Fatigue in LEMS is closely tied to how the condition affects muscle function, which in turn impacts weakness and energy level.
Muscle Weakness vs. General Exhaustion
Fatigue in LEMS can show up in different ways.
One is muscle weakness, which often begins in the hips and thighs. This can make movements like standing up from a chair, climbing stairs, or walking feel physically difficult, because the muscles aren’t receiving strong enough signals to sustain the effort, says Andrea Jaworek, a physical therapist at the Ohio State University Wexner Medical Center in Ohio.
Muscle weakness can involve other muscle groups in your arms, as well as those involved in swallowing and speech.
The ‘Warm-Up’ Phenomenon
One unique feature of LEMS is the “warm-up” effect, where muscle strength may briefly improve with repeated movement. It can be used to help with more challenging activities — for example, marching in place before walking up the stairs.
“I describe it as needing to ‘prime’ your body,” says Kathryn Jira, a physical therapist at the Ohio State University Wexner Medical Center in Columbus.
But the improvement is temporary and doesn’t prevent fatigue from building over time, she adds.
The Cumulative Effect
While staying active and exercising within safe limits is encouraged, overworking muscles isn’t a good idea. It can lead to increased fatigue or worsening weakness, and that can add up, says Katie Gingras, DPT, a board-certified neurologic physical therapist with UC Health in Cincinnati.
“Patients often notice that their muscles fatigue with activity, but there can also be an overall sense of decreased endurance as the day goes on,” says Dib. Activities that feel manageable in the morning can become much harder later on, as muscle endurance declines, she says.
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