What happens when someone with Chronic Fatigue Syndrome (CFS) exacerbates their fatigue?

From the Guidelines

Pushing through fatigue with Chronic Fatigue Syndrome (CFS) typically worsens symptoms and can trigger post-exertional malaise (PEM), a hallmark of the condition. When someone with CFS ignores their body's signals and continues physical, mental, or emotional exertion beyond their energy limits, they often experience a significant crash that can last for days or weeks. This crash may include intensified fatigue, increased pain, cognitive difficulties, sleep disturbances, and other symptoms that were present before overexertion.

Key Considerations

• The current evidence suggests that cognitive-behavioral therapy (CBT) has the greatest evidence for improving health function, health-related quality of life, or physical function in patients with CFS, as seen in a meta-analysis of 29 studies 1.
• Mindfulness-based therapies also have strong evidence supporting their use for patients with CFS, with improvements in daily functioning and quality of life 1.
• Instead of pushing through, patients should practice pacing strategies, where they balance activity with rest periods before reaching exhaustion, as this approach is based on understanding that CFS involves dysregulation of energy metabolism and autonomic nervous system function.

Management Strategies

• Energy conservation techniques like prioritizing essential tasks, breaking activities into smaller segments, and scheduling rest breaks throughout the day are recommended.
• Learning to respect energy limitations rather than fighting through them is essential for managing CFS effectively.
• The use of stimulants for treatment of fatigue in patients with CFS is not recommended, as stated in the 2021 US Department of Veterans Affairs and US Department of Defense clinical practice guideline 1.

From the Research

Effects of Exacerbating Fatigue in CFS

• When someone with Chronic Fatigue Syndrome (CFS) exacerbates their fatigue, the effects can be severe and long-lasting 2, 3, 4, 5.
• Exacerbating fatigue can lead to increased symptoms such as musculoskeletal pain, sleep disturbance, headaches, and impaired concentration and short-term memory 2, 3, 4, 5.
• Exercise therapy has been shown to reduce fatigue in adults with CFS, but exacerbating fatigue can undermine the benefits of exercise therapy 2, 3, 4, 5.

Comparison of Interventions

• Exercise therapy has been compared to other interventions such as cognitive-behavioral therapy (CBT), adaptive pacing, and pharmacological therapy 2, 3, 4, 5.
• Activity pacing interventions have been shown to be effective in reducing fatigue, psychological distress, and depression, and improving physical function in CFS 6.
• The effectiveness of exercise therapy and activity pacing interventions can be influenced by the type, duration, and intensity of the intervention, as well as the individual's response to the intervention 2, 3, 4, 5, 6.

Outcomes of Exacerbating Fatigue

• Exacerbating fatigue can lead to a range of negative outcomes, including increased symptoms, reduced physical function, and decreased quality of life 2, 3, 4, 5.
• The risk of serious adverse reactions is uncertain, but exacerbating fatigue can increase the risk of adverse outcomes 2, 3, 4, 5.
• Healthcare professionals should work collaboratively with patients to develop individualized self-management strategies to manage fatigue and prevent exacerbation 6.