Exercise and Chronic Fatigue - How does it help?
It sounds counter intuitive, right? You go to the doctor to discuss ongoing symptoms of fatigue and they give you what sounds like the most outlandish recommendation - “Have you thought about increasing your physical activity?”
When getting out of bed feels monumental, showering feels like running a marathon and preparing a meal seems completely unachievable, why on earth are health professionals telling me to move more?
It's understandable that you might jump straight to thinking that they don't get it, or that you're being dismissed - how frustrating! The thing is (and we’ll hold your hand while we tell you this) the evidence really does support physical activity as an effective method for managing chronic fatigue. The problem lies in how this is explained to people seeking support from their treatment providers. Health professionals often jump straight to the 'what' while bypassing the 'how' and the 'why'. Healthcare is most effective when it's collaborative - so taking the time to explain why a treatment method is recommended and how it works is important.
What is chronic fatigue?
The World Health Organisation states that ‘currently there is no consensus agreement amongst medical professionals as to how chronic fatigue syndrome may be definitively diagnosed. It may include chronic, profound, disabling, and unexplained fatigue with coinciding symptoms such as sleep problems or post-exertional malaise.’ You’d be forgiven for finding chronic fatigue management confusing or frustrating - the leading global governing body for health isn’t even sure how to classify it.
Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME) is the formal diagnosis given to extreme fatigue lasting more for more than six months. While there are many factors thought to contribute to the development of CFS/ME (e.g., physical or emotional trauma, infections, genetics, etc) a definitive cause is unknown.
While CFS/ME is considered a distinct, independent diagnosis, individuals living with chronic conditions can also experience secondary chronic fatigue. Fatigue in these cases is considered to be a symptom better explained by an underlying condition (e.g. autoimmune disease, heart conditions or cancer and associated treatments). The distinction between the two is important as fatigue may be a clue to an undiagnosed underlying condition (i.e. it may not be CFS/ME, but something else causing similar symptoms), and because exercise prescription looks different for CFS/ME vs secondary chronic fatigue.
Chronic fatigue can include various symptoms such as:
Extreme exhaustion after physical exercise or mental activity.
Difficulty with memory or thinking skills.
Dizziness that gets worse when moving from lying or sitting to standing.
Muscle or joint pain.
Unrefreshing sleep.
Flu-like symptoms.
Sensory and gastrointestinal issues.
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The current research tells us that exercise is an effective tools for combatting several complications of chronic fatigue:
Reduces physical deconditioning by preventing muscle wasting and cardiovascular decline related to inactivity.
Enhances circulation and oxygen delivery throughout the body by increasing blood plasma and red blood cell count.
Regulates the cardiovascular system through increasing the efficiency of the heart, alleviating symptoms like rapid heart rate (tachycardia) and dizziness upon standing.
Regulates the nervous system through improving stress responses and sleep quality.
Combats mental health struggles through neurobiological shifts within the brain. Exercise balances important mood-regulating neurotransmitters such as serotonin and dopamine, lowers systemic inflammation and lowers cortisol secretion.
Aerobic exercise in particular increases brain-derived neurotrophic factor (BDNF) which supports the growth of new neurons to improve cognitive functions like memory and attention.
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For CFS/ME, management through exercise aims to reduce future chronic disease risk, while also minimising the likelihood of symptom flare-ups such as post-exertional malaise. It is very much a balancing act.
Pacing and energy envelopes:
Focus on light, low impact exercise such as yoga, gentle stretching and flat terrain walking.
Exercise bouts are regular but short, with rest periods following a ratio of 1 part exercise to 3 parts rest.
Volume is increased very slowly and only if tolerated.
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For chronic fatigue better explained by an underlying condition, the approach to exercise focuses on graded exercise therapy. The main aim is to combat deconditioning and to build a larger ‘energy battery’ over time.
Mixed modes with gradual progressions:
Focus on a balance of cardiovascular activity (e.g., walking, swimming, stationary cycling) and light resistance/strength training (e.g. body weight, exercise bands or light weights).
Progress exercise volume and intensity incrementally (e.g., starting with 5 - 10 minutes of physical activity and slowly increasing as fitness and strength improves).
Benefits vs Risks
As with all types of exercise, for all levels of health and fitness, there will always be some degree of risk. While exercise is never 100% risk free, the benefits of maintaining regular physical activity are generally considered to outweigh these risks, as well as the added risks of being inactive. Exercise has been shown to reduce the risk of premature death by 20% - 40% compared to being inactive. Importantly, research also indicates that becoming physically active later in life can still have a significant impact in improving your longevity. Aside from the physical benefits, the research also shows substantial positive impacts on mental health and stress management.
When embarking on a new exercise routine, it is recommended that you speak with your general practitioner (GP) to request a referral to an Accredited Exercise Physiologist for clinical exercise prescription that is safe and appropriate for your circumstances.
Have you heard about spoon theory?
Spoon theory was introduced in 2003 by health advocate and writer Christine Miserandino. She created this metaphor to help people understand how chronic fatigue can limit daily energy levels. Spoons represent units of energy, with every daily task costing ‘spoons’. When a person runs out of spoons, they have no energy left to continue. Each day can be different, resulting in a different number of spoons available, or tasks taking up more spoons on some days than others - representing the unpredictable nature of chronic fatigue. The chronic illness community often refer to themselves as ‘spoonies’ and use terms like “I’ve run out of spoons” to communicate their level of fatigue.
The bottom line
While exercise is widely recommended for people with chronic fatigue, the type of fatigue you have matters. Different causes and patterns of fatigue can change which kinds of activity are most appropriate, so there isn’t a one-size-fits-all solution. Consulting a clinical exercise professional who understands your medical history and symptom pattern is strongly recommended.
Recommendations to introduce physical activity are grounded in hundreds of research papers and clinical trials. Even if starting feels daunting or near impossible, a slow, gradual approach is advised regardless of the nature of your chronic fatigue. Small, carefully paced increases in duration or intensity, tailored to your condition and tolerance, help build capacity while reducing the risk of setbacks.
Getting started can be challenging, but for most people the benefits of appropriately prescribed exercise outweigh the risks. If you’re unsure where to begin, seek an assessment from a clinician or exercise professional experienced with chronic fatigue, work with them to set realistic, measurable goals, and monitor your response so you can adjust the plan as needed.
