|Energy Conservation in CFS
Activity Mangement in CFS / Practitioner
- Obtain a thorough physical exam before starting any
physical activity/exercise program. In addition, cardiopulmonary testing may be indicated for many individuals
Post-exertional malaise - Understand the concept
post-exertional malaise, which affects the vast majority of people with the
illness. It is defined as exacerbation of symptoms following physical or
with symptoms typically increasing 12-48 hours after activity and lasting for days or even weeks. Post-exertional
exercise intolerance, though not unique to CFS, may help to distinguish CFS from other disorders.
- Numerous people with CFS avoid activity because personal experience has clearly demonstrated a link
between exertion and
symptoms. An even greater number of people engage in an endless ‘push-crash’ cycle of activity.
- Assess functional
capacity, level of impairment, exercise/activity perceptions, presence of orthostatic intolerance and
status of coping skills.
- Assist the person with CFS in identifying goals and setting realistic expectations.
Primary objectives for a CFS activity plan are to improve function and quality of life.
Develop an activity/exercise plan
- Develop this jointly with the person with CFS.
avoidance of over- and under-activity; balancing activity and rest are key elements in the plan.
Begin any activity program very slowly - even starting
with one minute of total exercise/activity time may be indicated for some people -
rest intervals that are at least the length of the activity. Some researchers encourage an activity/rest
a 1:3 ratio (a rest period that is three times the length of the activity).
Increasing activity gradually may help prevent relapse.
Gear activities toward
improving function in areas that are of greatest importance in achieving activities of daily living.
this is not a typical ‘exercise’ regimen to offset fears of overexertion and post-exertional relapse.
Examples of useful activities that could be included are:
Simple exercises such as repeated
hand stretches, sitting and standing, or picking up and grasping objects provide a good foundation.
Simple stretching and strengthening exercises using only body weight for resistance
is a good starting point. The focus is on function in activities of daily living.
Stretching and resistance training using latex resistance bands can
be included in the second step. The focus is on neuromuscular adaptation and motor learning.
- Assess progress and problem areas; monitor for post-exertional malaise, an important aspect in follow-up.
- Include other members of the health care team for
special interventions that address various symptom complaints and other concerns (e.g., orthostatic or
- Encourage self-care, self-management and self-determination.