Chronic fatigue syndrome and exercise

Chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME) is an illness characterised by extreme exhaustion. Other common symptoms include aching muscles, joint pains, headache, sore throat and flu-like feelings. The cause is unknown and recovery can take years. In some cases, people don’t recover and suffer relapses throughout their lives.

Exercise is often a problem for people with CFS because physical activity can worsen their symptoms. Medical opinion has been divided on whether people with CFS should attempt regular exercise or not – some believe that gentle exercise is helpful, while others caution against any form of aerobic activity.

Research has found that patient education on CFS and a graded exercise program can improve symptoms in many cases and, on average, is not likely to worsen outcomes.

Exercise may not be possible for everyone
Some people with CFS, especially in the weeks or months following onset, are unable to perform the most basic activities such as showering or walking from one room to another. In such cases of extreme exhaustion and pain, the person may be confined to their bed.

As time passes, the person may feel a little better and attempt regular exercise. However, aerobic activity can cause a relapse of symptoms. The added problem for people with CFS is that a sedentary lifestyle causes a range of other health problems including muscle wastage, loss of bone mass, and increased risk of obesity and cardiovascular disease.

The potassium connection
Medical problems that cause low levels of the electrolyte potassium often include chronic fatigue as a symptom. The bulk of the body’s potassium supply is found in muscle tissue, with the rest in the brain, blood and internal organs. A 2004 study by researchers at Adelaide University found that people with CFS have less total body potassium (TBP) than healthy people of similar age and weight.

Exercise suggestions
A person with CFS needs a gentle approach to physical activity and should only make tiny increases in the frequency, duration and intensity of their exercise program.

Be guided by your doctor or physiotherapist, but general suggestions include:

• Aim for no more than three exercise sessions per week.
• Experiment to find the type of exercise that works best for you. Choose from a range of gentle activities such as stretching, yoga, Tai Chi, walking and light weight training.
• Stretching seems to be well tolerated by people with CFS. You may prefer to perform your stretching program while lying down in bed.
• Aerobic exercise seems to cause relapses for many people with CFS. If this is true for you, try non-aerobic forms of exercise like weight training with light weights.
• Keep an activity diary so you have a long-term picture of your performance levels and factors that might impact on fatigue.
• Learn from past relapses. For example, if walking for 20 minutes worsened your symptoms, try walking for five minutes and see how that goes. Use your activity diary to keep track of what works for you and what doesn’t.
• Stop the physical activity well before you feel tired. Pacing yourself is very important.
• Remember that your exercise tolerance will differ from one day to the next.
• If possible, monitor your heart rate during exercise with a heart rate monitor or by manually taking your pulse.
• Listen to your body – if you don’t feel up to exercising on a particular day, don’t.
• Slowly increase the intensity, time spent or frequency of exercise, but only when you know you can cope with it. For example, if you can exercise for five minutes without suffering a relapse, try for six minutes.

• Find out as much as you can about CFS. You could consult with your doctor, physiotherapist or CFS association, read books on the subject or browse through reputable CFS sites on the Internet.
• Talk to other people with CFS who can give you more ideas on exercise. Consider joining a support group. Many CFS websites offer online chat rooms.
• Set realistic exercise goals and congratulate yourself for any gains that you make, no matter how small.
• Be patient – it may take months or years to slowly build up the intensity, duration or frequency of your exercise program.

• Your doctor
• Physiotherapist
• AAESS accredited exercise physiologist – search the AAESS website to find a practitioner
• ME/Chronic Fatigue Syndrome Society of Victoria, Information and Support Line Tel. (03) 9888 8798
• ‘Go for your life’ Infoline Tel. 1300 739 899

• A person with chronic fatigue syndrome (CFS) should only make very small increases in the frequency, duration and intensity of their exercise program.
• Set realistic exercise goals and congratulate yourself for any gains that you make, no matter how small.
• Stretching seems to be well tolerated by people with CFS.
• Listen to your body – if you don’t feel up to exercising on a particular day, don’t.

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