Living with chronic fatigue presents unique challenges when it comes to exercise and physical activity. While exercise is typically beneficial for health, people with chronic fatigue conditions require a carefully tailored approach. At M.O. Therapy in Markham, we help patients with fatigue conditions find the right balance of activity and rest.
Understanding Chronic Fatigue
What Is Chronic Fatigue?
Chronic fatigue involves persistent, debilitating exhaustion that isn't relieved by rest and significantly impacts daily functioning.
Key Features:
- Fatigue lasting 6+ months
- Not explained by other conditions
- Not substantially relieved by rest
- Reduces activity levels
- May worsen with exertion
Chronic Fatigue Syndrome (ME/CFS)
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome is a serious, complex condition:
Diagnostic Criteria:
- Substantial reduction in activity for 6+ months
- Fatigue not relieved by rest
- Post-exertional malaise (PEM)
- Unrefreshing sleep
- Plus cognitive impairment and/or orthostatic intolerance
Other Causes of Chronic Fatigue
May Accompany:
- Fibromyalgia
- Autoimmune conditions
- Long COVID
- Cancer-related fatigue
- Thyroid disorders
- Depression
- Chronic infections
Post-Exertional Malaise (PEM)
The Cardinal Feature of ME/CFS:
- Worsening of symptoms after exertion
- May be delayed (24-72 hours after activity)
- Can last days to weeks
- Triggered by physical, mental, or emotional exertion
- Key factor in exercise planning
Exercise Considerations
The Exercise Paradox
General Population:
- Exercise improves energy
- More activity leads to more capacity
- Standard exercise prescriptions apply
Chronic Fatigue:
- Exercise may worsen symptoms
- Standard approaches can cause harm
- Individualized approach essential
- Pacing is crucial
Why Standard Exercise May Not Work
For ME/CFS:
- Energy production is impaired
- Normal recovery mechanisms don't function
- PEM can cause significant setbacks
- Pushing through makes things worse
Goals of Activity
Realistic Goals:
- Maintain current function
- Prevent deconditioning (gently)
- Improve quality of life
- Avoid symptom flares
- Gradual improvement when possible
The Pacing Approach
What Is Pacing?
Pacing involves carefully managing activity levels to stay within your "energy envelope" and prevent symptom flares.
Key Concepts:
- Identify your limits
- Stay within those limits
- Balance activity and rest
- Avoid boom-bust cycle
- Consistent, sustainable approach
The Boom-Bust Cycle
Common Pattern:
- Feel good → do too much
- Crash → forced to rest
- Recover somewhat → repeat
- Overall decline over time
Solution:
- Do less on good days
- Maintain steady baseline
- Avoid peaks and valleys
- Sustainable activity levels
Finding Your Baseline
Steps:
- Track activity and symptoms for 1-2 weeks
- Identify patterns
- Find activity level that doesn't cause PEM
- Set this as your baseline
- Stay at baseline consistently
The 50% Rule
Practical Approach:
- If you think you can do X, do 50%
- Build in rest before you need it
- Leave energy in reserve
- Avoid hitting your limit
Appropriate Activities
Low-Energy Options
Gentle Movement:
- Slow walking (short distances)
- Gentle stretching
- Chair exercises
- Pool walking (if temperature tolerated)
- Very gentle yoga
Daily Activities:
- Paced household tasks
- Self-care with rest breaks
- Short standing periods
- Gentle gardening
Activity Guidelines
Duration:
- Start with minutes, not hours
- 5-10 minutes may be appropriate
- Split activities throughout day
- Include rest between activities
Intensity:
- Very light effort
- Should be able to talk easily
- No breathlessness
- No increase in heart rate above safe range
Frequency:
- Consistent daily activity
- Same amount each day
- Avoid compensating for missed days
Exercise Modifications
Heart Rate Monitoring
For Some Patients:
- Keeping heart rate low may help
- Prevents exceeding energy threshold
- Typically 50-60% of max (or lower)
- Individual guidance needed
Horizontal Exercise
May Be Better Tolerated:
- Lying down exercises
- Reduced cardiovascular demand
- Examples: gentle stretching, leg slides
Short Duration
Key Strategy:
- Multiple short sessions
- Better than one longer session
- 2-5 minutes may be appropriate
