There is a lot of scepticism around Graded Exercise in the ME/CFS world, perhaps understandably. In the early days (the late 90s and the 00s) Graded Exercise was prescribed by the NHS to ME/CFS sufferers, along with CBT (Cognitive Behavioural Therapy), with the intention of helping lessen the symptoms of sufferers and improve their quality of life. Of course, as most of us know (through your own experience or stories you've heard!).. prescription isn't generally very successful. It's my job to therefore identify why it isn't successful, and how it can be successful, even getting people fully recovered.
From what I've learnt at the clinic where I'm studying, along with several of the latest most in-depth studies and books out there, the reason Graded Exercise is generally unsuccessful is because it is not applied stage specifically, and it also requires for us to have other things in place first before this can be of benefit to us. Have no idea what I mean? Good, let me explain!
1) ...it's really important for us to address the stress side of the illness. (Worth reading my post on MECFS and the role of Emotions for in depth detail!) This condition is extremely stressful for the sufferer, understandably of course! Questions such as 'why me?' 'why am I getting all these unexplained symptoms?' 'will I ever recover?' Even though this is a natural response, it actually puts our already weakened bodies (nervous/immune/hormonal/endocrinal systems) on high alert all the time, and doesn't give our body a chance to start recovering and healing. I was taught at the clinic that we are in either a healing state (allowing yourself to get good quality rest and relaxation), or a stress state (worrying thoughts, anxiety, fear, the world is not safe etc.) The stress state keeps us in a sort of perpetual loop of Fight-or-Flight, and doesn't give our bodies the time to start recovering, because it's always stuck in stress. There are several tools you can adopt to calm this stress response down and start healing. It is beyond the scope of this post to explain each, but I'm happy to list a few ME/CFS specific places which specialise in teaching you these tools. Please comment below if you'd like me to send you links. Once you address these, you're likely to start seeing some changes in how you feel. This is a big reason why Graded Exercise doesn't get the best results often. If we're constantly in the stress/anxiety state about symptoms etc. our body can't heal properly because we're in a stress state rather than a healing state. These kind of leaves our bodies stuck in limbo, unable to push to the next level exercise wise, and when we try to, our body often isn't ready and crashes!
2) ...sorting out the nutritional aspect. THIS IS SO SO IMPORTANT! The physical and cognitive stress of ME/CFS on the body usually leaves us deficient in the vital nutrients we need to make our own energy. I'm not going to go into depth here as I'm not qualified in this field. However, it's absolutely worth seeking professional help here from a nutritionist who specialises in the field of ME/CFS, in order to imbalance out any imbalances i.e. mitochondrial dysfunction etc. I tried to do my own nutritional work and didn't get anywhere for ages! Finding the right person made a massive difference, and meant I didn't need to stress about doing my own research on what would support my recovery nutritionally.
3)...stage specificity. It seems that a majority of people for whom Graded Exercise didn't work weren't in the appropriate stage of recovery for it to have a positive effect. Most of those when diagnosed are really pretty ill. Graded Exercise is the last thing they need. They really need to rest and let their body recover a bit first. Graded Exercise is only usually effective in the latter stages of recovery (perhaps 70% - 100% fully recovered), as this is the point where you can push your body a bit in a sustainable way. It is also important to note here that remaining calm and grounded even in the last 30% of recovery is massively beneficial! Remaining calm whilst doing your exercise is really important. Listening to chillout music, or just being present to your surroundings really helped me in this respect. Anything below the 70% mark and rest/calming your system down is the most sustainable option.
4)...it needs to be graded at the pace your body feels comfortable at. This is again, extremely important. If you try and fight your body, it will just fight back. Take this really slowly. With my Phsyio, I only increase my exercise in small 20% increments every few weeks or so. I make sure I've stabilised at a certain level for at least a week before even considering moving up to the next level.
5) ...simplify your life for now and pace yourself whilst grading your exercise. NOTE - this doesn't mean traditional pacing. This means pacing your days, so that you are listening to your body and giving it rest when it needs rest, rather than running around like a headless chicken! This will really give your body the permission it needs to rest, recover, and strengthen enough to move up to the next level of exercise.
6) ...get the help of a qualified specialist, who specialises in M.E/CFS. Graded Exercise can be an art, which can often require a supervisor :)
By following these principles, I've found Graded Exercise very beneficial, having been doing it for around 4/5 months. I feel stronger, I'm more in control, and I'm moving up to jogging on a daily basis soon. Whoop!!
Adam
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