Chronic Fatigue Chronic Fatigue Syndrome (CFS)Syndrome (CFS)

Jonathan Cooke 0311284Jonathan Cooke 0311284

Kevin Repay 0275542Kevin Repay 0275542

Tara Ruberto 0306015Tara Ruberto 0306015

What is CFS?What is CFS?

A condition characterized by persistent A condition characterized by persistent debilitating fatigue, not relieved by rest and debilitating fatigue, not relieved by rest and not accounted for by any specifically identified not accounted for by any specifically identified medical or psychiatric condition.medical or psychiatric condition.

*The cause of CFS is unknown and therefore *The cause of CFS is unknown and therefore defined primarily by its symptomsdefined primarily by its symptoms

Common Symptoms of Chronic Common Symptoms of Chronic Fatigue SyndromeFatigue Syndrome

Frequent sore throatsFrequent sore throats Painful lymph nodesPainful lymph nodes HeadachesHeadaches Difficulty with concentration and memoryDifficulty with concentration and memory Low-grade feverLow-grade fever

Signs and SymptomsSigns and Symptoms*Major Criteria *Major Criteria

New onset of persistent or relapsing fatigue, not New onset of persistent or relapsing fatigue, not resolving with bed rest, and severe enough to resolving with bed rest, and severe enough to reproduce or impair average daily activities below reproduce or impair average daily activities below 50% of previous levels for at least six months50% of previous levels for at least six months

Other clinical conditions that could cause similar Other clinical conditions that could cause similar symptoms must be excluded by appropriate medical symptoms must be excluded by appropriate medical evaluation. These other conditions include, but are evaluation. These other conditions include, but are not limited to, malignancy, autoimmune disease, not limited to, malignancy, autoimmune disease, localized infection, chronic bacterial or parasite localized infection, chronic bacterial or parasite disease, endocrine disorder, and other chronic disease disease, endocrine disorder, and other chronic disease

Signs and SymptomsSigns and Symptoms*Minor Criteria*Minor Criteria

Mild feverMild fever Sore throatSore throat Painful lymph nodes in neck or underarm regionPainful lymph nodes in neck or underarm region Generalized muscle weaknessGeneralized muscle weakness Muscle discomfort or myalgiaMuscle discomfort or myalgia Prolonged generalized fatigue after levels of exercise that were Prolonged generalized fatigue after levels of exercise that were

previously well toleratedpreviously well tolerated Generalized headacheGeneralized headache Mygratory arthralgiaMygratory arthralgia Neuropsychologic complaintsNeuropsychologic complaints Sleep disturbanceSleep disturbance History of symptom complex having begun acutely following History of symptom complex having begun acutely following

viral infection viral infection

Signs and SymptomsSigns and Symptoms*Physical Criteria *Physical Criteria

Low grade feverLow grade fever Non-exudative pharyngitisNon-exudative pharyngitis Palpable tender lymph nodes in neck Palpable tender lymph nodes in neck

*To meet the case definition, clients must meet both major criteria and a total of *To meet the case definition, clients must meet both major criteria and a total of eighteight other symptom criteria’s, or other symptom criteria’s, or sixsix symptom criteria and symptom criteria and twotwo physical physical criteria.criteria.

Contraindicators for exercise with Contraindicators for exercise with CFSCFS

Cold/humid weatherCold/humid weather Insuffiecient sleepInsuffiecient sleep Fatigue Fatigue Excessive vigorous phsyical activity or Excessive vigorous phsyical activity or

inactivity inactivity Anxiety Anxiety StressStress Strenuous strength training exercisesStrenuous strength training exercises

Exercise Suggestions for Clients withExercise Suggestions for Clients with CFSCFS

Aim for no more than three exercise sessions per week. Aim for no more than three exercise sessions per week. Experiment to find the type of exercise that works best for the client. Experiment to find the type of exercise that works best for the client.

Choose from a range of gentle activities such as stretching, yoga, Tai Chi, Choose from a range of gentle activities such as stretching, yoga, Tai Chi, walking and light weight training. walking and light weight training.

