21 Apr 2023(C) Exact T & R

Chronic Fatigue and physical activity

Outline

21 Apr 2023(C) Exact T & R

What are chronic fatigue syndrome (CFS) and fibromyalgia (FM)?

How do those with CFS or FM respond to exercise?

What are the considerations for exercise in those with CFS or FM?

Summarise an appropriate exercise prescription for those with CFS or FM

Outline the changes that might be expected to the condition/symptoms with exercise.

What is CFS?

21 Apr 2023(C) Exact T & R

Also been known as Royal Free disease, Iceland disease, neurasthenia, myalgic encephalomyelitis (‘ME’), and post-viral fatigue syndrome. However, chronic fatigue syndrome (CFS) is the term that has been adopted and clearly defined for the purpose of research in this area.

Diagnosis of CFS Unexplained onset of fatigue Fatigue present > 6months Fatigue limits daily activity Fatigue not resolved by rest 4+ of the following symptoms:

muscle pain, joint pain, sore throat, tender lymph nodes, cognitive dysfunction, sleep disturbance, post exercise discomfort lasting >24 hours.

What is FM?

21 Apr 2023(C) Exact T & R

Fibromyalgia is a syndrome of persistent widespread pain and tenderness. Individuals may also experience a wide range of other symptoms such as difficulty sleeping, fatigue, stiffness, and depression.

No underlying inflammation.

Diagnosis of FM Chronic widespread pain in all

four body quadrants Pain in 11 out of 18 tender points Other symptoms: fatigue, morning

stiffness, weakness, attention and memory disturbances (‘fibro fog’), heat and cold intolerance, weight fluctuations, sleep disturbance, depression.

21 Apr 2023(C) Exact T & R

FM tender points

21 Apr 2023(C) Exact T & R

Other related conditions

Lupus

Temporomandibular disorder

Exercise response in CFS and FM

For many patients, minimal exertion i.e. less than others might consider exercise can exacerbate symptoms from 6 hours to 5 days

Response to aerobic activity Studies with cycle ergometer show

no difference in VO2 at same power output for patients vs controls

Similar, higher or lower heart rates – reflecting different fitness levels

RPE usually higher - ? Reflects de-conditioning, increased fatigue, pain and anxiety.

Response to strength training Weaker - ? Due to lower

motivation, de-conditioning and more fatigue and pain

No difference in muscle structure or metabolism.

21 Apr 2023(C) Exact T & R

21 Apr 2023(C) Exact T & R

Exercise responses in CFS and FM

No difference in basic physiology involved in performing aerobic or strength training

Different reactions in patients with CFS or FM to exercise probably associated with:-

Fitness Habitual physical activity

Perception of effort involved.

21 Apr 2023(C) Exact T & R

Considerations for exercise

Fatigue and pain Symptoms vary from day to day Patients may reduce or avoid physical activity to avoid

symptoms Rest longer after exercise Exercise may provoke feelings of anxiety and increased

vulnerability to pain and fatigue Increased pain and fatigue may be associated with or

exaggerated by de-conditioning.

Suggested primary goals : Increase physical tolerance Promote long term compliance

Transient increase in symptoms will occur when starting new activity or increasing activity

Start slowly and progress gradually.21 Apr 2023(C) Exact T & R

Exercise Prescription Overview

Frequency: 3 or more per week Intensity: Generally low or moderate intensity

tolerated better than high intensity. RPE 12 -14 Time: Brief exercise better tolerated than

prolonged and intermittent rather than continuous. 10-15 minutes or more

Type: Low impact, walking, swimming, aqua, stationary cycling.

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FITT

Establish a sustainable baseline of activity

Extend duration

Extend intensity.

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Graded Exercise Therapy

Frequency: 3-5/week Intensity: RPE 12 -14 Time & Type: Warm up - 5 mins water walking Work out 1 – 5 mins bounding/jumping Workout 2 – 10 mins ROM stretching Cooldown – 8 mins relaxation and swimming

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Just one example……

Week RPE HR max Frequency Time1 - 2 10-11 40-50% 3/week 10 mins

3 10-11 40-50% 3/week 12 mins

4 10-11 40-50% 3-4/week 12 mins

5 - 6 10-11 40-50% 3-4/week 14 mins

7 10-11 40-50% 3-4/week 18 mins

8 10-11 40-50% 3-5/week 20 mins

9 - 10 10-11 40-50% 3-5/week 24 mins

11 - 12 11-12 45-55% 3-5/week 28 mins

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Getting the right grade

Exercise Outcomes

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Aerobic activity Increased fitness Decreased fatigue and

pain Decreased heart rate Decreased RPE Increased functional

capacity Fewer symptoms.

Strength training Improvements similar to

healthy sedentary subjects No change in pain or

tenderness Improved perceptions of

mood and fatigue.

21 Apr 2023(C) Exact T & R

Thank you!

Your turn…..

21 Apr 2023(C) Exact T & R

The goal: Frequency: 3/weekIntensity: RPE 12 -14Time: 30 minutesType: Cycling, Walking

How would you get there?......How long will it take?..........