Exercise Relieves Chronic Fatigue

3 March 2005

Exercise Relieves Chronic Fatigue

A belief that exercise is dangerous for people with chronic fatigue syndrome is holding many back from managing their illness, according to research by The University of Auckland.

Chronic fatigue syndrome affects about one percent of the population and is characterised by debilitating fatigue, headaches, sleep disturbance and muscle pain. A higher percentage of sufferers are female.

Dr Rona Moss-Morris, a Health Psychologist in the Faculty of Medical and Health Sciences, was the principal investigator in a study analysing if and how exercise can help people with chronic fatigue. She says there is a long held belief by patients that exercise can increase symptoms of the syndrome, yet the study found exercise can actually help relieve symptoms.

The study involved 49 participants who were randomised into two groups. Half were put into a 12-week exercise programme and standard medical care, while the other half received just standard medical care.

At the end of treatment, 68 percent of the exercise patients in the study rated their treatment as better or very much better than any other treatment they had received to date.

"Patients often believe that too much activity is harmful for symptoms and the only way to manage their illness is to accommodate the condition. Our graduated exercise programme reassured them that if undertaken correctly, activity is beneficial rather than harmful," Dr Moss-Morris says.

Fifty-five percent of the exercise group rated their health as having improved, while only 24 percent in the control group said they had improved after the 12 weeks. The exercise group reported they were less mentally and physically fatigued and these gains were maintained at six months follow up.

"I don't believe that in New Zealand we currently provide good secondary care for people with chronic fatigue. They are often left untreated, yet only a small percentage appear to get better without help.

"We hope this research shows that interventions, such as an exercise programme, can go a long way towards helping people reduce their fatigue levels," she says.

Dr Moss-Morris says people with chronic fatigue should slowly take on some exercise and avoid doing too much on a good day and too little on a bad day. Consistency is the key.

"It is important that patients avoid the 'boom and bust' approach where they take on an exercise programme that is too intense, and then they feel worse, so decide to avoid exercise all-together. They need a graded programme that starts gently, and as they get fitter and more confident, they can increase the exercise," she says.

The research, which has been published in the latest Journal of Health Psychology in the United Kingdom, found that although exercise participants had improved mental and physical health they were no fitter than at the start of the programme.

Dr Moss-Morris says each person's current level of fitness was assessed at baseline and at 12 weeks after treatment by a sport's scientist. The baseline figure gave the researchers an indication of what level of exercise to start with.

"We started off as low as a five minute walk each day and slowly increased the amount of exercise from there. Decisions to increase the time or intensity of the exercise were always made in collaboration with the patient. Patients were given a heart rate monitor so that they could ensure that they reached, but did not exceed their target heart rate. Providing people with specific safe targets worked, because many of those in the study were fearful about rushing into exercise," she says.

At the follow up fitness tests, the increase in fitness was slight and Dr Moss-Morris says that was largely because of the low intensity of exercise initially prescribed.

"Yet we still had significant positive results in the outcome. So the most important mechanisms for improvement appear to be a lessening of the fear of exercise and symptoms rather than an actual physiological change - even without getting fitter they are feeling a lot better.

"That said, it appears that patients who do become fitter appear to be even less fatigued and disabled at the end of treatment," she says.

Dr Moss-Morris and her colleagues are now working on a project to look at the link between having glandular fever or campylobacter and developing chronic fatigue syndrome, and irritable bowel syndrome.

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