The role of deconditioning and therapeutic exercise in chronic fatigue syndrome (CFS)

Background: Patients with chronic fatigue syndrome (CFS) complain of tiredness or exhaustion, which is made worse by physical exertion. This results in their avoidance of exercise, which may lead to physical deconditioning. We do not know whether this deconditioning maintains the illness or is a consequence. Graded exercise therapy aims to reverse this cycle of inactivity and deconditioning, and to subsequently reduce the fatigue and disability associated with CFS.

Aims: To review the literature relating to the role of deconditioning in perpetuating CFS and the literature relating to the role of graded exercise therapy as a treatment of CFS.

Method: Non-systematic review of published papers concerning deconditioning and therapeutic exercise in patients with CFS.

Findings: Patients with CFS are at least as deconditioned as sedentary but healthy controls. Supervised graded exercise therapy reduces fatigue and disability in ambulant patients with CFS; efficacy may be independent of reversing deconditioning.

Conclusions: Graded exercise has an important role to play in the treatment of patients with CFS. Further work is necessary to elucidate the risks, benefits, and mechanisms of such treatment, especially in children and the severely disabled. Patient education is necessary to inform patients of the positive benefit/risk ratio in order to improve acceptance and adherence.