# Exercise as it relates to Disease/Aerobic exercise benefits on Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) is a medical disorder classified by unexplained, disabling physical and mental fatigue accompanied by several other specific symptoms, occurring over a minimum time period of 6 months for adults and 3 months for children$^3$. CFS significantly impacts on the quality of life, health, happiness and productivity of affected individuals. It affects up to 1% of the population and is most prevalent in adults, particularly women. The exact cause of CFS is still unknown; the symptoms are not caused by continued exertion, are not relieved by rest and are not a product of other medical conditions$^1$. There are several theories of how CFS may develop, including abnormalities in the neuro-endocrine system, although it is considered to have a complex and multifactorial etiology$^3$. Treatment strategies currently include psychological, pharmacological interventions and physical therapy$^4$.

## Symptoms

The lack of medical understanding of what causes CFS creates much uncertainty and disagreement between doctors regarding how it should be diagnosed, although it is generally considered that a patient must present with a certain number of specific symptoms, as well as mental and physical fatigue. The following symptoms are commonly experienced by chronic fatigue sufferers:
* Post exertional malaise
* Circadian dysrhythmia or sleep disturbances$^5$
* Muscle and joint pain$^2$
* Increased sensitivity to light, sound and smell$^4$
* Headaches
* Sore Throat
* Gastrointestinal complaints$^3$
* Depression or other psychological problems$^2$
* Cardio-respiratory problems
* Cognitive difficulties such as impaired memory or concentration$^3$
* Physical deconditioning$^5$

## Treatment

Exercise is among the current treatment options for CFS, and has been shown to improve the outcome of the condition when undertaken under controlled conditions. Exercise therapy varies in effectiveness between patients, and requires a careful balance of duration and intensity in order to improve rather than exacerbate symptoms. If intensity of exercise is too great, or duration too long, it can cause post-exertional malaise lasting longer than 24 hours$^2$. Sufferers are likely to avoid aerobic exercise because they perceive it to only worsen their symptoms, however aerobic therapy has been shown to improve cardiovascular function, general strength and psychological well-being when undertaken at an intensity and duration suitable to the individual$^5$.
One study compared sedentary subjects to CFS sufferers exercising at a submaximal level. The CFS patients showed higher submaximal oxygen uptake during exercise and greater perceived fatigue and incapacity than their sedentary controls. These results support the detrimental effect of inactivity, and reinforce the positive use of aerobic exercise to prevent deconditioning$^4$.

## Recommendations

Despite countless investigations into finding different treatments, no cure has been found. The only therapy that shows to lower symptoms and improve general functioning is cognitive behavioural therapy and a graded exercise program. However the subjective nature of fatigue symptoms makes measuring improvements difficult so self-reporting need to be used to assess effectiveness.
A graded aerobic exercise program should be implemented that is designed specifically for patients and tailored to their individual functional abilities. The program should monitor peak and submaximal oxygen uptake, heart rate, blood lactate, duration and perceived exertion.

## Further Information

ME/CFS Australia
http://www.mecfs.org.au/
Wikipedia Chronic fatigue syndrome
http://en.wikipedia.org/wiki/Chronic_fatigue_syndrome

## References

1. Edmonds. M, McGuire. H, Price. J. R. (2010), Exercise therapy for chronic fatigue syndrome (Review). The Cochrane Library, 6:1-33.
2. Gordon. B. A., Knapman. L. M., Lubitz. L. (2010), Graduated exercise training and progressive resistance training in adolescents with chronic fatigue syndrome: a randomized controlled pilot study. Clinical Rehabilitation, 24:1072-1079.
3. Vercoulen. J. H. M. M., Bazelmans. E., Swanink. C. M. A., Fennis. J. F. M., Galama. J. M. D., Jongen. P. J. H., Hommes. O., Van der meer. J. W. M., and Bleijenberg. G. (1997), Physical activity in chronic fatigue syndrome: assessment and its role in fatigue. Journal of psychiatric research, 31(6):661-673.
4. Fulcher. K. Y., White. P. D. (2000), Strength and physiological response to exercise in patients with chronic fatigue syndrome. Journal of neurology, neurosurgery & psychiatry, 69:302-307.
5. Powell. P., Bentall. R. P., Nye. F. J., and Edwards. R. H. T. (2001), Randomised controlled trial in patient education to encourage graded exercise in chronic fatigue syndrome. BMJ journals, 322:1-5.
6. Afari, N & Buchwald D (2003), Chronic Fatigue Syndrome: a Review, American Journal of Psychiatry, 160:221-236.