Fibromyalgia/ Chronic Fatigue Syndrome
Exercise Protocol

Did you know that fibromyalgia chronic fatigue syndrome requires an additional and separate protocol for exercise?
If you have both fibromyalgia and chronic fatigue syndrome, then you may need to learn how to balance exercise and rest in a more specific way in order to avoid exacerbating pain levels, fatigue and increase of all symptoms. The important point here is to create balance.

People with Fibromyalgia and Chronic Fatigue Syndrome (Myalgic Enchephalomyelitis) can have a greater challenge with exercise due to oxidative stress.With CFS oxidative stress presents a challange

People with Fibromyalgia and Chronic Fatigue Syndrome (Myalgic Enchephalomyelitis) can have a greater challenge with exercise due to oxidative stress. The body is less able to clear free radicals and can suffer with exhaustion, lack of stamina and decrease in immune status.

How is fibromyalgia different from CFS?
Studies show that with fibromyalgia, the initial rise in oxidative stress will begin to decrease as you continue your workout; however, with CFS, prolonged exercise can increase the oxidative stress and the associated pain. This is where you might feel malaise after exercise as well. You can see why it is necessary to start slow and work up with consistency. Having severe M.E. myself, I know it can be done and it does take persistence. 

Be sure to also visit our main article on Chronic Fatigue Syndrome here in the website by referring to the SITEMAP on the navigation bar or accessing the link at the bottom of this article. 

1.Consider supplementation 

Recent scientific studies have shown that Ubiquinol CoQ10 and PQQ supplementation will protect the mitochondria and reduce high levels of oxidative stress.Enhanced Pqq with Ubiquinol CoQ 10

Fortunately, recent scientific studies have shown that Ubiquinol CoQ10 and PQQ supplementation will protect the mitochondria and reduce high levels of oxidative stress. With less mitochondrial fatigue, tolerable exercise can be had by the CFS/ME person.  Please also check the supplement page as I also use PQQ for oxidative stress along with Ubiquinol. 

I recommend the Swanson Enhanced Pqq with Ubiquinol CoQ10 for a good and yet cost effective quality. Another high quality brand is Life Extension at a higher cost usually. These are the two brands we have used and I do believe Swanson is the best in quality and cost, however, if you are already using Co-Q10 Ubiquinol in another brand, that is great, continue doing what works. 

This supplement can be an important element of fibromyalgia chronic fatigue syndrome exercise protocol. Our bodies lose CoQ10 as we age anyway, so it becomes necessary for normal aging and fatigue as well. 50-100 mg per day is a good average dosage, but always speak with your doctor before adding new supplements. 

Because CFS/ME is often related to viral issues or co-infections in the body, the immune system is "working overtime". CFS can actually be more debilitating than fibromyalgia, depending on the pain levels within fibro on any given day. This is simply due to the complex nature of CFS within the immune system. In fact, my preferred reference to this illness is not CFS but rather CFIDS or ME (Chronic Fatigue Immune Deficiency Syndrome OR Myalgic Encephalomyelitis)

If your immune system is constantly fighting both its internal and external environment, it can be more challenging to live, work and exercise with the greater cognitive dysfunction, headaches, allergies, tender lymph nodes and both joint and muscle pain.  Yes, I do get it. However, I want you to be successful. Living myself with M.E, and lyme co-infections, the right approach is essential to making exercise work for us, not against us. 

CFS/ME is a debilitating condition that is both complex and difficult to treat. It is estimated by the CDC that full recovery is rare with only about 5-10% attaining a total remission. And as a person who has attended various treatments for CFS/ME, I know this to be true personally.

Even after long term IV therapy and other holistic type treatments to treat the Epstein Barr virus and co-infections in the blood, I still have CFS/ME. I have found effective ways to work with CFS/ME, yet this is not an overnight process and all of the lifestyle tools come into play even more so here. Visit our supplement page at anytime where we discuss options for immune support. Be sure you are getting enough zinc. This is sometimes overlooked. An additional 20-50 mg. can be helpful with CFS/ME. 


2.Exercise For Fibromyalgia Chronic Fatigue Syndrome

So what are we to do when we fall into that 90-95% category of people who may have ongoing symptoms or cycles of CFS/ME over a lifetime?

