How To Exercise with Chronic Fatigue


Katie Rapkoch, CHPC


Published on

April 7, 2024


Updated on

May 15, 2024

Medically Reviewed by

Dr. Robert Stevens

Chronic Fatigue

What is Chronic Fatigue Syndrome?

Myalgic Encephalomyelitis (also known as Chronic Fatigue Syndrome, or CFS, for short) is characterized by, but does not have to include all of, specific diagnostic criteria. This criteria includes experiencing the following symptoms for six months or longer:

  • Decreased ability to do normal activities of daily living due to feelings of tiredness, cardiovascular limitations, or malaise (a general feeling of discomfort or uneasiness)
  • Sudden changes in blood pressure
  • Trouble sleeping
  • Difficulty with thinking or memory
  • Swollen lymph nodes
  • Swelling and achiness in the muscles and/or joints (often referred to as fibromyalgia),
  • New or worsening headaches
  • Worsening of symptoms after physical activity

According to the Centers for Disease Control and Prevention (CDC), chronic fatigue syndrome patients generally present with prior infections or exposure to viruses like Epstein Barr or Long COVID, immune system dysfunction, high levels of stress, or potential genetic predispositions.1

In the re-origin program, we help individuals with chronic fatigue syndrome and other chronic illnesses retrain their brain in order to decrease symptoms and return to full health. If you want to learn more about how you can retrain your brain and heal your body, sign up for a free info call today.

Can I exercise if I have chronic fatigue syndrome?

Often, it can feel as though exercising with chronic fatigue syndrome can be a vicious cycle of uncertainty. Questions exist, such as:

  • “How do I use energy to exercise if I don’t have any?” or
  • “Will exercise even help my chronic fatigue, or just make it worse?”

These questions dart around our minds like ping-pong balls. This overthinking drains us of even more precious energy, eliminating any exercise motivation. There are answers to these questions, though, and they may help you solve your CFS woes.

Exercise is possible with ME/CFS. Even though your activity levels should be monitored while building exercise tolerance, you can retrain your body and mind to respond positively to physical activity.

What is the best way to exercise with chronic fatigue?

While considering adding a movement routine into your life when suffering from chronic fatigue syndrome, both energy management and incremental training are very important.

Energy management is a technique in which one identifies his or her individual tolerance to both physical and mental activity. Doing this allows you to build clarity around the participation limit of daily activities. Going over this tolerance threshold may worsen CFS symptoms, while adhering to said threshold may level off or even decrease the prevalence of said symptoms. That is not to say that one must constantly manage one's energy at the same level. This is where incremental training can be so valuable.

Once a window of tolerance has been identified through energy management, it becomes much easier to develop a treatment plan that supports exercising despite chronic fatigue syndrome. When beginning the exercise program, incorporating incremental training comes next.

Incremental training also referred to as graded exercise therapy, is an exercise regime in which you develop your “sweet spot” for activity. You gradually move beyond the edge of said “sweet spot” in an attempt to challenge yourself and build increased levels of activity endurance. Doing this will slowly increase your window of tolerance, which will then allow you to gradually raise the threshold on energy management.

  • For instance, if your goal is to eventually perform weight training for 45 minutes three days per week, consider starting with just 3-5 minutes of bodyweight movements. This type of exercise will not only gradually increase exercise tolerance but will improve overall muscle strength and decrease joint pain.
  • In the beginning, you may exercise regularly for weeks prior to seeing significant overall effects of exercise. With that being said, it is extremely important to celebrate yourself and appreciate your body for these small wins. This allows your nervous system to build a positive association with the activity, which will then motivate you to continue this level of exercise and eventually advance on your exercise routine.

How much should you exercise with chronic fatigue?

The amount of exercise you partake in will vary based on your perceived window of tolerance. People with chronic fatigue syndrome often have a lower baseline for activity, so it is important to consider day-to-day activities as exercise until your endurance improves. To start, you may consider doing any activity that elevates your heart rate to 30 beats per minute above your baseline. This could include, but is not limited to:

  • Folding the laundry,
  • Emptying the dishwasher,
  • Making the bed, or
  • Taking a shower

When dealing with deconditioning due to chronic fatigue syndrome, this elevation in heart rate is considered aerobic exercise and is more than enough engagement until activity tolerance is built. Pushing past this limit in the beginning may cause post-exertional malaise (also known as PEM).

  • PEM is known as a worsening of CFS symptoms after physical, emotional, or mental exertion. This can last up to 48 hours beyond the activity and can impact your overall quality of life.
  • Because of the risk for PEM, the amount of exercise initially performed should be kept around 3-5 minutes at a time, with the goal of using incremental training to slowly increase your overall endurance. If you would like to wear a heart rate monitor while starting exercise, you can. As you progress, the need to monitor your heart rate becomes less important as you build a more intuitive relationship between your body and exercise.2

There may be moments in which increasing your activity level feels scary or daunting. If this is the case, it is important to practice brain retraining to remind your body and mind that it is safe (nay, beneficial!) to engage in these and other types of activity.3

What are some exercises that I can do with Chronic Fatigue?

The most beneficial exercises for chronic fatigue syndrome are tai chi, qigong, walking, and gentle pilates or yoga. These exercises are considered beneficial for multiple reasons:

  • They have a much lower level of energy output,
  • They help build overall muscle strength and mobility, and
  • They can improve mental health.
  • They may help decrease muscle pain and reduce stiffness.

As CFS symptoms lessen, you may be able to engage in activities that require higher levels of energy output, such as strength exercises and long-distance running. This is a great opportunity to apply the technique of incremental training. Remember to start small (3-5 minutes of activity to begin), celebrate your effort, and gently push your boundaries, and you will begin to see the results!

Will exercise help my chronic fatigue?

The benefits of exercise cannot be overstated. Being physically active improves overall muscle and bone strength, lowers the risk of disease, and produces feel-good chemicals that impact overall mental health, create neuroplasticity, improve metabolic function, and increase energy! When dosed correctly and progressed accordingly, exercise can absolutely help those with Chronic Fatigue Syndrome. Applying the information above in a strategic way, coupled with brain retraining exercises, gradually increasing physical activity is a great way to manage symptoms of severe fatigue.

Can brain retraining help my chronic fatigue?

Brain retraining, also known as self-directed neuroplasticity, is a valuable tool to aid in decreasing the intensity of chronic fatigue syndrome and returning to optimal health. When we interrupt old thought and behavior loops related to CFS and create new loops that promote new thoughts and behaviors, we can slowly teach our nervous system that it is safe to participate in exercise again. If you are interested in hearing more about how brain retraining can help you, sign up for a free info call today.

Disclaimer: This article is not a replacement for treatment or diagnosis from a healthcare professional. If you are considering participating in graded exercise therapy, please seek expertise from a licensed physiotherapist.


  1. Possible Causes | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | CDC. (n.d.).
  1. Ruscio, D. M. C. (2020, July 15). How To Exercise If You Have Chronic Fatigue. Dr. Michael Ruscio, DC.
  1. Jason L, Benton M, Torres-Harding S, Muldowney K. The impact of energy modulation on physical functioning and fatigue severity among patients with ME/CFS. Patient Educ Couns. 2009 Nov;77(2):237-41. doi: 10.1016/j.pec.2009.02.015. Epub 2009 Apr 8. PMID: 19356884; PMCID: PMC2767446.


Katie Rapkoch, CHPC