Exercise Therapy for Chronic Fatigue Syndrome

People suffering from chronic fatigue syndrome (CFS) are more likely to experience improvement in their symptoms when they are given educational information designed to encourage physical exercise, according to studies in the British Journal of Medicine (2001:322;1–5) and the British Journal of Psychiatry (2004:184;142–6).

CFS is a debilitating condition characterized by extreme fatigue that is not improved by resting and that worsens after exercise. It may be accompanied by a sore throat, tender lymph nodes, joint and muscle pain, headaches, failure to be refreshed by sleep, and impaired concentration and memory. CFS affects about 500,000 Americans, with women diagnosed more often than men. No clear cause of CFS has been identified; however, the condition has been linked to a deficiency of cortisol (a naturally occurring hormone) and to disruptions in normal sleeping and waking patterns. Recent studies have shown exercise and cognitive-behavioral therapy (a technique used to replace thought patterns associated with negative behavior or feelings with ones that bring about desirable actions or feelings) to be of benefit in the treatment of CFS.

The current studies examined the role of education in the treatment of CFS. One hundred forty eight people aged 15 to 55 years with a diagnosis of CFS were randomly assigned to one of the following groups: (1) minimum intervention, (2) intermediate intervention, (3) maximum intervention, or (4) the control group. The interventions included physiological explanations for the symptoms of CFS intended to promote physical exercise.

The minimum intervention group received two phone calls and two face-to-face meetings with a therapist, and an information packet that provided explanations of symptoms and encouraged graded exercise (gradually increasing in intensity over time). The intermediate intervention group received the minimum intervention plus an additional seven follow-up phone calls with a therapist. The maximum intervention group received the minimum intervention plus an additional seven face-to-face meetings with a therapist. All intervention groups also received exercise programs tailored to their individual needs. Explanations of symptoms, the reasons for treatment, and the problems that participants encountered during treatment were discussed at follow-up phone calls and face-to-face sessions. The control group received an information booklet that encouraged graded activity without any explanations for the symptoms.

The groups were observed for one year for changes in the levels of physical functioning (a measure of the amount of physical limitation) and fatigue. At the one-year mark, people in the control group were offered treatment consisting of a combination of face-to-face and telephone sessions similar to the original intervention groups. This crossover group was then also observed for one year. The original intervention groups were reassessed at two years to determine the long-term effects of treatment.

All of the original intervention groups experienced a significant increase in the levels of physical functioning and fatigue compared with the control group. A larger percentage of intervention participants reported being “very much better” or “much better” at one year compared with the control group participants (84% versus 12%, respectively). At two years, the benefits of treatment were still apparent and 55% of the intervention participants no longer had CFS. The explanation of the symptoms provided to the intervention groups convinced 94% of those participants to engage in physical exercise. There were no significant differences in outcomes between the intervention groups. Crossover group participants also had significant improvement in the levels of physical functioning and fatigue, and 23% of participants no longer had CFS at the end of the study period.

In studies using exercise or cognitive-behavioral therapy to treat CFS, 60 to 79% of participants reported being better, compared with 84% in the new studies. This intervention has the advantage of requiring less expertise than cognitive-behavioral therapy and still significantly enhancing well-being in people afflicted with CFS.

Kimberly Beauchamp, ND, received her bachelor’s degree from the University of Rhode Island and her Doctorate of Naturopathic Medicine from Bastyr University in Kenmore, WA. Dr. Beauchamp is a co-founder and practicing physician at South County Naturopaths, Inc. in Wakefield, RI. Her emphasis is on women’s health, pediatrics, and detoxification.

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