EXERCISE & CFS

altered perception of effort with any phys- ical exertion, which may be associated with a profound fear of exacerbating the symp- toms and causing a relapse, should they over-exert themselves.

A recent study compared the physical and psychological characteristics between patients with CFS, depressed patients and healthy, sedentary controls. The CFS patients had a greater perception of phys- ical fatigue and incapacity than clinically depressed patients, were weaker than sedentary and depressed controls, and as unfit as the sedentary controls. Low exer- cise capacity in CFS was related to quadri- ceps muscle weakness, low physical fitness and a high body mass index (9). There is no evidence of (causative) functional abnor- malities in CFS patients.

Since exercise has also been shown to have beneficial psychological effects, an increase in exercise tolerance and subse- quent increased independence and self- esteem, it should have a positive effect on the psychological symptoms of CFS.

Exercise recommendations Since the causes and duration of the chron- ic fatigue are varied, this approach must be individually tailored, graded, realistic and include a very gradual return to physical activity. The exercise should initially be aerobic in nature, since cardiovascular and respiratory function are predominately

associated with deconditioning. However, after the initial adaptive phase, strength- ening or muscle conditioning exercise can be introduced, focused particularly on increasing functional capacity for daily lifestyle activities.

Exercise assessment Physiological assessment depends on the equipment available but should include an assessment of aerobic capacity using an incremental and continuous exercise test. This can be done either on a treadmill, at a moderate walking pace, or a stationary bike. On the treadmill the speed should be

constant and the slope increased, and on the cycle, the pedal revolutions maintained at 40 or 50 revolutions per minute (RPM) and the resistance increased gradually. Two-minute stages are most appropriate beginning at a very low work rate and using a very gradual progression. Patients should be asked to continue exercising to fatigue or symptom-limited maximum. Level of difficulty or intensity should be monitored using heart rate and/or rating of perceived exertion (RPE) at the end of each stage of the test (see SportEX issue 2).

The use of an incremental test, rather than

by increasing the duration by 1 - 2 min- utes per week up to 30 minutes and then by increasing the intensity to 60% and then 70% of their peak heart rate reserve. Walking is ideal, but patients can be encouraged to use other modes of exercise such as stationary equipment and outdoor cycling and swimming.

given instruction sheets to include some simple stretching exercises at the begin- ning and end of their exercise session.

If they are very restricted or have a very low exercise tolerance to begin with, it may be more appropriate to begin with two weeks of stretching and a general increase in daily activity and no aerobic

They can also be

activity. After 6 weeks into the pro- gramme, strengthening exercises can be added to the routine. This should take the form of local muscle conditioning exercis- es using their own body weight or hand held weights (tins/bottles of water) as resistance. Their weekly programme can be split in two with half the sessions being purely aerobic activities as described above, and the other half with a shorter aerobic warm-up followed by muscle strengthening exercises, split into sets of 5-10 repetitions. Illustrated sheets for both the stretching and strengthening exercises should be produced for patients to take away with them. Examples of exer- cise include, side lateral raises, bicep curls,

shoulder presses, half squats, seated leg extensions and standing from sitting.

Patients should keep an exercise diary recording duration of exercise, activity type, time of day and how they felt. These can be discussed and used for pro- gression at their visits. They should be advised not to exceed prescribed activi- ty during a good phase of the illness, but also to do something rather than nothing on the “bad” days. If they com- plain of fatigue in response to a new level of exercise, they are advised to remain at the same level for an extra week and to increase the exercise when the symptoms regress.

SportEX 13