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Activity and Exercise

Pacing Yourself

For people living with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), events that would not normally cause stress, such as a short walk or a long phone call, can act as stressors. These stressors can lead to fatigue, either immediately or the next day. This, in turn, can provoke feelings of discouragement, frustration, anger and anxiety. Meanwhile, it may seem as if the things that need to get done are "piling up." Added to this is the burden of financial, marital and work-related problems that may result from the inability to perform daily tasks or partake fully in a relationship. A vicious cycle can result, with increased frustration, stress and fatigue. A good way to break this cycle is to become aware of your particular stressors and the effect that they have on your energy level.

The best way to do this is to keep a diary, or activity log, of your activities throughout the day, including mental activities, and rate your energy level, (by giving it a score from 1 to 10). You will notice that you have higher and lower levels of energy throughout the day as well as “high-,” “moderate-” and “low-” energy days. You will see patterns emerge, indicating the activities that produce fatigue and those that conserve your energy. This will help you pace yourself.

Pacing yourself means living one day at a time, setting modest goals, being flexible and doing no more than what your energy will allow. If you look at your activity log and notice that late morning is usually a time of day when you have more energy, then you may want to schedule your "high-energy" activities for that time of day. This could be a physical activity, such as exercising, doing light housework or gardening; a mental activity, such as reading, studying or paying the bills; or an activity that includes both mental and physical activity, such as planning a meal, making a grocery list and shopping.

By listening to your body and observing how it responds to different activities, you will be able to identify how much time you can spend doing a "high-energy" activity without feeling fatigued. Learn to think of your symptoms as messengers – letting you know it is time to slow down or stop and rest. For example, if you know that grocery shopping usually causes you to "crash," then break it up over a few days by planning the meals one day, creating a shopping list the next and doing the shopping the following day.

If you wake up very tired and achy on the "shopping" day, if possible, ask a family member or a friend if they can do it for you, or have the groceries delivered. Many grocery stores now offer this service. Keep your freezer stocked with some frozen meals you have bought or made ahead of time so that if you can’t go grocery shopping, you don’t miss any meals because you ran out of food.

Allow for a period of rest and relaxation before and after the activities that use energy. Think of rest and relaxation as "energy-conserving" activities, rather than just a break or pause between other things that you "need to do." It's OK if the rest and relaxation are your main activities for the day, if you are very tired either physically or mentally. Your body is telling you something – listen to it!

Pacing yourself also means doing things that you enjoy. Some activities, such as socializing, may be "high-energy" but enjoyable. To identify these activities, create a list of activities from your diary, looking at what you "must do," what you "like to do," and what can be dropped.

Which of the things that “must be done” can be delegated to others? A supportive partner, friend or counsellor may be able to help you. By paring down the “must do” activities, you will make more time to rest and do the things that you enjoy.


Most healthy people are re-energized after moderate exercise. People with CFS/ME are exhausted after doing too much exercise, either immediately following the activity or the next day. Even a short period of moderate exercise, like a walk around the block, can be exhausting.

Don’t Push Yourself
The goal is to try to exercise regularly without “pushing yourself” and causing fatigue the next day. This may mean that you have to reduce the amount of physical activity you do, monitor your symptoms, and increase your activity level slowly as your energy increases. For example, if you are walking quickly for 15 minutes daily and find that you wake up tired and achy every day, try walking a little more slowly or for a shorter amount of time. Or you can break your walk into three five-minute walks. Use your activity log to monitor these changes and note how they affect your symptoms.

A physical activity program should involve aerobic exercise, strengthening exercises and stretching, though this may vary depending on your level of energy.

Aerobic Exercise
Walking, swimming (or aquatherapy) and bicycling are all low-impact activities that are gentle on your joints.

Start slowly. If you are bedridden, try exercising in bed with range of motion exercises or walking around your home a bit before you get back into bed. If you are house-bound, try walking for as little as five or 10 minutes each day, walking in and out of the rooms of your house making a circuit. As your energy level improves, try increasing your activity level by 10 percent. For example, if you are walking for 10 minutes each day comfortably, try walking for 11 minutes the next week.

Strengthening Exercises
Strengthening exercises can help build up your muscles and prevent osteoporosis. A physiotherapist or knowledgeable fitness instructor can show you some exercises. If you are bed-ridden, find one that is able to visit you at home. To avoid over-stressing your muscles, do only a few repetitions (three) at a time, using no weights but using your body weight as resistance.

Stretching helps maintain your flexibility. Start with gentle stretching exercises when your muscles are warm, for example, in the morning before getting out of bed, after a shower or after your muscles are warmed up from exercise. Do not stretch cold muscles. Even if you are bedridden or confined to sitting, you can stretch your muscles. Stretching should be gentle and not cause you any pain.

An Exercise Program that’s Right for You
A physiotherapist can help design an exercise program that is appropriate for you, given your energy level. Exercise DVDs are also available. Before starting any exercise program, consult your doctor.


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Chronic Fatigue Syndrome

Medical description


Living with CFS/ME

Activity and exercise




Pain relief


Coping emotionally

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