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Chronic Fatigue Syndrome: Exercise Therapy Safe & Effective

Abstract: The most current systematic review of exercise therapy for chronic fatigue syndrome concludes that exercise therapy is safe and results in reduced fatigue, better sleep, improved physical function, and greater self-reported general health.

Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis, is a diagnosis of exclusion characterised by severe, disabling fatigue; musculoskeletal pain; sleep disturbances; headaches; reduced concentration; and impaired short-term memory. Current research is finding prevalence to be as high as 2.54 in 100 - much higher than previously thought.1 Multiple guidelines call for the prescription of exercise therapy as part of the treatment plan for chronic fatigue syndrome. This was bolstered in part by a 2004 Cochrane review concluding that exercise therapy has strong potential in CFS treatment, but that larger studies were needed to address the safety of the therapy. Such studies have been conducted, and an updated Cochrane review on exercise therapy for chronic fatigue syndrome was published in 2015.2

The current review includes eight randomised controlled trials including 1,518 patients. The authors conclude that exercise therapy tends to cause patients to feel less fatigued, have better sleep, have better physical function, and report greater self-perceived general health. There were no serious adverse events. The studies tended to use different scales, but for example, one study found a mean before and after difference in fatigue of 6.06 points on a 0 to 11 scale. Interventions ranged from 12 to 26 weeks. Control groups included usual care, relaxation, flexibility, cognitive behavioural therapy, supportive listening, pacing, and pharmacological treatment.

A biological explanation for CFS growing in popularity and finding supportive evidence is that central sensitisation contributes to hyperresponsiveness of the central nervous system to a variety of visceral inputs.3 Professionally designed therapeutic exercise plans are known to modulate central sensitisation. This central sensitisation model also accounts for the commonly observed phenomenon among CFS patients that they have an increased sense of effort during exercise.4,5 This altered perception underscores the importance of professional guidance for CFS exercise intervention. Exercise therapy for chronic fatigue syndrome commonly involves graded exercise characterised by a baseline achievable activity goal, followed by negotiated, incremental increases. Our exercise physiologist can provide the right exercise plan at the outset and help patients monitor for and implement upgrades in the physical activity to maximise efficiency and outcomes of exercise therapy.

Advanced Physiotherapy and Injury Prevention can prove particularly helpful to your patients with chronic fatigue syndrome. In addition to exercise physiology, Advanced Physiotherapy provides a free patient gym where patients can conduct their between visit exercises with qualified staff available for reassurance and guidance.



  1. Reeves W, Jones J, Maloney E, et al. Prevalence of chronic fatigue syndrome in metropolitan, urban, rural, Georgia. Popul Health Metr. 2007; 5:5.
  2. Larun L, Bruberg K, Odgaard-Jensen J, Price J. Exercise therapy for chronic fatigue syndrome (Review). Cochrane Database Syst Rev. 2015; (2): CD003200.
  3. Nijs J, Meeus M, Van Oosterwijck J, et al. In the mind or the brain? Scientific evidence for central sensitisation in chronic fatigue syndrome. European Journal of Clinical Investigation. 2011; 42: 203-11.
  4. Fulcher K, White P. Strength and physiological response to exercise in patients with chronic fatigue syndrome. Journal of Neurology Neurosurgery & Psychiatry. 2000; 69: 302-7.
  5. Paul L, Wood L, Maclaren W. The effect of exercise on gait and balance in patients with chronic fatigue syndrome. Gait and Posture. 2001; 14: 19-27.

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