Chronic Fatigue Syndrome | Tailored Health

An Introduction to CFS

Covid-19 has brought new attention to fatigue syndromes with long COVID occurring in approximately 30% of COVID infections. However, this blog is all about chronic fatigue syndrome, given Long COVID is relatively new and these conditions present in a similar way. 

Chronic fatigue syndrome (CFS) is also known as Myalgic Encephalomyelitis (ME) and more recently referred to as Systemic Exertion Intolerance Disease (SEID). CFS is a long-term illness (> 6 months) impacting multiple body systems and leads to severe and disabling fatigue. The key feature of this condition is the post-exertion malaise meaning even though an individual can get through a task/tasks there may be a period of severe fatigue as a result which can last days.

This condition affects 1-2% of the global population and is associated with poor quality of life and impacted mental health. Unfortunately, there is no one treatment approach that works for all individuals, however, there are definitely ways to manage and improve your quality of life. 

Diagnosis

The cause of chronic fatigue is complex and not yet fully understood. The symptoms can vary significantly from person to person however there are certain symptoms that are needed for a diagnosis.

For a ME/CFS diagnosis the following symptoms must be present: 

  1. Post-exertional malaise aka. Complete exhaustion after doing something physical.
  2. Experiences of significant and persistent fatigue that is alleviated by rest for greater than 6 months. This fatigue means a person can not complete the sample level or a number of activities which can include simple activities around the home. 
  3. Unrefreshing sleep.
  4. Either cognitive impairment (challenges with memory, finding words, comprehension) OR orthostatic intolerance ( cardiac symptoms when standing that are relieved when lying down. e.g. sweating, dizziness, palpitations)

Questionnaires are often used to determine a diagnosis but also to measure the impact fatigue has on someone’s life. These measurements can be used over months to measure improvements over time. These outcomes are insightful, especially in situations where you feel you may not be making progress however these questionnaires can pick up slight changes and provide insight into a true progress that has been made. 

Treatment

A range of treatments have been explored both pharmacological and non-pharmacological. A recent systematic review identified nonpharmacological interventions appear to be most effective leading with psychiatric approaches and followed by graded exercise-related therapies. (Kim et al 2020) One randomised control trial (high level of evidence) in 2017 found guided graded exercise was safe and resulted in reduced fatigue and improved function in 107 individuals with CFS in comparison to 104 individuals with CFS who received specialised medicare care alone without the graded-exercise. 

This trial is supported by previous work indicating graded -exercise can improve symptoms of CFS. But what exactly does graded-exercise look like?

The truth is there is no one approach to graded exercise and prescription will vary for each individual. There is a misconception that graded-exercise has be completed in the gym or be a structured type of exercise, however, this is not the case. For example, simple tasks around the house serve as a good starting point for graded-exercise.

Handy hints to help manage CFS

PACING: Pacing is an INCREDIBLE strategy to help manage CFS. Breaking up bigger tasks into smaller ones. This may look like taking breaks while cooking dinner or vacuuming one room at a time.

AWARENESS of high energy/low energy tasks: Identify low energy and high energy tasks in your week. Once you have this awareness break up high-energy tasks with one or many low-energy tasks as a way to prevent post-exertional fatigue. 

TRIAL AND ERROR: No one way will work for two people so be sure to find out what strategies work best for you.

SEEK SUPPORT: Having a supportive and understanding healthcare team around you really can make all the difference. From giving you mini goals to focus on to sharing helpful tips on how to reduce fatigue or build a tolerance to graded-exercise. 

TRACK YOUR PROGRESS: Sometimes we can feel like we are not making progress and that is why tracking with objective measurements is so important. These can be physical measurements however this can be very dependent on the day which is why chronic fatigue-specific questionnaires can be a great way to track how you are truly progressing. 

And if you feel you are not making progress becoming aware of this will allow you to discuss with your healthcare professionals and use trial and error to find alternative.

REFERENCES

Kim DY, Lee JS, Park SY, Kim SJ, Son CG. Systematic review of randomized controlled trials for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). Journal of translational medicine. 2020 Dec;18(1):1-2.

Clark LV, Pesola F, Thomas JM, Vergara-Williamson M, Beynon M, White PD. Guided graded exercise self-help plus specialist medical care versus specialist medical care alone for chronic fatigue syndrome (GETSET): a pragmatic randomised controlled trial. The Lancet. 2017 Jul 22;390(10092):363-73.

White PD, Goldsmith KA, Johnson AL, Potts L, Walwyn R, DeCesare JC, Baber HL, Burgess M, Clark LV, Cox DL, Bavinton J. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. The Lancet. 2011 Mar 5;377(9768):823-36.

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