慢性疲劳综合征与运动

jacky

Summary

Exercise is difficult for people with myalgic encephalomyelitis (ME), also known as chronic fatigue syndrome (CFS). However, research suggests that, in many cases, a graded and careful exercise program may improve CFS symptoms.

Chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME) is a complex illness affecting multiple systems of the body, in particular, the nervous and immune systems.

ME/CFS has many symptoms including extreme exhaustion, aching muscles, joint pains, headache, dysfunctional sleep, and flu-like feelings. The cause is unknown and recovery can take years. In some cases, people don’t recover and suffer relapses throughout their lives.

Exercise may not be possible for everyone
People with ME/CFS react to physical activity differently. Exercise is often a problem for people with ME/CFS because physical activity can worsen their symptoms. Medical opinion has been divided on whether people with chronic fatigue syndrome should attempt regular exercise or not.

While vigorous aerobic exercise is beneficial for many chronic illnesses, CFS patients can't tolerate traditional exercise routines. On one hand, there is good evidence that a program of graded modest aerobic exercise may improve function in many patients. On the other hand, most people with CFS are affected by post-exertional malaise, which is when symptoms intensify following physical or mental exertion, with symptoms typically worsening 12-48 hours after activity and lasting for days or even weeks.

Exercise suggestions
People with chronic fatigue syndrome must learn to pace activities. It is important they work with their health care professionals to create an individualised exercise program that focuses on interval activity or graded exercise. The goal is to balance rest and activity to avoid both deconditioning from lack of activity and flare-ups of illness due to overexertion.

It is very important that any activity plan be started slowly and increased gradually. When beginning an activity program, some CFS patients may only be able to exercise for as little as a few minutes.

Pacing
Pacing, or keeping within your boundaries, is designed to ensure that you do not overdo activity or exercise. Pacing is shown in the steps below:

• Establish the total exercise or activity level you are capable of without any repercussion or post-exertional malaise. A pedometer (measures how far you walk, ran or bike) may be helpful in measuring the amount of physical activity you have done on any day or using a heart rate monitor will help guide your intensity.
• To begin with, you need to do less, so that eventually you increase the chance of doing more.
• Maintain the level of activity or exercise that you can manage and stay on this plateau until you have a reserve of energy. The correct level of activity or exercise is that which can be repeated the next day without any potential harm.
• Do not move to the next level of activity or exercise until you have the reserve which enables you to increase your activity level without potential harm.
• Repeat the pattern of staying at the next plateau of activity or exercise until you are able to increase it without any harmful consequences. You may reach a limit which should not be exceeded. You may need to stay at this level of activity.
• Balance physical and mental activity with rest, dividing activity into short segments, alternated with rest. Rigid schedules of activity or exercise should be avoided and activity should be tailored to your level of ability.
• If you have overdone activity or exercise or suffer a relapse for any reason, decrease the level of participation and rest more. Repeatedly overdoing it may cause a severe and long-lasting relapse, bringing with it a worsening of many CFS symptoms.
  

Be guided by your doctor or physiotherapist, but general suggestions include:

• Experiment to find the type of exercise that works best for you. Choose from a range of gentle activities such as stretching, yoga, Tai Chi, walking and light weight training.
• Anaerobic exercise is recommended. This involves exercise such as resistance training and stretching, which can be done more easily without potential harm.
• Keep an activity diary so you have a long-term picture of your performance levels and factors that might impact on fatigue.
• Stop the physical activity well before you feel tired. Pacing yourself is very important.
• Remember that your exercise tolerance will differ from one day to the next.
• Listen to your body – if you don’t feel up to exercising on a particular day, don’t.
• People who have a thorough knowledge of chronic fatigue syndrome tend to manage their condition better and have a more positive outlook. Find out as much as you can about CFS. You could consult with your doctor, physiotherapist or CFS association, read books on the subject or browse through reputable CFS sites on the internet.
  

Where to get help

• Your doctor
• Physiotherapist
• ESSA website to find an accredited exercise physiologist
• ME/CFS Australia (Victoria), support and information line Tel. (03) 9791 2199
  

Things to remember

• A person with chronic fatigue syndrome (CFS) should only make very small increases in the frequency, duration and intensity of their exercise program.
• Set realistic exercise goals and congratulate yourself on any gains you make, no matter how small.
• Stretching seems to be well tolerated by people with CFS.
• Listen to your body – if you don’t feel up to exercising on a particular day, don’t.
  

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