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Pacing with Chronic Fatigue

Exercise Therapy for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Clinical Manifestations

Myalgic Encephalomyelitis (ME)/ Chronic Fatigue Syndrome (CFS) is a complex chronic disease involing multiple bodily systems: signs and symptoms are found in the central and autonomic nervous systems, the cardiovascular system, the gastrointestinal system and the immune system. 

0.2 to 0.7% of the Australian population is diagnosed with ME/CFS. A hallmark symptom of ME/CFS is post exertional malaise (PEM), which is worsening of symptoms following physical or cognitive exertion. Other key symptoms include fatigue (both cognitive and physical), sleep disturbance, and muscle weakness. ME/coCFS frequently appears with other conditions, the most common are firbromyaglia, generalised pain and muscle stiffness around the body; and postrual orthstatic tachycardia syndrome (POTS), abnormal increase in heart rate after sitting up or standing.

These conditions contribute to the deterioration and severity of symptoms. The aetiology of ME/CFS is not yet established, although many proposed mechanisms exist. Current diagnosis relies on diagnosis of exclusion.

Treatment of ME/CFS

Currently, there is no cure or FDA approved treatment available for ME/CFS. This is because each patients presents with varying symptoms. Existing treatment strategies primarily focus on relieving symptoms and improving quality of life and functions.

Management of ME/CFS through Exercise: The Evidence

Current research evidence on the management of ME/CFS through exercise has been controversial. Graded exercise therapy (GET) and cognitive behavior therapy (CBT) have been commonly recommended as treatments for ME/CFS as the combined therapy has been shown to improve patients self rated fatigue and physical functions. This is under the assumption that encouraging physical activity would reverse activity avoidance and deconditioning, thus leading to reduction in symptoms. Since then, GET and CBT became a “go-to” therapy for people with ME/CFS. However, more recently, a systematic analysis suggests that there is low to moderate certainty about the evidence that GET may alleviate symptoms of ME/CFS. Keeping in mind that the central feature of ME/CFS is post exertional malaise (PEM), which varies significantly from person to person and from time to time. GET can repeatedly push a patient to the point where PEM is triggered, resulting in possibly permanet worsening of symptoms.

Benefits of Exercise

Many research studies have look at the pathways at how might exercise help with ME/CFS. Evidence suggests that exercise improves overall physical capacity without worsening the associated symptoms through altering pain cognitions and reducing fatigue.

ME/CFS Management at FORGE

Here at Forge we see a number of clients with ME/CFS. One strategy we use at Forge is “pacing”. The goal of pacing is to be able to remain as active as possible while taking steps to avoid reaching patient’s PEM point. We utilise different management approaches such as monitoring of heart rate and reporting of changes in day to day events through activity diaries. From here, we offer personalised programs to our patients using a combiation of pilates equpiment, weights and cardio machines to address the many changes associated with ME/CFS. 

As mentioned, ME/CFS is a relapsing-remitting condition. Patients can experience significant fluctuations in their general well being from a daily basis. Our exercise physiologists and physiotherapists take these characteristics into considerantion to help formulate exercise prescription that is hollistic and specific to both individual’s symptoms and personal goals. We are with you every step of the way!

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