The question of whether people with chronic fatigue syndrome (CFS), also called myalgic encephalomyelitis (ME), should engage in physical exercise remains a subject of intense discussion in the medical community. Recent studies confirm that while carefully managed exercise can benefit some individuals living with CFS, an overly aggressive or poorly supervised approach risks worsening symptoms—a dilemma with high relevance for patients and clinicians in Thailand and worldwide.
Chronic fatigue syndrome is a debilitating condition characterised by overwhelming fatigue that does not improve with rest and is often accompanied by cognitive issues, sleep disturbances, pain, and the hallmark symptom known as post-exertional malaise (PEM), where physical or mental activity provokes a sharp worsening in symptoms, sometimes days after the exertion. According to recent overviews, including the extensive summary on Wikipedia, CFS affects millions globally and is increasingly recognised as a sequela of post-viral illnesses, including long COVID, making up-to-date recommendations especially timely.
Historically, exercise therapy—particularly graded exercise therapy (GET), which incrementally increases physical activity—has been one of the few management options targeting improved function in CFS patients. However, international patient surveys and new medical reviews point to significant concerns: many individuals report harm from exercise regimens that are not carefully tailored to their limits, and recent guidelines, including those from the UK’s National Institute for Health and Care Excellence (NICE) and analyses from the Royal Australian College of General Practitioners (RACGP), now urge greater caution and personalization in using physical activity as a therapeutic tool.
In Thailand, where knowledge of CFS is still developing in both the medical and public spheres, these findings highlight the importance of thoughtful, informed care. The challenge is acute: misdiagnosis and insufficient awareness can lead to inappropriate advice for Thai patients, with social stigma and misunderstanding compounding the physical and psychological burden of the disease.
The highest-quality medical reviews, including a major Cochrane review of eight randomised clinical trials (RCTs) and a 12-study literature review in the European Journal of Clinical Investigation, support the idea that moderate, individually regulated aerobic exercise—such as walking or swimming—can reduce fatigue in some people with CFS in the short term. The typical regimens include 10–15 sessions over four to five months, starting with very low-intensity activity for 5–15 minutes and gradually increasing both the time and effort, provided the patient does not experience a sustained worsening of symptoms.
Notably, the benefits observed in these studies are modest and do not guarantee improvement for all, especially in the long term. Pain, sleep, and quality of life showed little or no change in many studies, and differences compared to cognitive behavioural therapy (CBT) were minimal. The latest guidelines stress a “time-contingent” (fixed schedule) rather than “symptom-contingent” (exercise as tolerated) approach to avoid exacerbation from overexertion. Importantly, severe or prolonged aggravation of symptoms means the exercise load is excessive for that individual.Cochrane Review, European Journal of Clinical Investigation.
Leading medical authorities caution that any activity plan should be set collaboratively with the patient, tailored to their current abilities, and supervised by professionals with experience in CFS/ME. The RACGP guidelines recommend only slow, stepwise increases in duration or intensity—of 10–20% every one to two weeks—and emphasize that any worsening of symptoms should prompt a halt or reduction of activity. The onset of post-exertional malaise may be delayed up to several days, making careful monitoring critical.
Australian clinical guidance and global evidence converge on one message: while exercise is often safe and helpful for many chronic diseases, CFS requires unique care. Even well-intended, professionally guided exercise programs have drawn criticism and caution from patient advocacy groups and clinicians who have seen individuals deteriorate rather than improve if limits are ignored. Some patients, perhaps those with more severe forms or particular vulnerabilities, may find any increase in activity counterproductive.
An exercise program is by no means a cure for CFS. Those living with the disorder in Thailand should also be aware of the high rates of mental health comorbidity—depression and anxiety are common, whether as a result of CFS or as overlapping conditions. Experts recommend treating psychiatric symptoms concurrently, supporting improved self-management and resilience when confronting the uncertainty of CFS.
Direct experience from physical therapists around the world suggests several practical tips: always respect the patient’s baseline, avoid sudden increases in activity, maintain open communication about symptoms, and encourage a variety of physical activities to prevent boredom or overuse. Physical activities as gentle as stretching, deep breathing, and movements that do not strain the body can be included, with walking and light swimming cited frequently in literature as manageable starting points Surrey Physio.
Within the Thai context, the importance of family support and understanding from peers and employers cannot be overstated. For many, particularly women (who are more likely to suffer from CFS), social isolation can be as great a burden as the symptoms themselves. Advocacy for patient-centred care and increased awareness among Thai physicians—the majority of whom may have had limited training on CFS complexities—will be vital to improving outcomes. According to a local university-affiliated physician specializing in complex medical conditions, “The key is to individualize treatment and progress very slowly, emphasising rest periods and honest communication about new or changing symptoms.”
As research continues, ongoing concerns regarding exercise regimens are prompting new studies and shifting official guidelines, notably calling for more inclusive patient voices and describing clearer risk/benefit narratives. Future research may bring more nuanced interventions, potentially integrating emerging findings about immune and metabolic dysfunction in CFS, highlighted in cutting-edge reviews such as those focusing on gut health PubMed - gut health in ME/CFS.
For now, Thais living with chronic fatigue syndrome should consult experienced healthcare professionals before starting any new exercise regimen, and should avoid programmes that do not monitor symptoms closely or that encourage pushing through fatigue “no matter what.” Support groups and advocacy organisations—both in Thailand and internationally—can be indispensable sources of guidance. As clinical understanding evolves, informed self-management and cautious optimism remain the best tools for those looking to maintain quality of life despite this challenging condition.
Practical Recommendation: Thai readers with CFS or caring for someone with the condition are urged to seek out specialist advice, start with very low-intensity, supervised activity if appropriate, monitor for symptom flare-ups, and advocate for greater understanding of CFS in medical and social settings. Heightened public dialogue and research participation will help shape the future of CFS management in Thailand.
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