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Similarly, the goal is to incorporate some level of routine exercise to help maintain general muscle tone, strength and mobility, which goes hand-in-hand with more mindful eating habits. But it is very important to stay within your "energy envelope." Patients with FM but not ME/CFS tend to do reasonably well with an exercise program that approaches that for a healthy person. Patients with ME/CFS tend to relapse (often badly) by trying to follow a healthy person's exercise program.

  • Start out slowly with very gentle types of exercise, increase these in small increments (even a few minutes at time) and rest in between—perhaps start with walking.
  • Most useful types of exercise are those which can improve range of motion, weight bearing, strengthening, stretching, and for ME/CFS and FM patients, in particular, it is generally not recommended to increase heart rate much over 60% of maximum rate.
  • Paying close attention to ergonomics and good body posture is helpful.
  • Exercising in a warm water pool can be reasonably helpful for many, but those with ME/CFS might have problems (including taking hot showers and baths) because the heat could up-regulate the immune system and release cytokines (which is what causes that flu-like feeling). There might also be increased problems with neurally mediated hypotension from this type of exercise and hot showers or baths. Usually, people would be working with a physical therapist or trainer to create a suitable program for their condition. It is extremely important to work with a physical therapist or trainer who understands ME/CFS or FM, since many patients have become more ill after physical therapy by being required to do too much. Joining a standard aquatic program for arthritis might be too much, for instance. Water pressure against the body in itself is thought to help by relieving the pooling of blood in lower limbs.

More options and practices to consider are described under Alternative Therapies.