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Chronic Fatigue Syndrome: Using Graded Exercise to Get More Energy

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You may be thinking, "How can I exercise when I'm so tired I can barely get through the day?" You can do it, as long as you start out very slowly and are careful not to overexert yourself. Most important, it will make you feel better.

Studies show that light aerobic exercise, such as walking, helps people who have chronic fatigue syndrome (CFS) feel more energetic and less tired.1 Maybe you have avoided exercise because you're afraid it will make you feel worse. But the opposite is true. Total rest leaves your body in worse shape. It can also hurt your self-image by making you feel as if you can't do anything for yourself.

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Graded exercise is exercise that starts out slowly and increases in very small steps. It means you have a plan for your exercise and you stay with it, even when you're having a good day and feel like doing more. Increasing your exercise very slowly lets your body make the changes it needs to cope with activity and exercise. People with chronic fatigue syndrome often have an exercise program designed for them by a health expert called a physiologist who can create a tailor-made plan and carefully watch the person's progress.

For example, you might start by walking, bicycling, or swimming as little as 5 minutes every other day for 2 weeks. If you feel strong enough at the end of 2 weeks, you might add 2 to 5 minutes to your exercise for another 2 weeks, and so on.

Test Your Knowledge

When your doctor talks to you about "graded" exercise, he or she means exercise during which you are supervised and given a grade based on how well you do.


If you have chronic fatigue syndrome, you may have days when you feel pretty good and days when you can barely get out of bed. On your good days, you may decide you can do twice as much. But that may cause a relapse of your symptoms. Those relapses may make you afraid to exercise at all. But if you avoid exercising altogether, your body grows weaker and you are less able to fight off fatigue and illness. People with CFS often feel like they have no control over their bodies, as if they cannot do anything for themselves. By starting a carefully controlled exercise plan, you can begin taking back control.

In combination with good sleep habits and careful scheduling of activities, a gentle, graded exercise program can help you feel better. You must start with very brief activities and gradually increase the frequency, duration, and intensity of exercise as you feel able. This kind of exercise plan can be extremely helpful in relieving and controlling symptoms of chronic fatigue syndrome.

Test Your Knowledge

Avoiding all exercise will not help people who have CFS feel better. In fact, it can make them feel worse.


You should work with your doctor to draw up a specific plan for your needs and abilities. But there are things you can do on your own.

Walking is an excellent form of aerobic exercise for people who have chronic fatigue syndrome. Other gentle exercises, such as riding a bicycle or stationary bike or swimming, are also good. You need to find a balance so that you are exercising enough to benefit from it but not exercising so much that you become overtired. Here are some things to consider:

  • Adopt a positive attitude toward exercise. Try to put aside your doubts and your worries that it will cause a relapse.
  • Start very slowly. If you have not been very active lately, it is a bad idea to jump into a vigorous exercise program. Start with just a few minutes of very gentle exercise, such as stretching. When you are comfortable with stretching exercises, add very short periods of a mild aerobic activity such as walking or swimming.
  • Increase very gradually. After you know that your body can tolerate this level of exercise over the course of several sessions, increase the length of your exercise session by only 1 minute. Rest frequently, and build up your exercise intensity a little bit at a time. Try to work up to at least 2½ hours of moderate exercise a week.2 One way to do this is to be active for at least 10 minutes 3 times a day, 5 days a week.
  • Don't push yourself too hard. You can easily become overtired, which will defeat the purpose of exercise. Sometimes you will not feel the effect of too much exercise until the next day.
  • Take a few days off when you need to. There may be periods of time when stress or other physical activities make exercise too difficult. When this happens, take a little time off, and then try to get back into your exercise routine as soon as possible.
  • Keep track of your exercise on a calendar or use this progress chart.

Test Your Knowledge

If you are having a good day and feel more energetic, it's okay to push yourself a little harder than your exercise plan calls for.


Now that you've read this information, you're ready to begin a graded exercise program.

Talk with your health professional

If you have questions, take this information with you when you visit your doctor.


  1. Reid S, et al. (2011). Chronic fatigue syndrome, search date March 2010. BMJ Clinical Evidence. Available online:

  2. U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online:

Other Works Consulted

  • Togo F, et al. (2010). Sleep is not disrupted by exercise in patients with chronic fatigue syndromes. Medicine and Science in Sports and Exercise, 42(1): 16–22.

  • White PD, et al. (2011). Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): A randomised trial. Lancet, 377(9768): 823–826.

ByHealthwise Staff
Primary Medical ReviewerAnne C. Poinier, MD - Internal Medicine
Specialist Medical ReviewerNancy Greenwald, MD - Physical Medicine and Rehabilitation
Last RevisedJanuary 18, 2013

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