Exercise Limits and CFS

Can exercise limits prevent post-exertional malaise in chronic
fatigue syndrome? An uncontrolled clinical trial.

Journal: Clin Rehabil. 2008 May;22(5):426-35.

Authors: Nijs J, Almond F, De Becker P, Truijen S, Paul L.

Affiliation: Department of Human Physiology, Faculty of Physical
Education and Physiotherapy, Vrije Universiteit Brussel. j.nijs@ha.be .

NLM Citation: PMID: 18441039


Objective: It was hypothesized that the use of exercise limits
prevents symptom increases and worsening of their health status
following a walking exercise in people with chronic fatigue syndrome.

Design: An uncontrolled clinical trial (semi-experimental design).

Setting: Outpatient clinic of a university department.

Subjects: Twenty-four patients with chronic fatigue syndrome.

Interventions: Subjects undertook a walking test with the two
concurrent exercise limits. Each subject walked at an intensity where
the maximum heart rate was determined by heart rate corresponding to
the respiratory exchange ratio = 1.0 derived from a previous
submaximal exercise test and for a duration calculated from how long
each patient felt they were able to walk.

Main outcome measures: The Short Form 36 Health Survey or SF-36, the
Chronic Fatigue Syndrome Symptom List, and the Chronic Fatigue
Syndrome - Activities and Participation Questionnaire were filled in
prior to, immediately after and 24 hours after exercise.

Results: The fatigue increase observed immediately post-exercise (P=
0.006) returned to pre-exercise levels 24 hours post-exercise. The
increase in pain observed immediately post-exercise was retained at
24 hours post-exercise (P=0.03). Fourteen of the 24 subjects
experienced a clinically meaningful change in bodily pain (change of
SF-36 bodily pain score >/=10); 6 indicated that the exercise bout
had slightly worsened their health status, and 2 had a clinically
meaningful decrease in vitality (change of SF-36 vitality
score >/=20). There was no change in activity
limitations/participation restrictions.

Conclusion: It was shown that the use of exercise limits (limiting
both the intensity and duration of exercise) prevents important
health status changes following a walking exercise in people with
chronic fatigue syndrome, but was unable to prevent short-term
symptom increases.

* * *

It's been my experience that I can "mosey" without getting worse, but walking at normal speed causes problems.  I also find that I have to take a day or two off between bouts of exercise.

The last time I followed doctor's orders to walk 1/2 hour every day, by the end of the week I was back in bed, so debilitated I could barely walk the 4.5 feet to the bathroom.  Doctor may think he knows best, but I have to listen to my body, and my body says every day is too much.  My way keeps me in better health than his way.

Do not let any doctor bully you into exercising.  There are plenty of studies out there that say exercise and CFS don't mix.  If he hasn't read them, print them out and highlight the sentence in the conclusion that says Exercise Makes CFS Worse.  I do stretches and resistance exercises to keep muscle tone, but I don't jog, I don't do aerobics, I don't go to spinning class, because I know those things can very quickly take me from feeling good to being bedridden.  And Dr. Cheney backs me up.

Honor your limits, whatever they may be.  There were times in this disease when getting from the bed to the kitchen 3 times a day was too much.  I bought a bunch of cereal bars and bottled water, stashed them under the bed, and found that walking to the kitchen only twice a day tipped the balance from making myself worse every day to holding steady.  At that stage, trying to walk 1/2 hour a day to appease a doctor would have landed me in the hospital the first day.

A friend got SSDI on her first try because she'd pushed herself to the point of hospitalization more than once.  And a year later is still suffering after-effects.  She was near-death when she was found collapsed on the floor, and the doctor suggested another hour or two might've been too late.  Not a risk I want to take, and especially because the judge I'm dealing with doesn't award benefits to anyone under 55, so I'd be near-killing myself for no reason.  (On the bright side, when I hit 55 and he does finally give me the benefits I have legally been entitled to since 2000, I will get a humongous check for back benefits, which I can invest for a nice additional monthly income the rest of my life.)