Disability is any physical or mental condition, which leads to the limitation of person’s movements, senses, cognitive abilities, and activities or a combination of these. It is not just a health problem, it is a complex phenomenon, reflecting the physical or mental attributes, which need to be fixed.
One such disabling condition is Chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME) is an illness characterised by extreme exhaustion. Other common symptoms include aching muscles, joint pains, headache, sore throat and flu-like feelings. The cause is unknown and recovery can take years. In some cases, people don’t recover and suffer relapses throughout their lives.
Exercise is often a problem for people with CFS because physical activity can worsen their symptoms. Medical opinion has been divided on whether people with CFS should attempt regular exercise or not – some believe that gentle exercise is helpful, while others caution against any form of aerobic activity. Research has found that patient education on CFS and a graded exercise program can improve symptoms in many cases and, on average, is not likely to worsen outcomes.
What is Chronic Fatigue Syndrome?
It is a long term illness with wide range of symptoms, and can affect anyone, including children. However, it is particularly more commonly seen in women, and usually tends to develop in the second to fourth decade of life. Estimates suggest that the number of persons with the condition vary from 7 to 3000 per 100,000 adults. Various biological, genetic, infectious, and psychological mechanisms behind the development of this condition have been proposed, but the exact cause is not yet understood.
The main symptom of chronic fatigue syndrome is the disabling feeling of being extremely tired and generally unwell to an extent that limits the person’s ability to carry out ordinary daily activities, compromising their quality of life. Other symptoms include sleep disturbances, myalgia or muscle and joint pain, headache, sore throat, flu like symptoms, irregular and fast heart beats (heart palpitations). Most of the patients report that exercise makes these symptoms all the more worse.
It must also be noted that, symptoms of chronic fatigue syndrome, overlap and resemble other common illnesses and hence are often overlooked by the patient. However, the distinguishing feature of extreme tiredness and exhaustion since a long time, and the worsening of symptoms upon exercise, must be kept in mind. Consult the doctor to get a proper diagnosis. As there is not a specific test for this condition, the physician usually establishes the diagnosis on the basis of history and examination.
Treatment of Chronic Fatigue Syndrome or Myalgic Encephalomyeltis aims to relieve the symptoms and is tailored accordingly. The treatment strategy includes:
- Cognitive Behavioral Therapy (CBT) : It is used to treat mild to moderate CFS. It is a talking treatment, which focuses on the way a person thinks and behave. It helps to feel to have a higher control over symptoms, and to channel a better understanding of how the behavior can positively affect the condition. The treatment is offered on a one-to-one basis by a CBT therapist.
- Graded Exercise Therapy: It is a structured exercise program, adapted to the individual’s capabilities, to gradually increase the duration of carrying out a physical activity and involves specific exercise regimes that raises the heart rate like swimming. The patient is also asked to set goals for doing daily chores and it takes patience to achieve them. The GET therapy is offered by a trained and experienced specialist on a one-to-one basis.
- Medications: There is no specific medication for chronic fatigue syndrome, however drugs can be taken to relieve some of the symptoms. Over the counter NSAIDS can help to relieve headaches, muscle, and joint pain. It is important to eat regularly and have a healthy balanced diet.
- Sleep, rest and relaxation: The sleep disturbances associated with CFS, make it even worse. Advice is given to establish a normal sleeping pattern. Avoid excessive day-time sleeping to get a proper night sleep. Limit each rest period to 30 minutes and practice relaxation techniques such as breathing exercises and medications. Include more breaks with your current levels of activities.
Tips For CFS Exercise
- Exercise may not be possible for everyone
Some people with CFS, especially in the weeks or months following onset, are unable to perform the most basic activities such as showering or walking from one room to another. In such cases of extreme exhaustion and pain, the person may be confined to their bed.
As time passes, the person may feel a little better and attempt regular exercise. However, aerobic activity can cause a relapse of symptoms. The added problem for people with CFS is that a sedentary lifestyle causes a range of other health problems including muscle wastage, loss of bone mass, and increased risk of obesity and cardiovascular disease.
Medical problems that cause low levels of the electrolyte potassium often include chronic fatigue as a symptom. The bulk of the body’s potassium supply is found in muscle tissue, with the rest in the brain, blood and internal organs. A 2004 study by researchers at Adelaide University found that people with CFS have less total body potassium (TBP) than healthy people of similar age and weight.
Exercise Suggestions For Chronic Fatigue
A person with CFS needs a gentle approach to physical activity and should only make tiny increases in the frequency, duration and intensity of their exercise program.
Be guided by your doctor or physiotherapist, but general suggestions include:
- Aim for no more than three exercise sessions per week.
- Experiment to find the type of exercise that works best for you. Choose from a range of gentle activities such as stretching, yoga, Tai Chi, walking and light weight training.
- Stretching seems to be well tolerated by people with CFS. You may prefer to perform your stretching program while lying down in bed.
- Aerobic exercise seems to cause relapses for many people with CFS. If this is true for you, try non-aerobic forms of exercise like weight training with light weights.
- Keep an activity diary so you have a long-term picture of your performance levels and factors that might impact on fatigue.
- Learn from past relapses. For example, if walking for 20 minutes worsened your symptoms, try walking for five minutes and see how that goes. Use your activity diary to keep track of what works for you and what doesn’t.
- Stop the physical activity well before you feel tired. Pacing yourself is very important.
- Remember that your exercise tolerance will differ from one day to the next.
- If possible, monitor your heart rate during exercise with a heart rate monitor or by manually taking your pulse.
- Listen to your body – if you don’t feel up to exercising on a particular day, don’t.
- Slowly increase the intensity, time spent or frequency of exercise, but only when you know you can cope with it. For example, if you can exercise for five minutes without suffering a relapse, try for six minutes.
Remember some of the patients of CFS make a full recovery and return to their previous activities. The doctor must discuss all of the treatment options, and explain the benefits and risks of any treatment. He must encourage the patient to be optimistic about the recovery.