A major problem for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) or fibromyalgia (FM) patients is the loss of muscle tone due to inactivity.  The body's muscles help to control the tone of the blood vessels and help regulate blood pressure. For this reason and many others, it is very important to take care of the body's muscles.

ME/CFS patients especially need to find ways to do even the most minimal exercise. Here is the approach recommended by Dr. Nancy Klimas. To start, determine how many minutes you have during a good part of your day to do minimal movement before you start to feel tired. This is the amount of time you will exercise at the beginning. There are two types of exercise: aerobic and strengthening.

Aerobic exercise

Aerobic exercise consists of body movement that increases the heart rate, such as swimming, bicycling, even walking.

Dr. Klimas highly recommends swimming since the water compresses vascular space, thereby encouraging circulation throughout the body. Swimming also cools and prevents overheating.

Your goal is to prevent deconditioning. Start with your minimal, fixed amount of time and do the same exercise every day for two weeks. Don't try to advance the amount of time or push yourself for the first 2 weeks.

After two weeks, add 7 minutes of the exercise at a different time of day. After another two weeks or so, you can begin to exercise a third time a day for another 7 minutes.

When you feel absolutely ready, you can increase the number of minutes in each period, but be flexible. If you're having a relapse, don't make yourself worse by forcing yourself to stick to your schedule. But as soon as you feel better, get back to your program. By sticking with it, over time, you will improve physically.

In six months, you may be able to exercise moderately for 15 minutes, two to three times per day. For many ME/CFS patients this is a rational goal that can be achieved without undue relapsing.

[N.B. Dr. Charles Lapp suggests doing two to five minutes of exercise followed by five minutes of rest instead. His suggestion might be more realistic, given the problems with mitochondrial dysfunction in ME/CFS. See "Mitochondrial Dysfunction, Post-exertional Malaise and ME/CFS" and Dr. Lapp's Exercise Suggestions .—Ed.]

Strengthening with isometric or weightlifting exercise

A major problem for ME/CFS patients is the loss of muscle tone due to inactivity and muscle catabolism from the cytokines involved in an over-activated immune system, especially when fever is present. Strengthening exercises are a very good way to maintain tone, and these exercises are not as difficult for the patient since they require less blood flow and oxygenation.

Moreover, the exercises should only be done every other day.

To start take a one-pound can of soup and do repetitions (biceps curls) with one hand until your arm is a little tired, then stop. Remember how many repetitions you did. Next, move on to the next muscle group and do the same thing.

Rest the next day, since the rest allows the muscle to strengthen. For the first week don't change the number of repetitions. You will need a book of weight exercises to teach you how to progress. Dr. Klimas recommends the FM Survivors Guide by Dr. Mark Pellegrino that outlines an excellent exercise program.

[2015 Note: Recent research conducted at Marquette University indicates that more strength is developed in people over 40 if the weightlifting exercise is done slowly,  holding the weight in place a few seconds, with fewer repetitions.]