Recently I have had a number of clients come to see me about fitness training and weight loss when they are suffering with chronic fatigue syndrome. Chronic fatigue is not a condition that is talked about often, it’s only recently recognised condition. In the medical community it is still an area of medicine that is unclear. There are many theories about its cause, but nothing has been set in stone. It’s because of this reason there aren’t very many treatment options.
Considering that exercise and fitness is such a vital part of health and wellness, I’ve put together an informative piece on chronic fatigue. It might help those of you who suffer from chronic fatigue to get an idea of what you can do with exercise to improve your well-being and potentially reduce feelings of fatigue. Remember to talk with your medical team before starting any new training program. They know you better than me 🙂
What is chronic fatigue syndrome?
Chronic fatigue syndrome is sometimes called myalgic encephalomyelitis. It is often misdiagnosed as depression, laziness, hypothyroidism or other autoimmune-related conditions like rheumatoid arthritis or fibromyalgia.
It’s a condition that leaves people feeling extremely fatigued, more so than your normal tired feeling. At times the body aches in pain, feels heavy and sleep is the only thing you can think of doing. Medically there is inflammation in the brain and spinal cord. For most chronic fatigue syndrome sufferers, it’s extremely debilitating to exercise, work and perform their normal tasks of daily living.
Many other conditions can arise from chronic fatigue syndrome because of the way people feel. Chronic fatigue simply doesn’t leave you with any energy to move, so weight gain is common. It can also lead to other weight and mental health-related conditions, such as depression and anxiety.
Fibromyalgia is another a common condition that is coupled with chronic fatigue syndrome. The reason for this coupling is unknown. Fibromyalgia is a condition that is associated with total body pain, disturbed sleep and tiredness. The mechanisms behind the condition, are thought to be caused by a deregulation of the central nervous system. The body responds to painful and non-painful stimulation the same way and there are also some theories to suggest cytokine or hormone levels have a role to play. Unfortunately, research in this area is lacking. The two main behavioural barriers with chronic fatigue syndrome are fatigue and pain. Both must be treated very seriously.
What is the difference between normal fatigue & chronic fatigue?
Normal fatigue could be described as extreme mental or physical tiredness. This type of fatigue may persist for a few days or weeks, but once adequate rest and sleep is achieved it subsides.
Chronic fatigue is unrelenting fatigue, where a person may experience full body pain, exhaustion and the inability to get out of bed. This fatigue may persist for months or years, and become worsened with mental and physical stress. Normal rest and sleep does not alleviate this feeling. Fatigue can also be a result of several other conditions. If you are feeling fatigued and don’t know why, go and talk to your doctor.
If you have never met anyone with chronic fatigue syndrome here is a documentary that gives you an idea of the range and depth of the condition. Remember some people with chronic fatigue may not be this bad. This video is more an extreme example of CFS.
Who will get chronic fatigue syndrome?
Chronic fatigue is a complicated disorder. Medical professionals don’t know why people develop chronic fatigue. Both men and women can get chronic fatigue syndrome, however it is more likely in women between the ages of 40-50. It hasn’t commonly been seen in children, although there are a small number of cases emerging.
There are many theories as to why it develops such as: a viral infection, psychological stress, nerve-ending sensitivities, immune system problems, hormonal imbalances, fibromyalgia and glandular fever. However, nothing has been conclusive yet in the research.
Loss of concentration
Pain around joints
Swelling of the joints
Flu like symptoms; sore throat, stuffy nose, drowsiness
Should you see a doctor for chronic fatigue?
Most definitely yes! Even though treatment options are scarce, there are many other conditions that are also related to feeling fatigued. You want to make sure the fatigue is not caused by some other underlying condition or nutrition deficiency. Your doctor might send you for further blood test, neurological and hearts scans or make a referral to a specialist, psychologist, dietitian or exercise physiologist.
It’s a good idea to get this medical condition diagnosed properly by a doctor. Often chronic fatigue can keep you away from work, and affect your mental health. You may need to have a documented medical history to explain leave and absence considerations at work and for access to mental health schemes provided by the government through Medicare.
