CFS Toolkit - Graded Exercise Therapy

Activity pacing

Activity pacing is recommended for many people with CFS. Pacing refers to taking activities such as doing laundry or shopping, and breaking it into small manageable tasks with rest breaks in between. Activities should be spread evenly throughout the day and should not make symptoms worse. If activities or exercises are not spread out, a "push - crash" cycle will occur. "Push - crash" cycle is when a person does too much all at once, crashes, rests, starts to feel better and does too much once again.

Graded exercise therapy

• Graded activity and exercise is defined as starting from a very low, basic level of exercise and/or activity and gradually increasing it to a level where people can go about their daily life. NOTE: the level of activity may not be the same as before the CFS diagnosis.
• People that have done no exercise or activity for a long period of time and feel very weak should only do a basic activity (ex: stretching, walking, or biking for a few minutes). They should not feel tired after the activity. If the activity does induce tiredness, it should be lessened.
• If any of the symptoms of CFS get worse after adding activity, people should return to the last level of activity where they felt comfortable.
• Lifting light weights and stretching can help some people with CFS feel better. People can start with using their body weight (for example, raising their arms) and gradually increase to wall push ups, modified chair dips, and toe raises. Strengthening activity should precede aerobic activity.
• Very ill people who are housebound or bedbound can start with working on picking up and grasping objects. Activity should be increased until the person can handle activities of daily living such as getting up, dressing, moving around the house and brushing teeth. Having CFS does not mean that a person should avoid these activities, but instead means they should go slowly when starting a new activity.
• The GET Guide 2008 by Chronic Fatigue Syndrome/ME Service at St. Bartholomew's Hospital can be helpful in structuring your graded exercise plan.