Stretching seems to be well tolerated by people with CFS. Clients may Stretching seems to be well tolerated by people with CFS. Clients may prefer to perform your stretching program while lying down in bed. prefer to perform your stretching program while lying down in bed.

Aerobic exercise seems to cause relapses for many people with CFS. If this Aerobic exercise seems to cause relapses for many people with CFS. If this is true for the client, try non-aerobic forms of exercise like weight training is true for the client, try non-aerobic forms of exercise like weight training with light weights. with light weights.

Learn from past relapses. For example, if walking for 20 minutes worsened Learn from past relapses. For example, if walking for 20 minutes worsened the client’s symptoms, try walking for five minutes and see how that goes. the client’s symptoms, try walking for five minutes and see how that goes. It may be helpful to keep a diary to keep track of what works and what It may be helpful to keep a diary to keep track of what works and what doesn’t for the client. doesn’t for the client.

Exercise Suggestions for Clients withExercise Suggestions for Clients with CFS cont.CFS cont.

Stop the physical activity well before the client feels Stop the physical activity well before the client feels tired. Pacing is very important. tired. Pacing is very important.

Remember that the client’s exercise tolerance will Remember that the client’s exercise tolerance will differ from one day to the next. differ from one day to the next.

Listen to your body – if the client doesn’t feel up to Listen to your body – if the client doesn’t feel up to exercising on a particular day, don’t. exercising on a particular day, don’t.

Only slowly increase the intensity, time spent or Only slowly increase the intensity, time spent or frequency of exercise when the client knows he or frequency of exercise when the client knows he or she can cope with it. For example, if the client can she can cope with it. For example, if the client can exercise for five minutes without suffering a relapse, exercise for five minutes without suffering a relapse, try for six minutes.try for six minutes.

Recommendations for Exercise Recommendations for Exercise Programming Con’tProgramming Con’t

Strength training exercises should be based on preservation of Strength training exercises should be based on preservation of levels of strengthlevels of strength

Progression of exercise activity should focus primarily on Progression of exercise activity should focus primarily on increasing the duration of moderate intensity activities instead increasing the duration of moderate intensity activities instead of increasing exercise intensityof increasing exercise intensity

Emphasize use of motivational cues – social and extrinsicEmphasize use of motivational cues – social and extrinsic Avoid eccentric or upper extremity overhead loadingAvoid eccentric or upper extremity overhead loading Supervise and control with follow up supportSupervise and control with follow up support Avoid early morning exerciseAvoid early morning exercise Ensure adequate time and attention for clientEnsure adequate time and attention for client

Special ConsiderationsSpecial Considerations

Depression may accompany condition as Depression may accompany condition as lifestyle changes occur due to persistent lifestyle changes occur due to persistent symptoms symptoms

Often clients will express frustration as people Often clients will express frustration as people are not sympathetic to their conditionare not sympathetic to their condition

Clients tend to cope with symptoms by Clients tend to cope with symptoms by planning acivities to budget their energyplanning acivities to budget their energy

ReferencesReferences

Mondell, D. L. (c2005.). Mondell, D. L. (c2005.). Living with chronic fatigue syndrome Living with chronic fatigue syndrome 4 steps to manage pain and lead a fulfilling life /4 steps to manage pain and lead a fulfilling life / (1st ed. ed.). (1st ed. ed.). New York : McGraw-Hill,. New York : McGraw-Hill,.

Sietsema, K. E. (1997). Chronic Fatigue Syndrome. In J.L. Sietsema, K. E. (1997). Chronic Fatigue Syndrome. In J.L. Durstine & G.E. Moore (Eds.), Durstine & G.E. Moore (Eds.), American College of Sports American College of Sports Medicine:Medicine: Exercise Management for Persons with Chronic Exercise Management for Persons with Chronic Diseases and DisabilitiesDiseases and Disabilities. (pp.141-145). Windsor: Human . (pp.141-145). Windsor: Human KineticsKinetics

Wallace, Daniel J. (Daniel Jeffrey),1949-. (2002.). Wallace, Daniel J. (Daniel Jeffrey),1949-. (2002.). All about All about chronic fatigue syndromechronic fatigue syndrome. Oxford ; New York : Oxford . Oxford ; New York : Oxford

University Press,.University Press,.