ME/CFS and Exercise

Patient Expert

While aerobic exercise is beneficial for many chronic illnesses, ME/CFS (also known as chronic fatigue syndrome) is not one of them. In fact, a key symptom of ME/CFS is post-exertional malaise, which is an exacerbation of symptoms following any kind of exertion (physical or mental) that usually begins 12 to 48 hours after the exertion and lasts for several days or even weeks.

Although aerobic exercise is not recommended, neither is strict bed rest and a complete avoidance of any kind of activity. Dr. Charles Lapp, well-known ME/CFS researcher and clinician, recommends a balance of light activity with frequent bed rest breaks. He suggests that ME/CFS patients think of exercise as movement. It's important to move as much as you're able to avoid deconditioning. If you can't get out of bed most of the time, gentle stretches or walking to the kitchen for a glass of water may be all you can handle.

The Push-Crash Cycle

Unfortunately, many people - including many doctors - don't really understand the enormous negative impact too much exertion can have on someone with ME/CFS so they continue to encourage them to exercise without giving them appropriate guidelines. This tends to lead to a "push-crash" cycle. Patients do too much then crash. After resting for several days/weeks, they begin to feel a little better, do too much then crash again, and so on. It's a vicious, never-ending cycle. If you find yourself caught up in the push-crash cycle, it's best to limit yourself to doing only what is absolutely necessary, such as personal hygiene and other essential tasks, until you have stabilized.

Beginning to Move

Two important movements Dr. Lapp recommends for ME/CFS patients that can be very helpful for easing pain and increasing energy are postural assistance and deep breathing.

Postural Assistance - Pain and muscle spasms tend to contribute to a rounded-shoulders, head-forward type of posture that only serves to increase the likelihood of headaches, neck and shoulder pain and shallow breathing. It's good for ME/CFS patients to stretch their muscles several times a day. If possible, consult with a physical therapist who can teach you gentle stretches that you're able to do, including stretches that can be done from a sitting position

Deep Breathing - Most ME/CFS patients breathe from just the upper part of the chest. As a result, their bodies are deprived of much-needed oxygen, which among other things fuels energy production, improves focus and concentration and strengthens the immune system. Learn "belly breathing" or how to breath through the lower part of your diaphragm here: The Importance of Breathing Properly

Developing an Exercise Program

When you are ready to try exercising, it is essential that you start very slowly. It's better to do several brief sessions a day than one long session. Exercise should be done on a 1:3 ration - one minute of exercise followed by three minutes of rest. When you are tolerating one-minute exercise sessions well, you can gradually go to two minutes, then three, and so on. The maximum you should do is five minutes at a time, with appropriate rest periods in between.

It is becoming apparent that there are a number of subsets under the ME/CFS diagnosis with varying degrees of disability. Some patients are mildly affected and may even experience ocassional periods of feeling relatively normal, while others are bedridden and unable to care for themselves. For the latter, simple hand stretches or picking up objects may be the only movement they can do. Only you and your doctor can determine where you are and what you're able to do. The important thing is to move as much as you're able without causing a relapse and exacerbation of symptoms.


Lapp, MD, Charles (2008, February). The Stepwise Approach. Hunter-Hopkins Center.

Chronic Fatigue Syndrome - Treatment Options. (2006, May 26). Centers for Disease Control and Prevention.

© Karen Lee Richards, 2009

Last updated: 8/29/09