Activity Mangement in CFS / Practitioner Guidlines

Physical exam - Obtain a thorough physical exam before starting any physical activity/exercise program. In addition, cardiopulmonary testing may be indicated for many individuals with CFS.

Post-exertional malaise - Understand the concept of post-exertional malaise, which affects the vast majority of people with the illness. It is defined as exacerbation of symptoms following physical or mental exertion, with symptoms typically increasing 12-48 hours after activity and lasting for days or even weeks. Post-exertional malaise and exercise intolerance, though not unique to CFS, may help to distinguish CFS from other disorders.  

Activity patterns - Numerous people with CFS avoid activity because personal experience has clearly demonstrated a link between exertion and symptoms. An even greater number of people engage in an endless ‘push-crash’ cycle of activity.

Assessment - Assess functional capacity, level of impairment, exercise/activity perceptions, presence of orthostatic intolerance and status of coping skills.

Goal setting - Assist the person with CFS in identifying goals and setting realistic expectations. Primary objectives for a CFS activity plan are to improve function and quality of life.

Develop an activity/exercise plan - Develop this jointly with the person with CFS.

• Emphasize avoidance of over- and under-activity; balancing activity and rest are key elements in the plan.
• Begin any activity program very slowly - even starting with one minute of total exercise/activity time may be indicated for some people - and include rest intervals that are at least the length of the activity. Some researchers encourage an activity/rest schedule at a 1:3 ratio (a rest period that is three times the length of the activity). 
• Increasing activity gradually may help prevent relapse.
• Gear activities toward improving function in areas that are of greatest importance in achieving activities of daily living.
• Reinforce that this is not a typical ‘exercise’ regimen to offset fears of overexertion and post-exertional relapse.

Examples of useful activities that could be included are:

• Simple exercises such as repeated hand stretches, sitting and standing, or picking up and grasping objects provide a good foundation.
• Simple stretching and strengthening exercises using only body weight for resistance is   a good starting point. The focus is on function in activities of daily living.
• Stretching and resistance training using latex resistance bands can be included in the second step. The focus is on neuromuscular adaptation and motor learning.

Monitor - Assess progress and problem areas; monitor for post-exertional malaise, an important aspect in follow-up.

Multidisciplinary team - Include other members of the health care team for special interventions that address various symptom complaints and other concerns (e.g., orthostatic or cognition problems).

Independence - Encourage self-care, self-management and self-determination.