Chronic Fatigue Syndrome; Therapeutic Management


Chronic Fatigue Syndrome (CFS) is a complex debilitating disorder characterized by overwhelming fatigue and other symptoms. This intense fatigue is medically unexplained and is not relieved by bed rest and may become worse by physical and mental exertion. Chronic fatigue syndrome recently has also been called myalgic encephalomyelitis (ME) and systemic exertion intolerance disease (SEID). Although these disorders share the common major symptoms, there are some variations when they are defined.

A recent review done by Larun, L. et al. (2016), has defined CFS as a medically unexplained persistent fatigue disorder with symptoms that include severe, disabling fatigue, musculoskeletal pain, headaches, sleep disturbances and cognitive disorders like concentration and memory impairments.

Centers for Disease Control and Prevention (CDC) has defined CFS based on the exclusion criteria. To define Chronic fatigue syndrome, there must be two major criteria and four or more of the eight symptoms criteria. They are (CDC case definition):

Major Criteria

  1. The fatigue must be present for at least 6 months which does not improve with bed rest. The condition is disabling the person to perform his daily living activities by at least 50 percent.
  2. Exclusion of other chronic conditions.

Symptoms criteria

  1. Prolonged and profound fatigue (lasting more than 6 months) with the post-exertional malaise that lasts more than 24 hours.
  2. Sleep disturbances or the sleep that is not refreshing
  3. Multiple joint pain (Arthralgia) without any cause and without swelling or redness
  4. Unexplained muscle pain (myalgia)
  5. A frequent and recurrent sore throat
  6. Tender lymph nodes in neck or armpit
  7. Headache, new onset of different nature of pain, severity, and pattern
  8. Significant impairments of short-term memory and/or concentration


Not specific. Various other causes have been cited such as psychological stress, hormonal imbalance, nutritional deficits, immune suppression or disorders, dysfunction of the hypothalamic-pituitary-adrenal axis, chronic infections, psychological stress and negative effects of overtraining.

Physical Therapeutic (PT) management

PT management mostly depends on the findings of the careful assessment. Often deconditioning is the major issue. Similarly, poor posture (postural stress syndrome) and movement adaptive syndrome, that is inefficient movement patterns disabling the activity and quality of movement levels are other major findings. Other common findings are orthostatic hypotension, fluctuating heart rate and blood pressure, anxiety and depression. A physical therapist should consider all of these problems while setting the management goals, outcomes, and interventions.

Unfortunately, no standard treatment protocol has been evidenced or cited. Recent studies have shown Graded exercise therapy (GET) combined with counseling and cognitive behavioral therapy (CBT) as an effective treatment approach. It has shown to improve the intensity of fatigue, overall improvement of malaise, and improvement in physical functions or work impairments. However, GET results are still variable and further research is warranted.

ACSM exercise guideline and other therapeutic management in practice to treat individuals with CFS go in line with the recommendations for Fibromyalgia syndrome. CFS is characterized by overlapping symptoms (about 70%) with fibromyalgia syndrome.

Click here for ACSM exercise guideline and therapeutic management

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