How to use exercise therapeutically when you have Post-Viral Fatigue Syndrome (PVFS)
People who have PVFS often experience Post-Exertional Malaise (PEM). This is an increase in symptoms following physical activity/exercise, which is usually worse with longer or more physically demanding forms of activity, for example walking fast, running, or climbing stairs.
For this reason, those who have PVFS are often advised to rest, and increasing rest can be helpful. However, there is some conflicting advice online about whether or not to exercise. This is because many people have had bad experiences when attempting exercise, as it can trigger setbacks.
Of course, there are many health benefits associated with physical activity, including improvements in sleep quality, concentration, and mood. Therefore, being able to maintain some activity without triggering setbacks is crucial. Alongside the pacing of activities and other strategies, exercise can be used therapeutically if it is structured carefully. It can also play an important role in supporting recovery from PVFS.
Below, we have outlined the strategies that clients we have worked with have found effective for using exercise in this way.
Please note that when we talk about ‘exercise’ this means any physical activity. Walking is the exercise most commonly chosen at the start of this process.
Tips for getting started with therapeutic exercise:
Use this approach alongside other strategies, such as sleep hygiene and pacing, especially if you experience large ups and downs in symptoms (‘boom-busting’) or you have frequent setbacks.
Find your ‘baseline’: This is an amount of exercise which you can do on 5-6 days of the week, without significant interference with your ability to do what you usually do from day to day. The ‘baseline’ is the number of minutes that the activity can be done for. Setting a baseline is hugely helpful and is often less than people imagine it to be. It can be one continuous form of exercise, or it can be several brief periods of activity during the day. People often start with walking as this is very practical and easy to measure.
Keep the exercise intensity low: Symptoms of PVFS are often triggered by more intense forms of exercise, so keeping the exercise intensity low at first is helpful.
Make it practical and achievable: Choose an activity that fits in easily with your life. Think about the practicalities, for example, are specific clothes or shoes needed and can you wear these or put these in an easily accessible place. Do you need to set a reminder to do it or tell someone you live with about your plans so they can support you?
Make it relevant: Think about how the activity may relate to what is important to you. For example, if you choose walking, what will this help you to be able to do?
Keep the amount you do the same for a week once you have found your baseline. This means that it is not causing significant post-exertional malaise.
Increase the time (not the intensity) you do the exercise for, by about 20%. Some people find increasing by a bit less than this works better. Choose a time to increase when you are not experiencing setbacks.
Manage setbacks: Depending on the cause of the setback, you may need to reduce or stop the exercise. It is important to reflect and identify triggers for the setback and make any appropriate adaptations.
Precautions:
We recommend doing this under the guidance of an appropriately trained Clinician to minimise setbacks and get the most from the process.
How does it work?
There are different theories for this. Using this approach to exercise is about retraining the response of the body’s multiple systems to physical activity, so the person can gradually tolerate more activity. It is likely to impact on the cardiovascular, muscular, and respiratory systems, and adjust how the brain, neural, and immune system responds to physical activity.
Written from the clinical perspective of Vitality360 Specialist Physiotherapist, Emily Tims.
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