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Overview of Chronic Fatigue Syndrome

This condition is an unexplained, persistent fatigue that is not a result of exertion and that lasts for 6 months or longer. Clients typically have unexplained fatigue along with symptoms of diffuse pain with impaired memory or concentration. This condition can result from numerous biologic, behavioral, and psychological factors. The leading cause is hypothesized to be the presence of a chronic infection that induces changes to the immunologic and neuroendocrine functions and autonomic nervous system regulation.1

Unexplained fatigue for fewer than 6 months is called prolonged fatigue. Clients with this condition experience abnormal responses to exercise activities that result in debilitating fatigue that is not reversed with rest or sleep. Their abnormal endocrinologic and immunologic responses produce fatigue that leads to significant deficits in endurance and cardiopulmonary functions. Prolonged inactivity in poorly supported seated positions can lead to altered trunk postures and abnormal breathing patterns. Clients will learn to limit their activity levels to avoid fatigue symptoms and develop avoidance behaviors that result in reluctance to participate in exercise.2

Comorbidities to Consider

  • Clients may also have a variety of physical symptoms with this condition.1

Concurrent Symptoms That May Occur With Chronic Fatigue Syndrome

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Sore throat Memory loss
Tender lymph nodes Muscle pain
Arthralgias Headaches
Unrefreshing sleep Postexertional malaise

Client Examination

Keys to Examination of Clients

  • Discuss with your clients what type of testing has been performed to rule out other conditions.

  • Monitor the results of tests for blood counts and chemistry for signs of infection.

Recommended Baseline Testing of Fitness Levels

  • Perform tests of vital signs and perceived exertion ratings before and after testing sessions.

  • Examine clients in sitting and standing positions for breathing patterns, dyspnea, and hypotension.

  • Have clients assess their fatigue level on a 1-10 scale before exercise and at intervals after exercise.1

Exercise Prescription


Type: Standing activities, walking, postural exercises

Intensity: Begin with very low levels of activities

Duration: Start with intermittent periods of 2–3 minutes

Frequency: Daily as tolerated

Getting Started

The combination of graded submaximal aerobic exercise and cognitive behavior therapy is the best method for improving activity levels and lessening fatigue symptoms.3,4,5 Begin exercise sessions with stretching activities and exercises for improving posture and breathing patterns. Exercise sessions may need to be started with only minimal durations of exercise along with encouragement for the client to increase daily activities that involve standing and walking activities. Closely monitor vital signs and perceived exertion levels, but do not use perceived ...

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