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How To Exercise If You Have Chronic Fatigue

Managing chronic fatigue syndrome with clinician and researcher Dr. Nancy Klimas.

Key Takeaways

  • Chronic Fatigue Syndrome patients should do very short exercise sessions (1-3 minutes), raising their heart rate no more than 30 beats per minute above their normal baseline.
  • Patients should rest to return heart rate to baseline between these short sessions.
  • Address oxidative stress, inflammation, and cell function to treat ME/CFS.
  • “You can’t rest your way out of this illness.”

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In This Episode

About Dr. Nancy Klimas … 00:05:08
What is Chronic Fatigue Syndrome? … 00:06:07
Is Chronic Fatigue Syndrome a Post-Viral Illness? … 00:07:26
Chronic Fatigue Syndrome Prevalence … 00:09:51
Chronic Fatigue Syndrome Predispositions … 00:10:38
How to Exercise With Chronic Fatigue Syndrome … 00:12:23
Chronic Fatigue Syndrome Treatment Approach … 00:20:46
Chronic Fatigue Syndrome Medications and Treatment … 00:24:58
Natural Anti-Virals … 00:28:40
New Chronic Fatigue Syndrome Research … 00:30:57

Exercise Tips for Chronic Fatigue Syndrome

Physical activity can be very difficult for people with Chronic Fatigue Syndrome. Even a small walk to the bathroom or the mailbox can leave them completely exhausted and bedridden, let alone 30 minutes of exercise.

Dr. Klimas explained that chronic fatigue patients have an extremely low aerobic threshold, and understanding this is key to creating an exercise regime that doesn’t leave them with a chronic fatigue flare up. “They’re much better doing short, but frequent exercise than to try to go longer on endurance.”

Key Exercise Tips:

  • Do short bouts of exercise with adequate rest in between to allow the heart rate to return to your baseline.
  • Keep heart rate within 30 beats per minute of your resting heart rate.
  • Let the patient be the guide.
  • Keep a log to track progress and understand flares.

She said, “You have to find this gentle way of moving them along and doing little short bits that they can tolerate. And then they’ll become more and more confident when they don’t crash, that they can do a little more…”

What is Chronic Fatigue Syndrome?

According to Dr. Klimas, Myalgic Encephalitis/Chronic Fatigue Syndrome (ME/CFS) is an immune-inflammatory condition. It’s diagnosed by:

  • chronic fatigue symptoms for 6 months or more
  • post-exertional fatigue or relapse
  • autonomic nervous system dysfunction, such as postural orthostatic tachycardia or sudden blood pressure changes
  • physical or cognitive difficulties with symptom flares

Symptoms of Chronic Fatigue Syndrome affect approximately 2-3 people in 100, while the related illness, Gulf War Syndrome, affects 1 in 3 people who served in the Gulf War.

Though many people experience fatigue, Dr. Klimas says the defining experience of ME/CFS is that “You can’t rest your way out of this illness… if you take a vacation for two weeks and you’re much, much better, you don’t have this illness.”

Chronic Fatigue Syndrome Causes and Risks

Chronic fatigue syndrome is often associated with viral illnesses, such as Epstein Barr virus, coxsackie virus, cytomegalovirus (CMV) or human herpes virus 6 (HHV-6). But Dr. Klimas said, “it can also happen after any neurological illness, like Lyme…or you were really exposed to pesticides, like farmers or pesticide workers.”

There also appear to be genetic reasons for chronic fatigue. Dr. Klimas noted, “the detoxification pathways are part of the issue of who’s more vulnerable. It partly has to do with how well you can clear and deal with toxins… and then women… have a much more vigorous inflammatory cascade that is triggered more quickly, and they’re more prone to chronic inflammatory illnesses.”

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Chronic Fatigue Treatment & Medication

Dr. Klimas said “There’s no better doctor for an ME/CFS patient or a Gulf War patient than an integrative medicine or functional medicine doctor, because they’re willing to see the big picture.” She noted 3 main areas to focus on for treatment.

Oxidative Stress

“If you don’t fix [oxidative stress], nothing else is going to get fixed… Remember, the brain is the key to this whole illness. It’s great to fix the body, but if you don’t fix the brain, that’s what’s driving most of this illness.”

The key chronic fatigue natural remedies Dr. Klimas uses for oxidative stress are antioxidants:

  • N-Acetyl Cysteine (NAC)
  • Curcumin
  • Intranasal Liposomal Glutathione


“Inflammation is driving most of the suffering having to do with this illness. You can’t really tease apart oxidative stress and inflammation because they’re feeding each other… A lot of the protocols that we’re doing are focused on interrupting the whole inflammatory cascade…”

The key treatments Dr. Klimas uses for inflammation are anti-inflammatory supplements:

  • Curcurmin
  • Mega 3
  • Fish Oil

Improve Cell Function

“The third piece is making the function of the cells work… Nutraceutical approaches can be somewhat helpful here… getting the viruses under control helps quiet immune activation.”

Key treatments Dr. Klimas uses to support cellular function include:

  • Antivirals such as Immunovir (isoprinosine), or herbals like quercetin, monolaurin, or reishi mushrooms.
  • Mitochondria support, such as PQQ, CoQ10 (ubiquinol), NAC, and alpha lipoic acid (ALA).
  • Ensure patients have adequate salt and electrolyte intake.

Researching a Cure for Chronic Fatigue Syndrome

Dr. Klimas’s team has recently been researching new treatment regimes for CFS and Gulf War Illness that might be able to “reboot their system back to its normal homeostatic balance.” The project is moving into human clinical trials once COVID-19 eases up. If successful, this would be a huge win for ME/CFS patients.

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