When I first started exercising I walked to the end of the driveway with a walking stick in one hand and my husband on my opposite arm. It was tedious and difficult but I did it every day regardless of how I felt. In hindsight sitting in some simple yoga poses for 5mins every day would have been an easier way to start in such a weakened state. Nonetheless it worked, Id created a graded exercise program without even realizing that’s what I was doing.
It was weeks before I felt strong enough to even cross the road, but eventually I was able to go to the end of the street without any assistance or my walking stick (the street is short, but it was a great start). These days I can do half an hour of fairly intense exercise without burnout on a good day; on a bad day I can go on a 10min walk.
You may have heard of a graded exercise program for chronic fatigue syndrome, it may have been recommended by a doctor, or maybe it’s something you’ve read about. One reason it works is because once someone has had CFS for long enough the body is de-conditioned, the muscles are weak, fitness levels have dropped significantly. A graded exercise program can re-condition the body, gradually building up strength and fitness.
This concept is useful for any chronic illness that has caused significant levels of fatigue or pain, and therefore a drop in activity levels.
So the big question, how do you exercise when you’re tired and weak all of the time? Doesn’t activity make CFS symptoms worse?
The key is to use the right type of activity in a controlled way. Certain activities will make symptoms worse, and too much of any activity will have the same effect.
Some exercises that are gentle:
· Yoga
· Tai chi
· Swimming
· Gentle bouncing on a mini tramp (bouncing without your feet leaving the mat uses minimal energy)
· Weights (VERY VERY light weights, small dumbbells or weighted wrist straps)
· Walking
Find what exercise works best for you, meaning that it doesn’t exacerbate symptoms, and you enjoy it. Avoid any intense forms of exercise to start with.
How to start:
1. Start small, consider how inactive you’ve been and determine the starting point. 5mins a day 3 times a week is a good way to start.
2. Create a schedule of what days and for how long, only increase the time when you’re ready.
3. If the increase exacerbates symptoms, or you have a bad run go back to the previous time schedule (e.g. back to 5mins a day if you just increased to 10mins)
4. Don’t push yourself, even if you’re feeling great and want to do more, always stay within the scheduled time. Bursts of lengthy exercising will exacerbate symptoms even if it feels ok at the time.
5. If you start exercising and it immediately feels as if it’s making you worse, stop, it’s not the day to exercise.
6. Take into account incidental activity, your body won’t distinguish between 5mins of walking and 5mins of sweeping the floor. If you’ve been active in other ways consider that your days exercise.
An example of a graded program, remember only you can determine when it’s time to go onto the next stage
1. 5mins a day 3 times a week
2. 10mins a day 3 times a week – Split the exercise into two 5min blocks with a rest in between
3. 10mins a day 3 times a week
4. 15mins a day 3 times a week – Split the exercise into a 10min and a 5min block with a rest in between
5. 20mins a day 3 times a week – Split the exercise into two 10min blocks with a rest in between
6. 20mins a day 3 times a week – Split the exercise into a 15min block and a 5min block with a rest in between
7. 20mins a day 3 times a week
If you’d like to increase days it’s a good idea to wait until you can comfortably manage 20min blocks without exacerbating symptoms. Then increase to 4 days a week, then 5 days a week.
I found splitting my exercise across the day very beneficial, so my first block would be when I first woke up, usually 5mins of yoga, then a short walk in the afternoon.
Eventually you might want a routine where you do a short block of stretching when you wake every day regardless of what other exercise you do. I’ve found this a key to a good day, it warms up my body early, shortening how long it takes me to ‘get going’ for the day. It used to take me 2-3hrs to start functioning; it now only takes at most an hour thanks to morning stretches.
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