Common medications or treatments prescribed for chronic fatigue
Typically medications are not prescribed for chronic fatigue itself, but may be for the associated conditions arising from the condition. For example pain relief medication might be prescribed for chronic pain or anti-depressant medications for anxiety or depression. Discuss these options with your doctor.
Cognitive behavioural therapy (CBT) for chronic fatigue
CBT is psychological therapy, a common therapy used to treat chronic fatigue and chronic pain. Fear avoidance theory suggests it is reversible and that fatigue is due to a cognitive response to avoiding doing activities. This is then exacerbated by psychological stress or a learnt response to stress, which we now know is not true.
It has just as much due to psychological as physiological reasons. This is why CBT can help chronic fatigue management but it is not a cure. A review has shown that CBT can reduce feelings of fatigue. For 40% of people undergoing CBT show clinical improvement compared to 25% who received usual care. Get a referral to a psychologist if you want to try this type of therapy as they are the most qualified practitioners in this area.
Pacing for chronic fatigue
Pacing is a technique derived from the theory that chronic fatigue is an organic condition that is not reversible by changes in behaviour. It results in a finite amount of available energy in which the patient must manage daily. Chronic fatigue sufferers are taught to recognise the signs and symptoms of over-exertion and to avoid exacerbations. They are also instructed to plan their day to priorities activities from the most to the least important only persisting if they feel able.
This type of therapy is usually performed with a specialised medical team consisting of an occupational therapist and pain management specialist. Talk to your doctor about a referral.
This therapy was originally used under the deconditioning and exercise intolerance theory of chronic fatigue. Which states that fatigue is caused by physiological changes in the body from deconditioning, part of the avoidance theory of avoiding activity. When feeling unfit movement becomes difficult with disuse, the person becomes more inactive and more fatigued with activities of daily life.
It suggests that deconditioning can be improved through exercise and that chronic fatigue can be reversible. Graded exercise therapy programs can be devised by an exercise physiologist. They are the most appropriate practitioner to be referred to if you want to trial this therapy.
All three of these options are only theories and are not accepted in mainstream consensus. A number of studies have tested the effectiveness of all three treatments with varying success.
Currently all three treatments are being used as a holistic way to treat chronic fatigue syndrome and all three are considered safe. You can try all of them simultaneously or stand-alone. In the literature CBT and exercise have been shown to decrease fatigue, whereas pacing was ineffective in reducing symptoms. Talk with your health care provider about getting a referral to the relevant people for help.
Benefits of exercising with chronic fatigue syndrome
Although exercise cannot alleviate fatigue it can help sufferers from chronic fatigue improve their life dramatically. Typically, even activities of daily life like sweeping the floor or hanging the washing on the line is enough to exhaust some one with chronic fatigue. With exercise you can increase your fitness and activity capacity so that these day-to-day activities are less draining.
Exercise will also reduce the risk of any chronic health conditions that may accompany inactivity for example; obesity, heart disease, cancer and diabetes. It’s good to remember to keep your body moving to maintain a healthy weight, normal blood sugars, a strong heart and strong muscles.
In addition we know that exercise can improve our mental health. We covered how to improve your mental health in our Mental Health Roundtable podcast. Depression and chronic fatigue often go hand in hand. The disability of not being able to do the things you want to do, coupled with feeling terrible sends people into a downward spiral.
Exercise can make you feel uplifted, if done with a group of people it can also be a point of distraction and helps to improve body confidence and self esteem.
In a review done by Cochrane it found that exercise has been shown to reduce fatigue and does not worsen symptoms of chronic fatigue syndrome. However, it was no more effective than cognitive behavioural therapy (CBT).
Exercise can be also be used to manage chronic pain as it helps the nervous system to relax with muscles getting stronger and not fatiguing as easily and improves mental health. Here is an extra video on pain and retraining the brain you might find interesting.
There is also a benefit in exploring exercise options with an exercise physiologist for specialised care. Keeping fit is heart protective and can help improve depressive feelings or anxiety. Studies have shown for mild cases of depression exercise programs are more beneficial than pharmaceutical medications. For severe depression the combination of medications and exercise works extremely well together for the best client outcomes.
