In Duchenne muscular dystrophy management, which is NOT a recommended measure?

• A. Vitamin D and calcium supplementation
• B. Adrenal crisis awareness
• C. Regular growth monitoring
• D. Routine intense weight-bearing exercise without supervision

Answer: (D)

In Duchenne muscular dystrophy, preserving function goes hand in hand with preventing complications, and any exercise plan is tailored and supervised to avoid injuring fragile muscles. The option that is not recommended is engaging in routine intense weight-bearing exercise without supervision. Muscles in DMD lack the structural resilience to handle high-intensity or high-load activities, and performing such exercise unsupervised can cause acute muscle damage, accelerate weakness, and raise the risk of fractures, especially since long-term steroid therapy often contributes to weaker bones.

Instead, activity should be low to moderate in intensity and supervised, with a focus on maintaining range of motion and preventing contractures. Safe options include gentle stretching, ROM exercises, and age- and disease-appropriate aerobic activities like swimming or stationary cycling, modified to the individual’s abilities.

Vitamin D and calcium supplementation helps protect bone health in the setting of steroid use and reduced mobility. Adrenal crisis awareness is important because chronic steroids can suppress the body's stress response, necessitating sick-day dosing and careful management during illness or surgery. Regular growth monitoring is also key because growth can be affected by steroids and chronic illness, guiding therapy adjustments to balance disease control with development.