chronic fatigue syndrome

How to exercise right with chronic fatigue syndrome (CFS)

Imagine being tired all the time. Like really tired, all the time. Exercise probably seems like the last thing you would want to do, but for patients with chronic fatigue syndrome (CFS), exercise is one of few therapies known to help.

What is chronic fatigue syndrome and does exercise help?

Persistent fatigue unrelieved by rest, cognitive difficulties, mood and sleep disturbances, pain, and prolonged worsening of all these symptoms lasting hours to days (i.e. a ‘crash’ or ‘bust’) after undertaking activities that were previously done with ease. These are just some of the issues that patients with chronic fatigue syndrome (CFS) deal with on a daily basis.

Currently, there is no cure for CFS, but there are therapies proven to reduce its severity and improve functional outcomes. Exercise is one such therapy, but not exercise in the way we would normally think about it.

What’s different about exercise prescription for CFS?

Exercise recommendations for CFS are not the same as those for the general population. Far from it. In fact, asking someone with CFS to go for a 30 minute jog or spend 45 minutes lifting weights may cause even the most functional of patients to crash. Instead, the type of exercise known to work for CFS is graded exercise therapy (GET), which usually starts at very low doses and is progressed very gradually. This approach requires patients to establish a ‘threshold’ of exercise that they can reliably complete without crashing, after which increases in the duration and then intensity of exercise are made.

GET in CFS: An example

In our practice, we usually prescribe low-intensity self-paced walking as GET to our patients, though the principles and progressions can be applied to other activities as well. We initially prescribe GET 3 times per week on non-consecutive days and recommend that patients take a 15 minute rest break before and after exercise. As an example, say a patient’s threshold for walking is 10 minutes (it may be much less than this, but 10 minutes makes the maths a little easier), we would ask them to walk for 10 minutes a day, 3 times per week, for 2-3 weeks. If they complete all sessions without crashing, then we would increase the exercise duration by 20% (i.e. 10 minutes to 12 minutes) and ask them to walk for 12 minutes a day, 3 times per week, for the next 2-3 weeks. We then continue to increase the duration of walking in this fashion until the patient is walking three times per week (still on non-consecutive days) for 30 minutes at a time.

Once they are managing this, then walking is introduced on the other days for the duration they initially started at (e.g. 10 minutes in the above example). These shorter walks are then progressed in the same fashion until the patient can walk for 30 minutes on most days of the week. This may not sound like much, but it is a level of physical activity more consistent with the physical activity guidelines. Moreover, for a patient who may have previously spent hours to days in bed after going a 30 minute walk, it is a significant improvement.

GET in CFS: some caveats

There is no exact science to GET and the example I provide above is only that, an example. The level at which GET is commenced and progressed will vary greatly from patient to patient depending on their level of function. We find this method works reasonably well for patients in our clinic, but there is usually a bit of trial and error involved when it comes to establishing thresholds and we also require patients to have a good understanding of how to manage their symptoms through activity pacing before we commence GET.

When done right however, GET is one of the few therapies proven to reduce fatigue and improve functional outcomes for patients with CFS (the other being cognitive-behavioural therapy), so it is definitely worth prescribing to patients. As always, this should be done in conjunction with your Accredited Exercise Physiologist.