Tips on how to exercise with chronic fatigue syndrome
Reintroduction to activity has to be done extremely slowly and is subject to individual fatiguability levels. The best place to start is with easy pace walking for 5 minutes each day or even a stretching routine, then try to build up exercise time over a number of months. Focusing on work out intensity is probably the worst thing you can do. The more intense, the larger the fatigue relapse will be the following day. Take it slow and easy!
After a degree of fitness has been built by walking and a person can complete 30 minutes of walking, you may want to also include light resistance based training. Note, this build up to 30 minutes may take months. Be patient as understanding fighting fatigue can be long and frustrating. When you get up to the stage of adding in strength training you may want to try using body weight, therabands or very light hand weights.
There are many other low intensity exercise forms you can try that are equally suitable for example; pilates, yoga, swimming, aqua aerobics and hydrotherapy. Walking and strength training were chosen to highlight for the purposes of this article, because they are exercises that you can do at home. However, there are many other different ways to exercise apart from the above mentioned.
It may help to be guided by an experienced exercise physiologist who can help pace your workouts and exercise progressions. You can also try exercising with a friend to keep you motivated and distracted from fatigue.
Adverse reactions to exercise with chronic fatigue
One thing to keep in mind is that exercise can trigger a relapse in extreme fatigue. Doing too much too soon, can leave some chronic fatigue suffers bed ridden for days or even weeks. This is why if you are thinking of taking up exercise, do it extremely slowly. It does pay to see an exercise physiologist who has experience in this area and can tailor a graded exercise regime for you. They will also hold you back if you are too enthusiastic and want to do too much to soon. You can try to manage fatigue by exercising a little more on good days and less on bad days and avoid exercises that cause continuous pain in the limbs.
Sample exercise program for chronic fatigue
Sit to stand squats 1 set x 6-8 reps
5 minute easy walk
Wall push-ups 1 set x 6-8 reps
5 minute easy walk
Body weight tricep dips 1 set x 6-8 reps
5 minute easy walk
Reverse bridge 20-30seconds 2 sets
5 minute easy walk
Begin your graded exercise program with 1-2 days and then build it up from there. You will need a lot of rest. Be patient as it will be a long journey. Eventually you may progress after a number of weeks to the above sample program.
A few low repetitions between 6-8 may be tolerated better than the usual higher rep, higher volume beginner based weight training. If this is too much start with 3-4reps and build it up from there. You can slowly build up reps, when lower volumes are tolerated.
Start with a single set only per exercise, especially with larger compound movements. For example 1 set of squats or 1 set of push-ups. For smaller muscle groups and single jointed exercises like bicep curls, you may tolerate more.
Remember you will probably feel ok during the exercise, but it is the following day’s recovery, which will impact the most. Post exercise fatigue is delayed by 1-2 days. Don’t over estimate your ability to recover.
Take a conservative approach and start with doing only a few minutes every second day. This will get your body used to movement again. Length of time to exercise should be the first variable to increase, rather than exercise intensity. What this means is, if you tolerate 2-3minutes worth of exercise, it is better to go for longer rather than going faster or lifting heavier.
Other forms of therapy
Nutrition for chronic fatigue
There are some schools of thought that fatigue can be caused by diet and gut health. I will explore this in future blog posts.
Meditation & mindfulness
Relaxation and mindfulness practice techniques are sometimes used to improve the lives of those with chronic fatigue syndrome. These techniques help the person to accept their current state of being, and have gratitude for what you do have in life.
Sleep hygiene is a good to practice especially when it comes to non-restorative sleep as experienced with chronic fatigue. Try to unwind before bedtime, and avoid sleeping for rest in the early afternoon. In the morning, try to sit in the morning sun to wake up and avoid caffeine for a pick-me-up. I’ve blogged about sleep hygiene during camping holidays. Click here if you want more tips.
Just a reminder that blog posts such as these are for reading-interest sake and do not replace the information given by your own health care practitioner. It is always better to see some one face-to-face for individual advice with specialised conditions because everyone’s case is unique.
If you do suffer from chronic fatigue syndrome and exercise already, how do you stay fit?