First, we must follow the same guidelines and general protocols for building a stronger ‘foundation’ as we have outlined in the fibromyalgia protocol articles here on this website. The idea is to build a stronger core and immune status. After we have created a support system for the immune and nervous system involvement, we can begin to incorporate an exercise program best suited for fibromyalgia chronic fatigue syndrome.

The goal with exercise is to work WITH our bodies and slowly condition over time. This is not a quick process because creating a “heal-thy” lifestyle takes diligence and consistency. The best way to avoid Post Exercise Malaise is to increase both duration and intensity SLOWLY over time and include adequate rest breaks and recovery time in between workouts.

Consistency is more important than every workout being perfect. Suiting up and showing up even on days when we don’t feel like it is where the changes in stamina and discipline will begin to occur.

Exercise sessions may need to be limited to 5-10 minutes at one time. This will increase conditioning and we will maintain consistency. Because the adrenal glands are often compromised in CFS/ME patients, it is essential to address proper care and nutrition for adrenal health (refer to adrenal stress article link at bottom of this page)

3.Exercise Recommendations for Fibromyalgia Chronic Fatigue Syndrome Patients

NOTE: Talk to your doctor before beginning any exercise program.

Mode: Activities of daily living such as cleaning and shopping; Low impact aerobics such as walking, hiking, swimming or cycling; Light stretching only; and Light strength work with supervision if needed.

Fibro-Girl’s Notes: As conditioning increases, using free weights can allow us to work up slowly in pushing weight and intensity. Using free weights requires focus and also allows us to control the "angle" at which we are pushing the weight. This is important, as many machines in the gym or fitness centers, are not fibro appropriate due to the "pushing angle"
Resistance bands can also be used. However, not everyone with fibro will be able to withstand the "pulling" that bands create on various body parts. Stop at any time if strain is felt near or around tender and trigger points of the fibro body.

Intensity: The best exercise intensity for CFS/ME patients is low intensity and low-impact, at least in the beginning. IF post exercise malaise occurs, try not to skip workouts, just go back to a lower intensity and less duration. Please note that I do consider cleaning one of those daily activities that can be harder on the fibro body than structured exercise. Do not determine your ability to exercise on difficulty with cleaning, bending, stopping, starting, etc that is involved there.

Frequency:  3-5 days per week is recommended.

Fibro-Girl’s Notes: Keeping a workout journal is very helpful in staying consistent and tracking our progress. It is very rewarding to see our goals and accomplishments on paper. And, just like in the Summary Protocol for Fibromyalgia, I recommend using a notebook rather than doing this online. Avoid distraction.

Duration: Gradually increase by 5-10 minute intervals when performing any kind of daily activities or low impact exercises. Work up gradually to 30 minute training sessions. A heart rate monitor can be helpful as well.

Exercise to Rest Ratio: CFS/ME may require a 1:3 exercise to rest ratio. This means that in the beginning, exercise for one minute, rest for three. Working up slowly to then increase work mode and decrease rest mode. Always go back to the previous mode if greater fatigue or malaise occurs.

Sample Exercises for Strength Training

  • wall pushups
  • resistance bands (avoid tender point areas of the body)
  • body weight exercises using ROM, Range of Motion, with arms and legs.
  • Free weights (start with lowest weight, 1-2-3-4-5 pounds and so on)
  • leg press (at gym) light weight
  • supervised Pilates
  • light yoga but not full sessions (this means we incorporate yoga moves into the workout. A 60-90-minute class of yoga exclusively will be too much for the fibro/CFS/ME client.

    NOTE: When working with a trainer or physical therapist, be sure they are licensed and certified. Ask if they understand the complexity of working with a FMS/CFS/ME client. Instead of signing up for a session package, ask for 1-2 sessions first to see if they are a good fit for you and your condition. 

    Be sure to follow me on the fitness page Fibro Fit People for ongoing suggestions and information on safe and effective exercise. Lisa. 


Additional links to articles that will aid in greater success:



Before you leave, my sitemap can provide you with a "God's-eye" view of this website laid out in  "outline format".  It shows the titles of the major sections as well as subpages in an easy to understand manner AND each entry is a link to the respective page.  Click on this link, sitemap, and read one more page before you go. 

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