Article compliments of Personal Training on the Net. Imagine waking up every morning more tired than you were before you went to bed. The very simple act of getting out of bed drains you, never mind the idea of work. As the day draws on, so does your fatigue, and with it an increased soreness in your muscles and joints that you cannot trace to a particular activity. Completing everyday work and home tasks prove to be challenging when you lack the energy and mental focus to concentrate. Considering these symptoms, your physician still insists that you exercise to help alleviate your exhaustion and muscle soreness.
This is just a simplified example of what a person with Chronic Fatigue Syndrome (CFS) endures. Every day is a struggle as the CFS patient contends with low energy, exhaustion and muscular pain untraceable to any activity they did. Exercise sounds like an unthinkable task. But since physical activity has been known to improve energy levels and strengthen the musculoskeletal system, afflicted patients cannot go without it. Our responsibility and challenge as fitness professionals is to guide and empower these clients with an exercise program individualized for their needs and goals.
Training clients with CFS poses many challenges. As personal trainers, we can typically rely on our judgment in determining just how far to push our clients, but in this case, CFS sufferers are often the best judge of their own exertion levels and threshold. A comfortable training environment and consistent communication between the client and fitness professional are the foundations to success in this population. Provide constant encouragement and reminders of progress. Struggling with a workout they breezed through a week ago will take a toll on their motivation to continue exercising regularly. Keep in mind principles of proper progression and increased work load for designing an exercise program, but be flexible enough to modify exercises and even improvise, depending on what the client communicates.
Goals and Fitness Assessments
The first item to discuss is setting reasonable, yet challenging goals. Weight loss and increased energy levels are common goals to CFS patients, but again, depending on the severity of an individual’s condition, weight loss and more energy may be long term goals as it is often difficult to see noticeable results within the first several weeks of training. Being the expert in fitness goal setting, redirect the CFS client’s concept of progress to other equally important fitness milestones. Improvements in balance, flexibility, posture, strength and endurance are all achievements as they help improve the ability to complete everyday physical activities like walking, standing tall, carrying heavy objects or climbing a flight of stairs. Set one or two short term goals of making progress in these functional components. Long term goals can be aimed toward reaching a healthy weight and increased energy levels.
Once goals have been set, the new challenge is to make sure fitness assessments are relevant to goals. Extensive quantitative fitness measurements like the step test, a timed mile run and/or a 10RM bench test will be too exhausting for most CFS clients and irrelevant to their needs and goals. In fact, most measurable goals and fitness assessments are inappropriate for CFS clients due to the unpredictable nature of their symptoms. Be creative in designing fitness tests unique to each individual. Using subjective measurements such as the rate of perceived exertion scale along with more objective assessments like heart rate zone will work well together in determining client progress, but keep in mind subjective measurements will often be more relevant to this population. For this reason, maintaining detailed summaries of individual workouts will serve as a record of progress unique to every client.
The following table lists sample goals and related fitness assessments:
|
Fitness Goal |
Fitness Assessments |
|
Walk a few minutes (i.e., to local bus stop) without exhausting. |
Treadmill test: Walk at comfortable pace for 1-3 minutes. Measure HR and RPE at end. Re-evaluate every 3-4 weeks. |
|
Improve posture so client can stand for one minute without tiring and minimal shoulder, neck and upper back soreness. |
Have client stand so you can observe posture quickly (take note of any postural deviations) and ask him to rank his soreness and exhaustion on a 1-5 scale (1-low, 5-high) from standing for a few seconds. If client is comfortable with pictures, take pictures of client standing at four different angles (front, left and right side, and back), then evaluate images later. Re-evaluate every 3-4 weeks. |
|
Improve energy. |
Energy log/journal: Have client rate energy from day to day on a scale of 1-5 and keep record in exercise program along with estimated average energy levels per week. Lose 20 pounds. Traditional body fat and girth measurements. Before and after pictures. Re-evaluate every 3-6 weeks. |
|
Improve strength and endurance. |
Keep detailed summaries of exercise programs to show client evidence of progress, especially on days they may feel particularly weak and drained. |
Exercise Programming
Like fitness assessments, exercise programming will vary depending on goals and severity of symptoms. It would be unreasonable to expect someone who tires after walking a few minutes to endure an hour long training session. For such clients, aim for 30 minutes of physical activity three to four times a week, focusing on gentle dynamic flexibility and light core stabilization exercises. Basic exercises will help introduce proper form checkpoints like the drawing in maneuver and will help the client increase neuromuscular efficiency through better balance, posture, flexibility and core stabilization. Working to fatigue is not the objective here. Mastering beginner exercises requires a lot of mental focus, energy and integrated strength, so that will be enough of a challenge!
As the client becomes more comfortable with single sets of dynamic and core stabilization exercises, try short bouts of circuits including cardiovascular activity. This will work well with for CFS sufferers who tire after a minute of aerobic activity. Short circuits will promote training in a healthy heart rate zone, prevent boredom and fit a comfortable amount of programming into a 30 minute session. Combining these three types of exercises in a mini-circuit will also make way for improvements in cardiovascular endurance, postural equilibrium and flexibility, all of which will help reduce chronic muscular tightness and provide a foundation for traditional and functional strength work. Strength training should initially emphasize traditional and functional exercises with tubing, bands and stability balls. Using these non-traditional implements for strength training will help further strengthen core muscles that are typically weak in this population.
Be cautious of using free weights as they often put too much stress on already ailing and sore joints. Typical strength training recommendations of high reps and low sets of a single exercise to improve muscular endurance are unreasonable for CFS clients since repeating the same motion will likely over exhaust their muscles and joints. Instead, try different exercises for the same muscle group within the same set. For example, to strengthen chest muscles, complete three to five reps of flys followed by three to five reps of presses using resistance tubing. To strengthen legs, try a few stability ball squat variations, three to five reps each: shallow squats, shallow squats with abduction and shallow squats with adduction.
For a client with mild symptoms, programming may be no different from a traditional exercise prescription designed for a specific goal with exercise sessions lasting anywhere from 30 to 45 minutes. Programming for mildly affected exercisers should focus on similar components: flexibility, core and functional strength. Depending on the client, cardio can be completed within circuits or alone for 10 to 30 consecutive minutes. Regardless of how much activity a client may complete during the course of one training session or how mild his symptoms may be, revert and cycle back to previous workouts emphasizing gentle flexibility and core stabilization. Going back to these exercises will help follow sound periodization and unloading principles, and depending on how a client feels during a particular training session, reverting to earlier programming will be necessary.
Keep in mind the individual with CFS is often the best judge of his own exertion and comfort level with an exercise, and even though he may feel comfortable and strong enough to complete an exercise during one training session, his symptoms may be too severe the following session to even mange one single rep! Remember to communicate consistently, improvise reasonably, rely on your expertise and trust the client's judgment.
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