Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Using Graded Exercise to Get More Energy

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Some doctors may recommend a graded exercise program as part of your treatment plan for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). This type of therapy doesn't work for everyone with ME/CFS. More research is needed to better understand how well this treatment works for ME/CFS.

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.

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 ME/CFS. 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 1 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. 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

  • 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.


ByHealthwise Staff

Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine

E. Gregory Thompson, MD - Internal Medicine

Kathleen Romito, MD - Family Medicine

Specialist Medical Reviewer Martin J. Gabica, MD - Family Medicine

Current as ofNovember 29, 2017