May is designated National Physical Health Month and can be a great motivator for people to get out and exercise. Unfortunately, those with energy-sapping and debilitating conditions such as Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FM) have significant disadvantages when it comes to taking part in physical activity. While regular exercise at a moderate level of exertion is widely recognized as a healthy piece of one’s lifestyle, those with CFS or FM may harm themselves by engaging in even mild activity.
Many medical professionals still posit that patients, even if they are showing signs of CFS and FM, are simply deconditioned or not physically fit. However, for individuals suffering from these conditions that may not be the case.
The concept of exercise intolerance may sound like an excuse to avoid the gym, but individuals who experience it, particularly those with CFS or FM, can attest that it is debilitating, painful, and incredibly frustrating. Imagine starting out on a jog and not even five minutes in you begin feeling painfully short of breath (dyspnea) and dizzy to the point that all you can do is lay down. Fast forward a few days, and you still feel exhausted, full of pain, and unable to think clearly. Your fatigue is so great that even getting out of bed seems like an impossible challenge. This kind of scenario is not uncommon among those suffering from CFS and FM.
Although there is still much to learn about why these conditions cause severe exercise intolerance and post-exertional malaise, there are theories and research available that may help us understand more. It is important to not only be well-informed on possible causes of exercise intolerance but also recognize the different ways it manifests in both CFS and FM.
What Causes Exercise Intolerance in CFS and FM?
There are many possible reasons that one may experience exercise intolerance. New research conducted by Dr. David Systrom, a pulmonologist at Brigham and Women’s Hospital in Boston, has published a study that gives a strong case for blood flow and heart function being a major component in reduced energy and exercise intolerance. These findings were not only expressed among CFS and FM patients but those who have unexplained exertive difficulties and heart abnormalities as well.
Among the 600 participants, nearly 10% of them showed low QT and reduced ventricular filling ability while exercising. A shortened QT interval suggests poor diastole function (the process of filling the heart with blood). This can inhibit oxygenation and blood flow, making it difficult to be physically active. Those who have difficulty with exercise intolerance may also experience low preload. When referring to the heart, preload is how much the heart muscles can stretch while expanding to improve ventricle volume during diastole. Without proper expansion of the heart, various issues arise that can lead to long-lasting fatigue.
Inhibited heart function and oxygenation is closely tied to energy deficiencies particularly in CFS patients. Unsurprisingly, reduced oxygen utilization was also found among study participants. Without proper blood flow and circulation, the body is incapable of effectively delivering energy and oxygen throughout the body. Blood flow and heart atrophy are often connected to autonomic dysfunction, adrenal insufficiency, and autoimmune processes. Such issues are recognized as common contributors to both CFS and FM. Regardless of diagnosis, if one has difficulty exercising or experiences extreme fatigue after exertion it may be worthwhile having a doctor examine one’s heart function and test for abnormalities.
Exercise Intolerance with Fibromyalgia
When one thinks of exercise they likely imagine various sports such as, running, cycling, basketball etc. For people with fibromyalgia exercise looks significantly different. Overly exhausting a fibromyalgia patient can cause them to be incapacitated for days or even weeks. To avoid exertion, it is important to engage in activities that are controllable, easily stopped, and not too intense.
Both clinical and anecdotal data suggests that those with fibromyalgia should take part in regular activity that is appropriate for their condition. Depending on individual fitness level this can look like 2 minutes of yoga, a 10-minute walk, or even doing laundry. The most important aspect of exercising with fibromyalgia is carefully gauging one’s level of exertion while regularly engaging in low-intensity exercise.
Exercise Intolerance with Chronic Fatigue Syndrome
Those with chronic fatigue syndrome are well-acquainted with post-exertional malaise typified through extreme or debilitating symptoms that occur after exercise or exertion. Similar to FM, these symptoms can last days to weeks. Although there are many common features shared among CFS and FM, there are important differences.
Those with CFS tend to have a greater tolerance for exertion and may be more capable of engaging in physical activity. However, this does not mean that they should pursue exertion or aggressive exercise. Of certain concern is abnormal heart rhythms that may be associated with CFS. Those diagnosed with CFS may in fact cause more harm than good when exercising due to cardiovascular abnormalities. Again, it is important for those with CFS to listen to their body and be willing to stop when it needs to.
Being Active While Having CFS and FM
The primary concern of both CFS and FM patients engaging in physical activity is knowing one’s own limits and to remain within them. Current fitness level and disease severity will vary depending on the individual. These factors must be considered when engaging in exercise programs. The intensity of exercise can vary from simply stretching in bed to walking for half an hour. Length and intensity of exercise should be increased at an intentionally slow rate to avoid over-exertion and possible symptomatic repercussions. Optimal activities depend on the individual’s ability and condition. The following frequently suggested activities are low-intensity while still providing strength and muscle building qualities:
- Tai Chi
- Warm-water exercise
If these exercises are too demanding, ask your doctor about possible stretches or movements that can help build up to these activities. Staying positive and understanding that improvement takes time is an important piece of staying active.
Know Where You Stand
Hopefully with better understanding of the cause of energy loss and exercise intolerance one can better approach the difficulties associated with them. Carefully incorporating regular exercise while suffering from CFS and/or FM can be incredibly beneficial for one’s condition. However, it is critical that one does not overstep their physical limitations and cause more harm than good. Being well acquainted with one’s own body and being cognizant of its limitations is a critical piece of properly exercising while living with a disease that promotes exercise intolerance.