Trouble at Home: The Value of Family Counseling

Graded Exercise Therapy For Chronic Fatigue Syndrome

Graded exercise therapy is useful for people with chronic fatigue syndrome (CFS), as it helps them slowly become more active again. It's best to participate in graded exercise therapy under the supervision of a physical therapist who customizes the program for each patient and carefully monitors the patient's physical responses. Learn more about what to expect from this type of therapy.

Initial Evaluation

During your first meeting, the physical therapist will establish a baseline of your ability to exercise. This will include an interview about your general activity levels and direct observation of your efforts to achieve a specific exercise goal during the session.

The therapist then can advise you how much exercise to perform on a daily basis until the next session. Depending on the level of your symptoms, you may need to start very slowly. Some patients begin by taking a daily walk that lasts just a few minutes.

The two of you determine together which types of activity you'll focus on. This might include, for example, a short bike ride one day and a moderately paced walk the next day.

Ongoing Sessions

Your sessions might be weekly or twice monthly. Between sessions, you are not to increase the amount of exercise you do, even if you feel well and motivated.

At each appointment, the therapist talks with you about your progress and any problems you've encountered. He or she then adds an incremental amount of activity to your schedule. That might involve lengthening the time you exercise each day, or adding a new form of activity.

Intensity also is increased little by little. You might walk at a slightly faster pace for a minute or two, for example, and then walk at your previous pace for a few minutes. 

Eventually, your therapist will determine that you are ready to stop having these sessions and continue to progress without supervision. 

Why It Works

Many people who decide to start an exercise program overdo it relatively quickly. This can lead to a cycle of becoming inactive again and then later attempting another fitness program and overdoing it. CFS patients who approach exercise this way suffer more serious consequences, since trying to become too active too quickly can set them back significantly in their symptoms.

The very slow, incremental pace of graded exercise therapy is why it works. It may seem frustrating sometimes, but having a supervisor in the form of the physical therapist can provide the extra incentive to follow directions precisely.


You likely will feel temporary worsening of some symptoms, at least at first. It's important to understand that this is normal. Even people without CFS can feel tired and achy when they start exercising again after a long period of inactivity. 

Contact your physical therapist if the worsening of symptoms is significant or goes on for more than a couple of days. You may need to cut back on the activity and start from a different baseline.


Graded exercise therapy typically decreases excessive fatigue and improves physical function in CFS patients. In addition, you should experience less chronic muscle and joint pain. You can expect to sleep better and your mood should improve. 

Some of the goals can be entirely practical. For instance, you may want to become able to walk to the grocery store or go swimming with your kids. You may want to plant and tend to a vegetable garden. A therapist, like those at Dynamic Rehabilitation Services, can help you reach these goals with the use of incremental activity steps. 

After you become accustomed to the program -- and especially when you've completed therapy -- you'll have a new sense of empowerment in managing your symptoms and making decisions about how much exercise you can handle.