Chronic Fatigue Syndrome: Using Graded Exercise to Get More Energy

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You may be thinking, "How can I exercise when I'm so tired I can barely get through the day?" You can do it, as long as you start out very slowly and are careful not to overexert yourself. Most important, it will make you feel better.

Graded exercise starts out slowly and increases in very small steps. If your fatigue is severe, this can mean starting out with 1 minute of gentle movement, like stretching. And it means that you have a plan and you stay with it, even when you're having a good day and feel like doing more. This helps your body make the changes it needs to cope with activity and exercise.

Studies show that light aerobic exercise, such as walking, may help people who have chronic fatigue syndrome (CFS) feel more energetic and less tired. People vary in how much they are helped by this kind of program.footnote 1 Maybe you have avoided it because you're afraid it will make you feel worse. But the opposite is true. Total rest leaves your body in worse shape. It can also hurt your self-image by making you feel as if you can't do anything for yourself.

How can I start an exercise program?

Work with your doctor to make a specific plan for your needs and abilities. But there also are things you can do on your own.

Walking is an excellent form of aerobic exercise for people who have chronic fatigue syndrome. Other gentle exercises, such as stretching, riding a bicycle or stationary bike, or swimming, are also good. Try to find a balance so that you are moving or exercising enough to benefit from it but not so much that you get overtired. Here are some things to think about:

  • Keep a positive attitude toward exercise. Redefine what "exercise" means in terms of what your body can handle. If you're not sure about it, try to put aside your doubts and your worries that it will cause a relapse.
  • Start very slowly. If you have not been very active lately, it is a bad idea to jump into a vigorous exercise program. Start with just a few minutes, or even 1 minute, of very gentle exercise, such as stretching. When you are comfortable with stretching exercises, add very short periods of a mild aerobic activity such as walking or swimming.
  • Increase very gradually. After you know that your body can tolerate this level of exercise over the course of several sessions, increase the length of your exercise session by only 1 minute. Rest often, and build up your exercise intensity a little bit at a time. Try to work up to at least 2½ hours of moderate exercise a week.footnote 2 One way to do this is to be active for at least 10 minutes 3 times a day, 5 days a week.
  • Don't push yourself too hard. You can easily become overtired, which will defeat the purpose of getting your body moving. Sometimes you will not feel the effect of too much exercise until the next day.
  • Take a few days off when you need to. There may be periods of time when stress or other physical activities make exercise too difficult. When this happens, take a little time off. Then try to get back into your exercise routine as soon as possible.
  • Keep track of your exercise on a calendar, or track your progress on a chart.



  1. Brurberg L, et al. (2015). Exercise as treatment for patients with chronic fatigue syndrome. Cochrane Database of Systematic Reviews (2). Accessed February 23, 2016.
  2. U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online:

Other Works Consulted

  • Cleare A, et al. (2015). Chronic fatigue syndrome. BMJ Clinical Evidence, published online September 28, 2015. Accessed February 23, 2016.
  • Togo F, et al. (2010). Sleep is not disrupted by exercise in patients with chronic fatigue syndromes. Medicine and Science in Sports and Exercise, 42(1): 16–22.
  • White PD, et al. (2011). Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): A randomised trial. Lancet, 377(9768): 823–826.


ByHealthwise Staff
Primary Medical ReviewerAnne C. Poinier, MD - Internal Medicine
E. Gregory Thompson, MD - Internal Medicine
Specialist Medical ReviewerMartin J. Gabica, MD - Family Medicine

Current as ofMarch 29, 2016