Jay Dawes, MS, CSCS, NSCA-CPT,*D
Chronic fatigue syndrome (CFS) is a medically unexplained illness that is estimated to affect 20-70% of the population in Western countries (8). This condition is typified by fatigue lasting longer than 6 months, that is unmitigated by bed rest (4,8).
SIGNS AND SYMPTOMS
The signs and symptoms associated with CFS can be diverse and range dramatically in severity between individuals. Typically, those with CFS exhibit signs and symptoms common to many viral-type infections. In addition to severe and profound fatigue, these symptoms often include sore throat, headaches, impaired cognition, depression, and sleep disturbances (4,8,12). However, unlike most viral infections symptoms often last for months to years instead of days to weeks (10).
Viral infection, immunological dysfunction, abnormal hypothalamic-pituitary adrenal axis activity, neurally mediated hypotension, central nervous system dysfunction and/or nutritional deficits may trigger the onset of this illness (1-4). It is also considered by some to be a type of fibromyalgia. However, some researchers believe that this condition is most likely related to a combination of both physiological and psychological impairments (11).
At this time, no cure for CFS is available; thus, the majority of treatment options for this condition are aimed at symptom management (1,6-9). A combination of therapies may be used to help individuals cope with the symptoms. Stress management, group therapy/counseling, medication, nutritional interventions, and exercise are commonly used in an attempt to aid in the amelioration of symptoms for those with CFS (1,5-7,9,11).
One of the most effective treatment options available for this condition may be engaging in a well-structured strength and conditioning program. When using a strength and conditioning program in patients with CFS, one must consider the special needs and challenges these individuals face with increasing physical activity levels and adjust exercise levels accordingly based on daily and weekly symptomology (1,5-8,11).
Many individuals with CFS have an aversion to exercise because physical activity can often be a symptom aggravator, especially in the early stages of the disease. As a result, many individuals with CFS attempting to remain asymptomatic avoid physical activity whenever possible (1,4,6,7). Thus, many individuals suffering from CFS can become deconditioned and may experience significant reductions in health, fitness, and functional performance. Conversely, others that do attempt to engage in an exercise routine mistakenly follow guidelines set forth for the apparently healthy individual. Unfortunately, these types of training routines often accentuate many of the symptoms associated with this disorder, especially fatigue (13).
Because of exercise tolerance and disease severity, fitness levels and symptoms may dramatically vary among this population. For this reason, providing standardized exercise guidelines can be difficult for individuals experiencing CFS. To develop an effective strength and conditioning program for an individual with CFS, the fitness professional must be prepared to modify the training program, especially the volume and intensity, on the basis of the client's individual daily symptoms and fatigue levels (9).
Regular aerobic training may improve a variety of symptoms associated with CFS, especially fatigue (1). It may also be beneficial for weight management purposes, which can aid in the reduction of additional stress being placed on the musculoskeletal system in the form of excess body fat. Aerobic types of activity for those with CFS should emphasize a low-impact modality, such as pool therapy, fitness walking, or cycling (1,4,7). The intensity of these activities should correlate with a light-to-moderate rating on a standard rating of perceived exertion scale (13).
When progressing through a cardiovascular training program with an individual, consider increasing the frequency and duration of the activity before significantly increasing the intensity. Initially use smaller (5-10 minutes), more frequent bouts of light-to-moderate cardiovascular exercise 3-5 days per week (as exercise tolerance allows) rather than one long training session to improve exercise adherence, reduce the effects of postexertional fatigue, and the delay the onset of muscle soreness.
Enhancing muscular fitness can profoundly impact quality of life for those with CFS. Strengthening the major muscle groups may significantly reduce fatigue as a result of the improved mechanical efficiency when performing many activities of daily living (ADLs) (13). When engaging in resistance training, it is not recommended that these individuals perform exercises to the point of volitional fatigue because doing so may exacerbate their symptoms and could potentially lead to kinesophobia, or a fear of movement (13).
Initially, clients should focus on performing multijoint exercises using their own bodyweight before adding external resistance. The client should be progressed from a seated position to standing as tolerated. As a guideline, once the client is able to perform approximately 10-15 repetitions with proper form and without significant fatigue, the use of other modalities of training, such as free-weights and resistance training machines, can be introduced. Select an intensity that leaves the client feeling as if they could have performed at least 2 additional repetitions at the end of the set. This may aid in the improvement of muscular fitness and reduction of postexertional fatigue and malaise related to physical activity.
Initially, performing one set of exercises for each of the major muscle groups may be sufficient to improve fitness levels as well as provide valuable information regarding how the training program should be manipulated to improve exercise tolerance. As the client's fitness and confidence levels improve, the client may slowly progress until he or she is able to perform a greater overall volume of training. Progress the client until he or she is able to perform 2-3 sets of 10-15 repetitions per exercise before significantly increasing the training intensity to reduce the likelihood of overtraining and to help improve exercise tolerance. In addition to focusing on the major muscle groups, the program should reflect the ADLs of the individual client.
Flexibility and mobility tend to be poor in this population (9). Stretching performed on a daily basis is recommended. Initially, the client should strive to perform at least one set of stretching exercises for each of the major muscle groups, holding each stretch for approximately 10-15 seconds. As tolerance improves, the duration of each stretch may be increased to 20-30 seconds. Once able to maintain each stretch for 30 seconds additional sets may be considered.
A comprehensive strength and conditioning program may significantly improve the health, fitness, and quality of life for individuals with CFS provided that conservative and steady training progressions are used. The key to developing an effective training program for individuals with CFS is to start at an intensity and volume level that is well tolerated and does not significantly exacerbate their symptoms. Volume and intensity of physical activity should be progressed over time. Make sure the training regimen can be maintained by the client for several weeks without significant increases in postexertional fatigue or malaise before increasing the duration or intensity of exercise. Regular communication with client's health care provider(s) can ensure the client's safety and keep the fitness professional informed of all current treatments, exercise recommendations, and contraindications.
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