Great question this week about burn-out and Chronic-Fatigue Syndrome (CFS), and how to maintain a physical activity program.
Usually, with my Ask an EP column, I answer two of your questions, however this week I’m going to focus my attention on one question, as I feel it needs some time and love.
Once again, thank you to the HerCanberra community for being so open, honest, engaging and asking the tough questions. Addressing your concerns is the first step in finding answers.
I’ll get to the other questions on female hormonal cycle and exercise, morning lumbar spine aches and pains, mountain running, periodisation in the gym and the benefits of exercising with depression over the next few columns.
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Let’s get started:
I suffer from Chronic Fatigue Syndrome (coming up to 12 years). I was wondering if there are any hacks for preventing burn-out and CFS?
Whenever I’m overwhelmed and stressed, my exercise routine is the first thing to go. Hard to push through a weights program when I’m depleted. I’m at the gym 4-6 days a week—it’s all-or-nothing for me.
– Sammy, 28
Sounds like you need a pacing program, and someone to guide your energy balance. Do you have a team around you to manage your lifestyle and goals?
Did you know Chronic Fatigue Syndrome (CFS) occurs 2-4 times more often in women than in men? It is actually estimated that as many as 150,000 Australians have CFS, and costs the Australian Government around $416 million dollars per annum. Staggering. So, you aren’t alone, Sammy.
For those reading this Ask an Exercise Physiologist column, CFS, often known as ME (myalgic encephalomyelitis) is a complex condition characterised by a state of chronic fatigue and other debilitating symptoms, such as neuro-immune exhaustion (also known as post-exertional collapse), cognitive difficulties (memory and concentration), metabolic, cardiac, gut and immune dysfunction—the list goes on. It’s a complex condition, that needs very strategic management.
These symptoms and other related impairments persist for more than six months and typically arises between 20 and 40 years of age. So, you’re right on the age mark Sammy!
Furthermore, the symptoms are not just fatigue orientated as many people suffer from debilitating, deep, aching muscle pain, low blood pressure and have difficulty with short-term memory and trouble thinking clearly (“brain-fog”). It’s very hard to adhere to a gym program when you have those debilitating symptoms.
Now, to answer your question. CFS receives a lot of controversy as there’s no identified cause. It is hard to diagnose as there are no specific diagnostic tests or biological markers. Diagnosis is often made by ruling out all other disorders that cause chronic fatigue. It really is a mystery.
I know you don’t want to hear this, however, CFS is primarily managed, rather than cured. The condition itself is poorly understood.
I have personally had Chronic Fatigue now for over 11 years. I manage it really well most of the time (I have no choice with a small business to manage, 16 teammates to care for and three little kids—good times), so I feel your pain!
I manage by being meticulous with my planning, scheduling in my exercise (yoga/Pilates, light jogging (nothing over 5 km at the moment), hydrotherapy and High-Intensity Interval Training for 30 minutes twice a week (now that I’m in a recovery period), plan my downtime, daily meditation and attempt to get on top of my sleep hygiene.
Here are five “hacks” to help manage your CFS.
Graded exercise therapy
Exercise is medicine. You already know that, being a gym junkie. However, it sounds like you need to choose the right type of activity for the current stage of your CFS.
Supervised and graded exercise/movement therapy is important in order to increase activity levels and improve fitness. I am a big believer in Hydrotherapy treatment, as the water is taking 70-80% of the load off the joints (depending on depth), which allows for quicker recovery, and increased tolerance. The warm water allows the muscles to relax and release, while they are being strengthened, stabilised and increasing mobility.
A 2017 Cochrane review found that people with CFS who performed exercises may feel less fatigued, there is a positive effect of exercise on sleep, physical function and self-perceived general health, although no outcomes were conclusive for pain, quality of life or depression.
Find an activity that you can adhere to—there’s no point in “boom-busting”. Where’s the happiness in that?
Cognitive behavioural therapy (CBT)
Have you tried CBT? It is a long-term treatment option and needs a consistent structured plan for months in order to succeed.
It is your interpretation of the symptoms that primarily shapes your behaviour and exacerbates the illness and, changing these thoughts can lead to recovery.
Focussing on changing dysfunctional beliefs/behaviours, treating mood/emotions and addressing sleep disorders can be beneficial. Think long-term benefits!
Pacing is essential for your “all-or-nothing” mindset. Understanding pacing techniques encourages behavioural change. The aim of pacing is to gradually increase over time the level of routine function.
Once you can function within your individual limits you may then try to gradually increase your activity levels while maintaining pacing methods. Knowledge is power, and everyone is different.
I have attached a ‘Doing Diary’, which will allow you to take control of your daily routines and start management strategies. Find a therapist who will set manageable daily activity/exercise goals and balance your activity and rest to avoid a possible “flare-up”.
Download it here.
Sammy, do you have someone to talk to about your condition? If you understand the complexity of your condition, recovery is much more likely.
Communication involves explaining the diagnosis and causes and educating about self-management.
Sunlight and Nutrition
I often recommend my CFS patients to source the sun for at least 20 minutess a day for Vitamin D and see a dietician or nutritionist to restore their gut health.
Nutritionist Kate Freeman from the Healthy Eating Hub recommends to “check vitamin/mineral deficiency” (iron, zinc, vitamin D, B12 can all lead to fatigue). Once tested, directly treat the deficiency with supplements and then diet therapy for long term management”.
Kate believes “research indicates the link between gut and chronic fatigue is not very strong, however, overall functioning of the body is better when the gut bacteria are flourishing with a good diet consistently maintained (eg: eating vegetables, fruit and whole foods as they are rich in fibre).”
Another point from Kate regarding meeting daily energy needs is very important: “Restricting dieting can lead to low energy levels, peaks and troughs in blood sugar levels. Ensuring they are eating enough food and not cutting back on their intake too much will make a huge difference to how they feel day to day.”
Sleep and full relaxation are when your internal systems recover. Sleep and meditation should be your priority.
Hope those hacks help, Sammy. What can you start tomorrow?
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