EXERCISE & CFS

a submaximal predicted test, allows for a comparison on a range of work levels, and patient termination of the test enables an assessment of their exercise pain tolerance and their individual heart rate range.

If no equipment is available local muscle strength can be assessed on specific tasks or adapted exercises (eg. press-ups against the wall, standing up from sitting in a chair, climbing steps).

It is important to be aware that the low volume of activity that CFS patients toler- ate at the early stages of an exercise pro- gramme may not be sufficient to stimulate significant increases in fitness levels. However, significant changes will still be

observed in perceived physical function, general health and symptoms (7).

Conclusion Although the objectives of the exercise programme are to reduce fatigue and to reverse the deconditioning effects, the ini- tial low levels of activity and very gradual progression, may stimulate relatively small increases in physiological capacity, while allowing larger improvements in symptoms.

Psychological improvements with exercise training can occur when submaximal car- diorespiratory fitness improves, despite no change in VO2 max. (11).

Individuals, who may have been inactive

for a long time, are inclined to do too much too soon and then give up. It should be stressed at all times that it is more important to slow down and to continue exercising for the entire peri- od than to adhere to a faster pace for shorter periods. It also makes the exer- cise more enjoyable and encourages patients to monitor their own progress.

Regardless of amount and intensity of exercise, the importance of a regular routine and taking positive action can- not be over-emphasised.

Most patients with CFS, regardless of the duration of illness, should respond positively to a well-monitored and carefully planned graded exercise pro- gramme. Cognitive behavioural therapy can be a helpful adjunctive treatment.

References 1. Sharpe MC et al (1991) A report - Chronic Fatigue Syndrome: guidelines for research. J Roy Soc Med 84:118-121 2. Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A (1994) The chronic fatigue syndrome: A comprehensive approach to its definition. Ann Int Med 121:953-959 3. Goldenberg DL, Felsen DT & Dinerman H (1986). A randomised, controlled trial of amytriptyline and naproxen in the treatment of fibromyalgia. Arthritis and Rheumatism 29, 1371-1377 4. Sharpe M, Hawton K, Simkin S, Suraway C et al (1996) Cognitive behaviour therapy for the chronic fatigue syndrome: a randomised controlled trial. BMJ 312:22-26 5. Cox D & Findley L (1994). Is chronic fatigue syndrome treatable in the NHS envi- ronment. Clinical Rehab 8,76-80. 6. Archer MI (1987). The Post-viral Fatigue Syndrome: a review. J Roy Coll Gen Pract 37, 212-214. 7. Fulcher KY & White PD (1996). A ran- domised, controlled trial of graded exercise therapy in the chronic fatigue syndrome. BMJ, 314;1647-1652. 8. Morriss R, Weardon A, Mullis R, Strickland P, Appleby L, Campbell I, Pearson D (1996) A double-blind placebo controlled trial of fluoxetine and graded exercise for chronic fatigue syndrome (CFS). Eur Psychiatry 11(Suppl4) :273s (Abstract) 9. Fulcher KY & White PD (2000). Disability, strength and physiological response to exer- cise in patients with chronic fatigue syn- drome. (In press) 10. American College of Sports Medicine (1995) Guidelines for Exercise Testing and Prescription. 5th ed. Baltimore; Williams & Wilkins. 11. Martinsen EW (1990) Benefits of exer- cise in the treatment of depression. Sp Med 9(6), 380-389.

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