG symptoms (eg. ptosis or diplopia) during exercise
General aerobic exercise is also valuable, helping with respiratory function as well stamina.