Accompanying symptoms and the contribution of Graded Exercise Therapy
Fatigue is the main symptom in Chronic Fatigue Syndrome (CFS) but it is not the only one. There are plenty of other symptoms that can cause severe difficulties in the daily life of the person living with CFS. Often, such accompanying symptoms present in cases where fatigue is not due to CFS but it is due to other chronic diseases such as cancer, rheumatoid arthritis and others. Graded Exercise Therapy takes into account these intense associated symptoms and the rehabilitation program includes improving and preventing them whenever possible. Such symptoms can be:
Muscle fatigue and weakness
Prolonged fatigue experienced by people with chronic fatigue leads to the reduction of physical activities and increased rest. Lack of physical activity can lead to muscle weakness and rapid muscle fatigue during physical activity and exercise. Both these symptoms are common and persistent in both Chronic Fatigue Syndrome and other chronic diseases in which there is fatigue (such as cancer, stroke, rheumatoid arthritis and others).
In Graded Exercise Therapy the type and amount of exercise that will be used for each patient is carefully selected, gradually increased and planned through reassessing fatigue and weakness during each session. The aim is to reduce fatigue and weakness, but without provoking more symptoms.
Chronic muscle and joint pain
Almost all patients report pain in various muscles groups such as at the neck, the arms and thighs. Also, there are painful joints, especially the wrists, hips and knees. Pain can often be daily and may be increased by exercise and activities.
In the program of the Graded Exercise Therapy, the treatment of chronic pain is important. The administration of the correct dose and type of exercises without causing extra pain symptoms is a precondition in order to improve the patient's health. Furthermore, the aim is to explain to the patient the appearance and complications of chronic pain in order to better understand this symptom and to actively participate in tackling it.
Most patients with Chronic Fatigue Syndrome report sleep disorders, which often are severe. These may include problems before and during sleep, as well as on waking up. These disorders cause, in turn, problems in the everyday life of the individuals, as they have not been relaxing during sleep resulting in further exhaustion on the following day.
Sleep management and sleep hygiene are part of the patient's education and monitoring of the quality of sleep throughout the course of Graded Exercise Therapy
Loss of routine
The loss of routine may not seem by some like a real or important symptom in Chronic Fatigue Syndrome or chronic fatigue. But it is a persistent and intense reality that all people with chronic fatigue are faced with. It is possibly one of the hardest symptoms to deal with. The patients themselves find it difficult to restore the routine in their lives, since the intensity of their fatigue can fluctuate from day to day, causing turmoil in their routine. Sometimes they manage to build and maintain a daily routine, which however includes only a few physical activities.
The first step in Graded Exercise Therapy is to stabilize everyday activities and routine. Then, a gradual, controlled increase in the physical activity is introduced, by adding exercises and activities that do not elevate the symptoms while they maintain an continuously increasing daily routine.
Setback or lack of progress
People who have Chronic Fatigue Syndrome or chronic fatigue are well aware that the lack of progress and setbacks are very common phenomena. During setbacks, all or some of the symptoms worsen and progress is inhibited. This has a strong impact on both the daily life and the psychology of the individual.
With Graded Exercise therapy the patient learns how to prevent and respond to periods of setbacks, while maintaining physical activity and exercise. Dealing with relapses is a very important topic in Graded Exercise Therapy as it contributes significantly to better and faster improvement and rehabilitation of the individual's health.
Loss of employment
It may be that loss of is not a direct “symptom” in chronic fatigue, but it is a common situation that affects mainly people with moderate or severe chronic fatigue. Job loss is the result of the intense symptoms which in turn create more problems of both economic and psychological nature, for example bad mood and possible lack of incentives for improvement. Most patients do not know how they could return to their work (in the existing, previous or new job) without worsening their physical condition. This lack of knowledge often creates fear of returning to work.
At the final stage of Graded Exercise Therapy, building goals around returning to work are set and the patient works on them by using gradual steps based on physical exercise and activity.
The mood disorders can trigger the onset of Chronic Fatigue Syndrome according to some researchers. They, also, can appear during the syndrome. This is something that happens very often and both in the cases of Chronic Fatigue Syndrome, and also in chronic fatigue from other conditions like stroke, multiple sclerosis, fibromyalgia, burnout syndrome and others. Mood disorders and their intensity can vary from person to person and from period to period. Cognitive behavioural therapy is one of the two treatments recommended by the National Institute for Health and Care Excellence of the United Kingdom of the United Kingdom . This treatment considers that Chronic Fatigue Syndrome is reversible and believes that cognitive responses, such as fear of engaging in activities or avoidance of activity, contribute to the interaction of physiological processes and perpetuate fatigue. Thus, this treatment uses techniques and strategies with which the individual changes their behaviour towards the symptoms of chronic fatigue, thereby reducing or eliminating physical symptoms .
During Graded Exercise Therapy thus the purpose is not to deepen around the cognitive perceptions and behaviour of the patient towards their condition, it is important that the properly trained Graded Exercise Therapist can understand the cognitive behaviour of the patient and to take it into account when designing a physical activity and exercise programme.
White P, Goldsmith K, Johnson A, et al. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet 2011; 377: 823–36.