Treating Chronic Fatigue Syndrome (ME/CFS): 'Exercise'
"The key is patience--not doing too much at once and learning not to exceed the threshold that results in "payback" symptoms…Today, 9 years after onset of CFS…. I HAVE BICEPS.. I have lost 15 unwanted pounds. I look better and I feel better in some ways. Besides adding stamina and strength, exercise has reduced my pain"
Linda Milne, disabled 64 year old CFS patient
Post-exertional malaise or the severe increase in symptoms that often occurs in ME/CFS patients (called a ‘crash’) after even mild exercise is a hallmark of ME/CFS. Yet most ME/CFS patients are aware that no ‘exercise’ at all can lead to deconditioning which has severe consequences of its own. Exercise and activity is one of the first things Dr. Lapp talks about with his patients. Dr. Lapp believes its critical that ME/CFS patients walk the ‘narrow road’ between too little and too much exercise.
The Foundation of a Chronic Fatigue Syndrome (ME/CFS) Exercise Program
The key to a successful exercise program is staying below the ‘threshold point’ at which exercise is transformed from a beneficial activity into a pathological one. ME/CFS patients that carefully manage their exercise program can increase their stamina and reduce their pain.
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Begin slowly
with seated stretching, relaxation and breathing exercises. After
several weeks of these graduate to standing stretches or to
strengthening activities.
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Progress gradually
with strengthening activities. Begin with very low weights, light
stretch bands or body weight. Strength training should initially be
limited to 30-60 seconds with at least I minute of rest in between and a
maximum of 3-5 intervals per session. Start with 2-4 repetitions and
build up to a maximum of eight. The total amount of activity in a single
session should not exceed 20 minutes. The CDC recommends
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Be careful with cardiovascular
conditioning.
Start with a slight increase of your daily activities. Increase slowly
and find a sustainable regimen. Because exercise in water creates a
pressure gradient that may assist with circulation and is less impactful
on the joints hydrotherapy is a good option.
Don't 'go for the burn’. Instead of ‘No pain, no gain’ CFS patients should follow the adage ‘No pain, no pain’.
Drop the Word Exercise. 'Exercise' with all its connotations should be dropped in favor of less heavily charged ideas such as ‘keeping ones muscles from becoming weak’, ‘staying loose and flexible’, and ‘building up ones conditioning'. CFS patients should also expand the definition of exercise to include any kind of physical activity such as walking, pulling weeds, doing the dishes, etc.
Break up the exercise period. CFS patients are far more tolerant of five three minute exercise periods than one fifteen minute one. CFS patients should take at least one rest day between ‘workout’ days’ and be ready to allow for more if necessary.
Don't push too hard. All negative symptoms caused by exercise should be back to baseline the next morning. Each step of the conditioning regime should plateau at for several weeks at a certain level before moving to the next level.
Be flexible. If you have problems standing (orthostatic intolerance) do your conditioning while seated or supine or in the pool or on a stationary bicycle.
Focus on the abdominals. The abdominal muscles are the foundation of the body. Strengthening the abdominal muscles can help relieve back pain and improve circulation.
Conclusion: Exercise in CFS will always be problematic to some degree but researchers and physicians are devising ways many CFS patients can glean benefits from exercise while sidestepping its costs.
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CFS and the Exercise Conundrum, Lucinda Bateman, M. D.
The ‘Skinny" on Exercise and CFS. The CFS Research Review. Summer 2006. Vol. 7, Issue I, 8-10, A publication of the CFIDS Association of America.
A Realistic Approach to Exercise for CFS Patients
By J. Mark Van Ness, PhD, Christopher R. Snell, PhD, and Staci R. Stevens, MA.