The role of deconditioning and therapeutic exercise in chronic fatigue syndrome (CFS)

Abstract

Background: Patients with chronic fatigue syndrome (CFS) complain of tiredness or exhaustion, which is made worse by physical exertion. This results in their avoidance of exercise, which may lead to physical deconditioning. We do not know whether this deconditioning maintains the illness or is a consequence. Graded exercise therapy aims to reverse this cycle of inactivity and deconditioning, and to subsequently reduce the fatigue and disability associated with CFS. Aims: To review the literature relating to the role of deconditioning in perpetuating CFS and the literature relating to the role of graded exercise therapy as a treatment of CFS. Method: Non-systematic review of published papers concerning deconditioning and therapeutic exercise in patients with CFS. Findings: Patients with CFS are at least as deconditioned as sedentary but healthy controls. Supervised graded exercise therapy reduces fatigue and disability in ambulant patients with CFS; efficacy may be independent of reversing deconditioning. Conclusions: Graded exercise has an important role to play in the treatment of patients with CFS. Further work is necessary to elucidate the risks, benefits, and mechanisms of such treatment, especially in children and the severely disabled. Patient education is necessary to inform patients of the positive benefit/risk ratio in order to improve acceptance and adherence

A precarious balance: Using a self‐regulation model to conceptualize and treat chronic fatigue syndrome

“…The best evidence is for interventions that gradually increase physical activity. From the self‐regulation perspective outlined above, this may work by not only reversing deconditioning (Clarke & White, 2005) or by desensitizing the fear of activity, (Moss‐Morris and Wrapson, 2003), but also by acting as a graded exposure to avoided interoceptive sensations (fatigue and pain) and emotions, allowing them to be somatically remarked as benign, thus terminating self‐defeating attempts to regulate experience of them.…”

Chronic fatigue syndrome: An approach combining self-management with graded exercise to avoid exacerbations

“…coNcLuSIoN there is currently strong evidence to support the use of graded exercise therapy for people with cFS. Early approaches to graded exercise therapy advised patients to continue exercising at the same level when they developed symptoms in response to the exercise (6,7). this led to exacerbation of symptoms and adverse feedback from patients and patient charities.…”

“…For more details regarding how to apply appropriate exercise therapy to individual cases of cFS, the reader is referred to other manuscripts reporting the graded exercise interventions in detail (6,21,57). coNcLuSIoN there is currently strong evidence to support the use of graded exercise therapy for people with cFS.…”

“…cognitive behavioural therapy represents a psychological and physical intervention approach aimed at assisting individuals in re-evaluating concepts related to their illness and in adopting thoughts and behaviours designed to promote recovery (5). this approach to graded exercise therapy, however, advises patients to continue exercising at the same level even when they develop symptoms in response to the exercise (6,7). conversely, there is some evidence of immune dysfunction in cFS, and recent experimental research shows further deregulation of the immune system in response to too-vigorous exercise, leading to an increase in fatigue and musculoskeletal pain (post-exertional malaise) (8,9).…”

The long wait for a breakthrough in chronic fatigue syndrome

“…9 In psychological terms, patients may avoid activity because of the prolonged exacerbation of symptoms that follows minor physical activity; this leads to an understandable conclusion that exercise is harmful or to a conditioned fear of such activity. 10 In this respect, the recent mediation analysis of the outcomes of the PACE trial is of interest. 11 This trial compared standard medical care, cognitive behavioural therapy, graded exercise, and adaptive pacing therapy, concluding that both cognitive behavioural and graded exercise therapy were more effective at reducing fatigue and improving physical disability than standard care or adaptive pacing.…”