Treating chronic fatigue with exercise

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7158.599a (Published 29 August 1998) Cite this as: BMJ 1998;317:599

Exercise, and rest, should be tailored to individual needs

  1. Ellen Goudsmit, Editor, ME and CFS Capita Selecta Quarterly.
  1. 23 Melbourne Road, Teddington, Middlesex TW11 9QX
  2. Italian State Railways, Padua, Italy
  3. West Suffolk Hospital, Bury St Edmunds IP33 2QZ
  4. University of Edinburgh, Royal Edinburgh Hospital, Edinburgh EH10 5HF
  5. King's College School of Medicine, London SE5 8AF

    EDITOR —While I welcome Sharpe and Wessely's reminder about the dangers of bed rest,1 I am concerned about the blanket advice regarding activity levels for patients with chronic fatigue. Chronic fatigue syndrome is now generally acknowledged to be a heterogeneous condition, not a single entity with a single cause. Accordingly, what may suit one person may be totally inappropriate for another. As research has shown, most patients with chronic fatigue syndrome remain ambulant, spend relatively few daytime hours resting, are no more inactive than people with mild multiple sclerosis, and tend to perform at or near their activity ceiling.2 What these patients need is not a strict programme in which rest is allowed according to a predetermined plan but a flexible approach that does not ignore current energy levels or make people feel guilty if they increase rest periods when they consider this to be right for them.

    From a theoretical perspective, inactivity may well be an important factor in chronic fatigue syndrome, but I note that Sharpe and Wessely did not provide a single reference to back their claim that many patients simply “go home and rest,” let alone that most resort to “excessive rest.” Does this mean that the theory that “excessive inactivity” perpetuates chronic fatigue syndrome is based largely on anecdotal reports and articles in magazines? Moreover, in this age of evidence based medicine, discussions of a treatment should mention the negative reports of its efficacy as well as …

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