Chronic fatigue syndrome: Using graded exercise to get more energy

Graded exercise is exercise that starts out slowly and increases in very small steps. It means you have a plan for your exercise and you stay with it, even when you're having a good day and feel like doing more. Increasing your exercise very slowly lets your body make the changes it needs to cope with activity and exercise. People with chronic fatigue syndrome often have an exercise program designed for them by a health expert called a physiologist who can create a tailor-made plan and carefully watch the person's progress.

For example, you might start by walking, bicycling or swimming as little as 5 minutes every other day for 2 weeks. If you feel strong enough at the end of 2 weeks, you might add 2 to 5 minutes to your exercise for another 2 weeks, and so on.

Continue to Why?

If you have chronic fatigue syndrome, you may have days when you feel pretty good and days when you can barely get out of bed. On your good days, you may decide you can do twice as much, but that may cause a relapse of your symptoms. Those relapses may make you afraid to exercise at all. But if you avoid exercising altogether, your body grows weaker and less able to fight off fatigue as well as illness. People with CFS often feel like they have no control over their bodies, as if they cannot do anything for themselves. By starting a carefully controlled exercise plan, you can begin taking back control.

In combination with good sleep habits and careful scheduling of activities, a gentle, graded exercise program can help you feel better. You must start with very brief activities and gradually increase the frequency, duration, and intensity of exercise as you feel able. This kind of exercise plan can be extremely helpful in relieving and controlling symptoms of chronic fatigue syndrome.

Continue to How?

You should work with your doctor to draw up a specific plan for your needs and abilities, but there are things you can do on your own.

Walking is an excellent form of aerobic exercise for people with chronic fatigue syndrome. Other gentle exercises, such as riding a bicycle or stationary bike or swimming, are also good. You need to find a balance so that you are exercising enough to benefit from it but not exercising so much that you become overtired. Here are some things to consider:

• Adopt a positive attitude toward exercise. Try to put aside your doubts and your worries that it will cause a relapse.
• Start very slowly.If you have not been very active lately, it is a bad idea to jump into a vigorous exercise program. Start with just a few minutes of very gentle exercise, such as stretching. When you are comfortable with stretching exercises, add very short periods of a mild aerobic activity such as walking or swimming.
• Increase very gradually.After you know that your body can tolerate this level of exercise over the course of several sessions, increase the length of your exercise session by only 1 minute. Rest frequently, and build up your exercise intensity a little bit at a time. Try to work up to at least 2½ hours of moderate exercise a week.² One way to do this is to be active for at least 10 minutes 3 times a day, 5 days a week.
• Don't push yourself too hard.You can easily become overtired, which will defeat the purpose of exercise.
• Don't exercise within 3 to 4 hours of bedtime. Exercising just before you go to bed may make it harder to fall asleep.
• Take a few days off when you need to. There may be periods of time when stress or other physical activities make exercise too difficult. When this happens, take a little time off, and then try to get back into your exercise routine as soon as possible.
• Keep track of your exercise on a calendar or use this progress chart.

Continue to Where?

Now that you've read this information, you're ready to begin a graded exercise program.

Talk with your health professional

If you have questions, take this information with you when you visit your doctor.