If you’ve been diagnosed with Chronic Fatigue Syndrome (CFS/ME) or Fibromyalgia, there’s a good chance that you’ve heard the word “exercise” more times than you can count from health professionals. And it can be a daunting feeling - when your body is already in a state of constant fatigue, pain, or fog, the thought of keeping active may feel challenging.
The research is clear: exercise is helpful for you, as long as it’s the right type, at the right time, and introduced in the right way. That’s where we come in. Today, we’re taking a closer look at how physiotherapy-guided movement can support you when you’re managing chronic fatigue syndrome or fibromyalgia.
Understanding Chronic Fatigue Syndrome
Medically referred to as myalgic encephalomyelitis, chronic fatigue is a complex condition characterised by severe, persistent tiredness. It’s often made worse by even small amounts of physical or mental exertion. This isn’t the kind of exhaustion that goes away after rest - it tends to linger and impact your daily life.
Common symptoms include:[1]
- Post-exertional malaise (feeling significantly worse after activity)
- Muscle or joint pain
- Unrefreshing sleep
- Memory issues or “brain fog”
- Dizziness when standing
- Sensitivity to noise or light
For many people, chronic fatigue can be unpredictable - those affected can have good days followed by crashes, like small activities leading to hours or days of worsened symptoms.
What is Fibromyalgia?
Fibromyalgia shares a few overlaps with CFS, but instead of being centred around fatigue, fibromyalgia is mainly characterised by widespread musculoskeletal pain, often accompanied by:[2]
- Persistent fatigue
- Poor sleep
- Memory or concentration issues (cognitive dysfunction)
- Headaches
- Sensitivity to touch, temperature, or pressure
- Psychiatric symptoms such as anxiety and depression
While no single cause of fibromyalgia has been confirmed in the research, what is known is that is related to changes in how the brain and nervous system process pain signals, almost like the volume knob is turned up too high. Many physical and emotional stressors can trigger or worsen symptoms.
Where Does Exercise Fit In?
Exercise can play an important role in the management of both chronic fatigue syndrome and fibromyalgia, but it must be approached with careful consideration and tailored to the person affected. For those with chronic fatigue, one of the defining features is the post-exertional malaise. This makes traditional (unguided, unmodified) exercise recommendations problematic, as pushing through fatigue or following a set progression can lead to significant setbacks.[3]
Instead, current best practices[4] recommend starting with a baseline level of activity that a person can comfortably sustain without triggering symptom flares. This might be as simple as two minutes of light stretching or walking around the house. Once that baseline is stable, increases in activity are made gradually and only when the person feels ready. The focus is not on intensity or performance, but on consistency and symptom management. In fibromyalgia, exercise is considered a core part of treatment because of its potential to reduce widespread pain, improve sleep quality, and support mood and energy regulation. However, because those with fibromyalgia often experience heightened sensitivity to pain and fatigue, movement needs to be introduced in a way that feels safe and manageable. Low-impact aerobic activities, gentle strength training, and mind-body exercises, such as yoga or Pilates, have been shown to be particularly beneficial when introduced at a gradual pace.
Importantly, both conditions require a shift away from the traditional “no pain, no gain” mentality. In these cases, overexertion can exacerbate the very symptoms exercise is intended to alleviate. Instead, pacing strategies, nervous system regulation, and recovery monitoring are all essential tools. This is where exercise plans created together with a physiotherapist can help those affected stay within their energy envelope and avoid the boom-bust cycle of overactivity followed by crashes.
Remember: exercise should never feel like a test of willpower if you have chronic fatigue or fibromyalgia. When done correctly, movement can help regulate your nervous system, reduce pain sensitivity, enhance sleep quality, and boost your mood. But the key is pacing, gradual progression, and listening to your body.
How We Work With You at PhysioCentral
Our experienced physiotherapists maintain strong relationships with clients who have fibromyalgia and chronic fatigue, focusing on keeping you safe and optimising your strength and function for the long term. This is a slow and respectful process - and it's one we guide closely with you.
Here’s what working with us can look like:
1. Starting with where you’re at
We begin with a full understanding of your current capacity, not where you think you “should” be. We conduct thorough assessments to get to know you, understand your current capacity, and measure your progress. We’ll create a comprehensive management plan for you, go through it all, and answer any questions and concerns you may have. It’s important to us that you are fully informed and confident in your management plan.
2. Pacing and energy management
As part of your plan, we’ll teach you how to use pacing strategies, such as the “energy envelope,” which involves staying within your safe energy range to avoid post-exertional crashes. We’ll help you track energy usage, plan your days, and space out activity so your nervous system doesn’t go into overdrive.
3. Gentle movement
When it comes to your movement, we’ll introduce techniques best suited to your circumstances, like:
- Basic floor-based mobility
- Breath-led stretching
- Gentle isometrics
- Somatic awareness exercises to help you reconnect with your body safely
The aim here is to help build confidence in movement again and to teach a range of techniques to help you do it safely. We want you to feel comfortable moving - and to feel confident that you’re making the right decisions for your body.
4. Progressing slowly, as you’re ready
We then monitor your progress and help you progress as you’re ready, not on a predetermined timeline. You should never be pushed into flare-ups, and should avoid comparing your progress with anyone else's, as each person’s symptoms and severity are unique. Remember: your progress is measured not just by physical strength, but by how you feel in your body after movement.
5. Supporting the nervous system
Exercise here isn’t just about strength and movement, but also about calming the system. We’ll incorporate relaxation techniques, breathing patterns, and gentle loading, helping your system trust in your movement abilities.
Research into exercise for both CFS and fibromyalgia has shifted significantly in recent years. It’s no longer about blanket “graded exercise therapy” with fixed increases each week, but rather going at your individual pace, providing collaborative care, and listening to your body and symptoms, not ignoring them. That’s exactly how we work at PhysioCentral.
Book your appointment by calling us at +852 2801 4801 or book online here.
References
[1] https://www.cdc.gov/me-cfs/about/index.html
[2] https://www.ncbi.nlm.nih.gov/books/NBK540974/
[3] https://pmc.ncbi.nlm.nih.gov/articles/PMC6419524/
[4] https://www.racgp.org.au/clinical-resources/clinical-guidelines/handi/handi-interventions/exercise/incremental-physical-activity-for-cfs-me