Q&A – Chronic fatigue

Q. In spring 2005 I was told I probably had Post Viral Fatigue (aka ME and Chronic Fatigue Syndrome). How do I build up my fitness for cycling again?


Q. In spring 2005 I was told I probably had Post Viral Fatigue (aka ME and Chronic Fatigue Syndrome). This followed a period of about nine months during which a stressful time at work was immediately followed by my mother’s illness and death.


I sank into complete exhaustion, was off work for six weeks, and couldn’t even mow the lawn without having to go to bed afterwards. Medical advice was that I should wait for anything up to five years for it to pass. A homeopath helped to get me back on my feet and I’m now able to work and function almost normally except for anything that requires prolonged exertion, such as cycling.

Before the illness I was doing 80 to 100 miles a week with regular rides of 50 or 60 without even noticing it. Now, often I can do 20 miles and be fine, but sometimes I do 12 and sink back into feeling exhausted for a week. I feel great while on the bike, it’s later that it hits me.

On one occasion I extended a 20-mile jaunt to 35 because I felt good, but my energy crashed the next day and it took me two weeks to get over it.

The latest advice is to take graded exercise but no one seems to know what that means other than start by walking to the shops. I love cycling and cannot contemplate not doing it, but if I wait four years my fitness will be down to nothing and I will be 55 so it will be that much harder to build it up again. Any ideas?

Steve, email

A. Sorry to hear of your illness, Steve. As I’m sure you’re aware, Chronic Fatigue Syndrome is not straightforward to diagnose or treat. It’s characterised by a severe, disabling fatigue (both physical and mental), accompanied in varying degrees by other symptoms such as pain and memory, mood and sleep disturbances. Its cause is still unknown, although glandular, genetic and infective hypotheses have all been put forward – the latter in keeping with its onset being triggered by another illness.

Randomised trials of treatment options suggest that graded aerobic exercise and cognitive behavioural therapy are both effective, although you’re right to ask what’graded exercise therapy’actually is, since different studies (all of them with small numbers) used different exercises. What’s right for one individual won’t be right for another, and common sense dictates that if the level of exercise you do wipes you out, it should be decreased initially and built up regularly and slowly.

The situation to avoid is swinging between doing lots and then little due to relapse. It doesn’t have to be walking to the shops – any aerobic exercise (jogging, swimming, cycling) is beneficial. The official Department of Health advice recommends that each exercise programme’should be adapted to physical capability’- very useful, huh? Other treatments are more controversial, though a lack of hard evidence might simply reflect a scarcity of proper studies, rather than out and out ineffectiveness.

A number of common features between CFS and the late stages of Lyme disease (a tick-borne infection) has sparked a debate in the literature regarding the use of long courses of antibiotics. Other suggested treatments include dietary changes and supplements, and even moving to warmer climes.

It’s not possible to reliably judge any of these on the existing evidence, but if you search for’Chronic Fatigue Syndrome’on en.wikipedia.org, you’ll find more than 100 references to help you form your own opinion, along with a useful list of support groups.


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