Chronic Fatigue Syndrome (CFS) Jonathan Cooke Kevin Repay Tara Ruberto

What is CFS? A condition characterized by persistent debilitating fatigue, not relieved by rest and not accounted for by any specifically identified medical or psychiatric condition. A condition characterized by persistent debilitating fatigue, not relieved by rest and not accounted for by any specifically identified medical or psychiatric condition. *The cause of CFS is unknown and therefore defined primarily by its symptoms *The cause of CFS is unknown and therefore defined primarily by its symptoms

Common Symptoms of Chronic Fatigue Syndrome Frequent sore throats Frequent sore throats Painful lymph nodes Painful lymph nodes Headaches Headaches Difficulty with concentration and memory Difficulty with concentration and memory Low-grade fever Low-grade fever

Signs and Symptoms *Major Criteria New onset of persistent or relapsing fatigue, not resolving with bed rest, and severe enough to reproduce or impair average daily activities below 50% of previous levels for at least six months New onset of persistent or relapsing fatigue, not resolving with bed rest, and severe enough to reproduce or impair average daily activities below 50% of previous levels for at least six months Other clinical conditions that could cause similar symptoms must be excluded by appropriate medical evaluation. These other conditions include, but are not limited to, malignancy, autoimmune disease, localized infection, chronic bacterial or parasite disease, endocrine disorder, and other chronic disease Other clinical conditions that could cause similar symptoms must be excluded by appropriate medical evaluation. These other conditions include, but are not limited to, malignancy, autoimmune disease, localized infection, chronic bacterial or parasite disease, endocrine disorder, and other chronic disease

Signs and Symptoms *Minor Criteria Mild fever Mild fever Sore throat Sore throat Painful lymph nodes in neck or underarm region Painful lymph nodes in neck or underarm region Generalized muscle weakness Generalized muscle weakness Muscle discomfort or myalgia Muscle discomfort or myalgia Prolonged generalized fatigue after levels of exercise that were previously well tolerated Prolonged generalized fatigue after levels of exercise that were previously well tolerated Generalized headache Generalized headache Mygratory arthralgia Mygratory arthralgia Neuropsychologic complaints Neuropsychologic complaints Sleep disturbance Sleep disturbance History of symptom complex having begun acutely following viral infection History of symptom complex having begun acutely following viral infection

Signs and Symptoms *Physical Criteria Low grade fever Low grade fever Non-exudative pharyngitis Non-exudative pharyngitis Palpable tender lymph nodes in neck Palpable tender lymph nodes in neck *To meet the case definition, clients must meet both major criteria and a total of eight other symptom criteria’s, or six symptom criteria and two physical criteria.

Contraindicators for exercise with CFS Cold/humid weather Cold/humid weather Insuffiecient sleep Insuffiecient sleep Fatigue Fatigue Excessive vigorous phsyical activity or inactivity Excessive vigorous phsyical activity or inactivity Anxiety Anxiety Stress Stress Strenuous strength training exercises Strenuous strength training exercises

Exercise Suggestions for Clients with CFS Aim for no more than three exercise sessions per week. Aim for no more than three exercise sessions per week. Experiment to find the type of exercise that works best for the client. Choose from a range of gentle activities such as stretching, yoga, Tai Chi, walking and light weight training. Experiment to find the type of exercise that works best for the client. Choose from a range of gentle activities such as stretching, yoga, Tai Chi, walking and light weight training. Stretching seems to be well tolerated by people with CFS. Clients may prefer to perform your stretching program while lying down in bed. Stretching seems to be well tolerated by people with CFS. Clients may prefer to perform your stretching program while lying down in bed. Aerobic exercise seems to cause relapses for many people with CFS. If this is true for the client, try non-aerobic forms of exercise like weight training with light weights. Aerobic exercise seems to cause relapses for many people with CFS. If this is true for the client, try non-aerobic forms of exercise like weight training with light weights. Learn from past relapses. For example, if walking for 20 minutes worsened the client’s symptoms, try walking for five minutes and see how that goes. It may be helpful to keep a diary to keep track of what works and what doesn’t for the client. Learn from past relapses. For example, if walking for 20 minutes worsened the client’s symptoms, try walking for five minutes and see how that goes. It may be helpful to keep a diary to keep track of what works and what doesn’t for the client.

Exercise Suggestions for Clients with CFS cont. Stop the physical activity well before the client feels tired. Pacing is very important. Stop the physical activity well before the client feels tired. Pacing is very important. Remember that the client’s exercise tolerance will differ from one day to the next. Remember that the client’s exercise tolerance will differ from one day to the next. Listen to your body – if the client doesn’t feel up to exercising on a particular day, don’t. Listen to your body – if the client doesn’t feel up to exercising on a particular day, don’t. Only slowly increase the intensity, time spent or frequency of exercise when the client knows he or she can cope with it. For example, if the client can exercise for five minutes without suffering a relapse, try for six minutes. Only slowly increase the intensity, time spent or frequency of exercise when the client knows he or she can cope with it. For example, if the client can exercise for five minutes without suffering a relapse, try for six minutes.

Recommendations for Exercise Programming Con’t Strength training exercises should be based on preservation of levels of strength Strength training exercises should be based on preservation of levels of strength Progression of exercise activity should focus primarily on increasing the duration of moderate intensity activities instead of increasing exercise intensity Progression of exercise activity should focus primarily on increasing the duration of moderate intensity activities instead of increasing exercise intensity Emphasize use of motivational cues – social and extrinsic Emphasize use of motivational cues – social and extrinsic Avoid eccentric or upper extremity overhead loading Avoid eccentric or upper extremity overhead loading Supervise and control with follow up support Supervise and control with follow up support Avoid early morning exercise Avoid early morning exercise Ensure adequate time and attention for client Ensure adequate time and attention for client

Special Considerations Depression may accompany condition as lifestyle changes occur due to persistent symptoms Depression may accompany condition as lifestyle changes occur due to persistent symptoms Often clients will express frustration as people are not sympathetic to their condition Often clients will express frustration as people are not sympathetic to their condition Clients tend to cope with symptoms by planning acivities to budget their energy Clients tend to cope with symptoms by planning acivities to budget their energy

References Mondell, D. L. (c2005.). Living with chronic fatigue syndrome 4 steps to manage pain and lead a fulfilling life / (1st ed. ed.). New York : McGraw-Hill,. Mondell, D. L. (c2005.). Living with chronic fatigue syndrome 4 steps to manage pain and lead a fulfilling life / (1st ed. ed.). New York : McGraw-Hill,. Sietsema, K. E. (1997). Chronic Fatigue Syndrome. In J.L. Durstine & G.E. Moore (Eds.), American College of Sports Medicine: Exercise Management for Persons with Chronic Diseases and Disabilities. (pp ). Windsor: Human Kinetics Sietsema, K. E. (1997). Chronic Fatigue Syndrome. In J.L. Durstine & G.E. Moore (Eds.), American College of Sports Medicine: Exercise Management for Persons with Chronic Diseases and Disabilities. (pp ). Windsor: Human Kinetics Wallace, Daniel J. (Daniel Jeffrey), (2002.). All about chronic fatigue syndrome. Oxford ; New York : Oxford University Press,. Wallace, Daniel J. (Daniel Jeffrey), (2002.). All about chronic fatigue syndrome. Oxford ; New York : Oxford University Press,.