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Article: Finding the right balance of physical activity


Senior Member
I appreciate that this study was essentially a compilation of focus group comments but to that end, its refreshing to read a study about physical activity (not "exercise") where the authors were listening to CFS patients.

The conclusions are amongst the most reasonable to date as well: "Exercise programmes (and the authors were so close to making it through he abstract without using the word "exercise" - I don't think they can help themselves) should be adapted (good), paced (good), and self-managed (better) in accordance with personal preferences and activity levels to be beneficial and empowering for CFS patients."

Now if they could drop the need to call it exercise and emphasize that CFS patients need to be counseled to avoid the crashes associated with too much activity.

Has anyone read the entire article? It is behind an Elsevier paywall.

Patient Educ Couns. 2010 Jun 25. [Epub ahead of print]
Finding the right balance of physical activity A focus group study about experiences among patients with chronic fatigue syndrome.

Larun L, Malterud K.
Research Unit for General Practice, Uni Research, Bergen, Norway; Norwegian Knowledge Centre for the Health Services, Oslo, Norway.

OBJECTIVE: To explore contexts of experiences of physical activity perceived as beneficial or harmful for CFS patients. METHODS: A qualitative study with empirical data from two focus groups with purposive sampling. Mean age was 50, two of ten participants were male, and social demographics varied. Participants were invited to share stories of good as well as bad experiences concerning physical activity. Data were analysed with systematic text condensation. RESULTS:Participants were not averse to physical activity, but specific preconditions would determine how the activity was perceived. Physical activity was experienced as helpful and enjoyable, especially related to leisure activities where flexible and individual adaptation was feasible. Non-customized activity may precipitate set-backs giving patients the impression of losing control and being betrayed by their bodies. Strategies to review energy usage in daily life could adjust expectations, diminish stress load and assist in approaching a more appropriate priority and balance. CONCLUSION: Self-management, body awareness and physical activity of choice combined with facilitation and advice from health care professionals is essential to achieve a positive outcome. PRACTICE IMPLICATIONS: Exercise programmes should be adapted, paced, and self-managed in accordance with personal preferences and activity levels to be beneficial and empowering for CFS patients.



Senior Member
Good pick-up, CBS!

This is E-pub so maybe it'll be free after fully published. Anyone able to get full-access text?


Senior Member
Long Beach, CA
The word exercise doesn't grate on me in this as much a the word "perceived." I know they tend to use it with self-reported data, but it has that "all in their heads" connotation for me. I "perceived" that the physical activity left me bedridden for a week...


Ormond Beach, Fl
The biggest problem with activity for me is while I am doing the activity my body does not warn me to quit. By the time I am aware I am doing too much it is too late. I must quit when I still feel like I can do more. If I am able to walk I count my steps and try to gradually increase the number but I frequently misjudge and have a relapse.


Senior Member
I just read it. It's an easy read in terms of there being no statistics or science. Although the lack of science is a bit of a problem as the authors make it sound at one point that patients do the same level of activity as leisure and see that as not a problem but if it is more formal or is a chore, they complain about it.

I could certainly relate to the patients' experiences.

I have problems with the authors' interpretations.
(from Introduction - how they set the stage)
The authors', a physiotherapist (=physical therapist) and GP, think patients can improve themselves by exercise and come from this perspective throughout:
Patients suffering from CFS perceive greater fatigue compared with a normal population after physical exercise [15]. It is still unclear whether
symptoms following physical activity are caused by the condition itself, long-term inactivity, maladaptive illness beliefs or psycho-logical distress [16,17]. It has been suggested that beliefs about
avoidance of exercise and activity reported among CFS patients are due to an increased interoceptive sensitivity (awareness of visceral or proprioceptive signals) for activity [18–20].

From Discussion:

While the avoidance of exercise may be caused by beliefs that exercise is damaging or could exacerbate illness [17], appropriate physical activity may help breaking the vicious circle maintaining symptoms of sustained arousal and adjust stimulus and expectation responses in CFS patients [26]. This contradicts the arguments from patient organisations that physical activity is contra productive for this patient group [12,13]. Clearly the need to find the right balance between exercise and rest is as important for people with disabilities as it is for elite athletes and in both groups over exercising, relative to capacity, can produce a negative effect [27].

From Conclusion:
Bodily phenomena following set- backs (‘push-crash’ or ‘boom-bust’) give patients a strong feeling of losing control. In order to build confidence and trust, a treatment program enhancing the patient’s body awareness may therefore provide empowerment by breaking the vicious circle maintaining symptoms of sustained arousal and adjusting stimulus and expectation responses.
I'm not convinced that expectation responses are a major problem. I was undiagnosed for over 5 years and didn't expect many symptoms I had. Other people have told me similar things.