- Rest between sessions
Adequate Recovery
Essential:
- Plan rest after activity
- Factor recovery into schedule
- Don't schedule back-to-back activities
- Listen to your body
Sample Gentle Program
Week 1-2 (Finding Baseline)
Track:
- Activity type and duration
- Symptom levels (before and after)
- Delayed symptoms (next 24-72 hours)
- Energy levels
Identify:
- What triggers PEM
- What's tolerated
- Your current safe limit
Gentle Activity Examples
Morning (5-10 minutes):
- Gentle stretching in bed
- Slow standing and walking
- Chair exercises if tolerated
Midday (5-10 minutes):
- Brief walk or standing
- Gentle movement
- Rest before and after
Evening:
- Very gentle stretching
- Relaxation exercises
- Rest and recovery
Progression (If Appropriate)
Very Gradual:
- Add 1-2 minutes only when stable
- Wait 2+ weeks between increases
- Monitor for delayed effects
- Back off if symptoms increase
Managing Setbacks
If PEM Occurs
Response:
- Rest immediately
- Reduce activity significantly
- Don't push through
- Allow full recovery before resuming
Preventing Setbacks
- Stay within limits
- Plan for demands (appointments, social events)
- Rest preemptively
- Don't compensate for missed activity
After Recovery
- Return to previous baseline
- Don't try to make up lost ground
- Reassess if needed
Other Energy Management Strategies
Sleep Optimization
Important Despite Unrefreshing Sleep:
- Consistent sleep schedule
- Sleep hygiene practices
- Address sleep disorders
- Rest even if not sleeping
Stress Reduction
Energy Drains:
- Stress uses energy
- Relaxation techniques
- Reduce unnecessary stressors
- Pacing mental/emotional activity
Nutrition
Support Energy:
- Regular, balanced meals
- Adequate hydration
- Some benefit from anti-inflammatory diet
- Avoid energy spikes and crashes
Environmental Modifications
- Reduce sensory overload
- Adapt home for energy conservation
- Use aids and adaptations
- Accept help when offered
Treatment at M.O. Therapy
Physiotherapy
Our physiotherapists understand chronic fatigue:
Assessment:
- Comprehensive evaluation
- Activity tolerance testing
- Baseline identification
Treatment:
- Individualized activity prescription
- Pacing education
- Gentle movement programs
- Symptom management
Massage Therapy
Our RMTs can help with:
- Gentle, relaxing massage
- Pain management
- Muscle tension relief
- Modified approach for fatigue
Support and Education
- Understanding your condition
- Energy management strategies
- Advocacy and support
- Ongoing guidance
Important Considerations
Not One Size Fits All
Individual Variation:
- Severity varies greatly
- What works for one may not work for another
- Medical guidance important
- Flexible approach needed
Graded Exercise Therapy (GET)
Current Understanding:
- Traditional GET is controversial for ME/CFS
- May cause harm if not individualized
- Activity pacing preferred
- Patient-led approach recommended
Working with Healthcare Providers
- Communicate clearly about symptoms
- Report PEM patterns
- Be honest about capacity
- Advocate for appropriate care
Frequently Asked Questions
Should I exercise if I have chronic fatigue? Some gentle movement may be beneficial, but it must be carefully tailored to your capacity. Traditional exercise recommendations often don't apply. Working with a knowledgeable professional is important.
Why does exercise make my fatigue worse? In conditions like ME/CFS, energy production systems are impaired. Exceeding your limited capacity triggers post-exertional malaise. Staying within your energy envelope is essential.
How do I know how much activity is too much? Track your activities and symptoms to identify patterns. Any activity that causes delayed symptom worsening (even 24-72 hours later) was too much.
Will my capacity ever improve? Some people do improve over time with careful management. For others, maintaining function is the goal. Individual outcomes vary significantly.
Book Your Assessment
If you're living with chronic fatigue and need guidance on appropriate activity levels, M.O. Therapy in Markham can help. Our team understands the unique challenges you face.
Call (905) 201-5827 or book online for your assessment. We offer direct billing and same-day appointments.