What Is Chronic Fatigue Syndrome?
Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), is a serious chronic disease with many symptoms, the most common being extreme tiredness, concentration difficulties, and even an inability to perform daily tasks . This debilitating illness can affect anyone, including children, but it’s most common among women between the ages of 20 and 40 .
The Institute of Medicine (IOM) published a report in 2015 estimating that between 836.000 and 2.5 million Americans suffer from chronic fatigue syndrome, but most of them have never been diagnosed. 
Besides feeling tired all the time, people with chronic fatigue syndrome often have symptoms like post-exertional fatigue, headaches, cognitive problems, muscle pain, sleep problems, heart palpitations, tender glands, and flu-like symptoms, including a sore throat .
Fatigue is a very common symptom in today’s society. However, it is usually transient, resolves with a good rest, and it is almost always the result of a previous strenuous physical or mental activity. In cases when persistent fatigue cannot be explained by a medical condition, chronic fatigue syndrome should be considered as a possible cause .
Could Physical Activity Be Of Any Help For Chronic Fatigue Syndrome?
A carefully guided intervention in the form of a graded exercise program is considered safe for patients with chronic fatigue syndrome, but only if it is planned and monitored by a psychotherapist and physical therapist. According to the latest results from a review conducted by an international team of researchers and published every year in the Cochrane Database of Systematic Reviews journal:
“Patients with CFS may generally benefit and feel less fatigued following exercise therapy, and no evidence suggests that exercise therapy may worsen outcomes” .
In the largest trial of self-help interventions for chronic fatigue syndrome (the GETSET study), Dr Lucy Clark of the Queen Mary University in London — and the lead author — recommend a self-help approach that slowly and safely levels up physical activity (from only a few minutes of walking), after establishing a daily routine .
The study suggested that guided graded exercise self-help, as an addition to specialist medical care, had a moderate effect on fatigue, but not a significant effect on the improvement of a physical activity score in patients with severe forms of chronic fatigue syndrome .
Chronic Fatigue Syndrome And Fear Of Exercise
Most people suffering from chronic fatigue syndrome report that exercising makes their symptoms worse. Many of them are worried about conducting any kind of exercise because it could aggravate their symptoms, which is understandable. In fact, there’s actual research that shows how chronic fatigue gets worse when patients try to do only as much as they need to do — a symptom known as post-exertional malaise .
What would be a minor exertion for most people brings severe tiredness and pain to those suffering from chronic fatigue syndrome, because exercise lowers the pain threshold. People with chronic fatigue syndrome find it harder to recover their muscles after a workout and often show lower scores on the Maximum Voluntary Contractions test (MCV) after physical activity, compared to control groups . Patients often reduce their activity levels in response to fatigue, a feature shown to be a protective mechanism in humans as well as animals . They learn to adapt to the fatigue rather than persistently “picking the wound”.
In a study published in the Lancet in 2011, researchers used a method called mediation analysis to identify how abstract factors like beliefs affect fatigue. The study found that patients who were properly instructed on how to gradually change their beliefs about cognitive behavioral therapy and graded exercise therapy can receive substantial benefit .
Researchers found that fear avoidance improves more with graded exercise therapy than with cognitive behavioral therapy. According to the lead researcher, Professor Trudy Chalder, fear of exercise may be affected by directly challenging these beliefs with cognitive behavioral therapy combined with the graded approach to the activity the patient is afraid of.
Benefits Of Exercise In People With Chronic Fatigue Syndrome
The key is neither avoiding exercise altogether nor doing too much, more than the patient can comfortably handle. The key is rather to begin slowly and to gradually increase the length and intensity of the workout, and the entire process should be guided by the trained psychotherapist.
Safety Precautions Of Exercise In Persons With CFS
Most people suffering from CFS can benefit from carefully planned, guided physical activity. Considering that the severity of CFS varies, both among different people and in the same person periodically, any decision about including exercise in the treatment of this disorder should always be made through a multidisciplinary medical approach. This includes your family doctor — who is familiar with your medical history — as well as a psychiatrist or psychotherapist who will assess the severity of your CFS symptoms. A physical therapist who will make a personalized exercise plan by taking into consideration the assessment reports from other medical professionals should also be involved in your care.
Only by following these principles, can CFS patients receive benefit from physical activity. Doing anything on your own is not advised, since overexercising can worsen the symptoms of chronic fatigue sydrome.
Although a great majority of well-conducted studies published in peer-reviewed journals constitute growing evidence that this type of carefully planned and guided physical activity is beneficial for persons suffering from CFS, you can still find strong critics against the idea. Much has been done, but more research is currently still needed in order to properly investigate the exact effects of physical exercise on individuals with chronic fatigue syndrome.