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For fatigue patients, caution is advised when it comes to exercise. It doesn't help everyone.

People who are prone to fatigue should pay attention to exercise, it is not a panacea.

Original translation: Longteng Network http://www.ltaaa.cn Please indicate the source when reprinting

This article comes from the supplement ZEIT Doctor Extra "Fatigue, the pathological exhaustion." Fatigue can occur after an infectious disease, but also as a result of cancer or cancer therapy, multiple sclerosis or rheumatism.

At first glance, it seems paradoxical to want to alleviate leaden fatigue with effort. Doesn't that put an additional strain on the body? As late as the 1990s, doctors actually thought so and prescribed strict bed rest to their exhausted patients. But this is wrong: Numerous studies now prove how beneficial regular training is, even for people with fatigue. But be careful: In chronic fatigue syndrome, CFS for short, which is not the result of cancer, multiple sclerosis (MS) or rheumatism, exercise often increases the symptoms. In the following, therefore, it is mainly about patients who benefit from physical activity, and less about people who suffer from CFS.

This article is taken from an article in the Medical Supplement of Time Magazine titled "Fatigue, Sick Fatigue." Fatigue can occur after an infectious disease, or it can occur after cancer or anti-cancer treatment, multiple sclerosis, or rheumatism. Trying to reduce heavy fatigue by doing exercise hard sounds contradictory at first. Doesn't it add an extra burden to the body? Doctors did think so in the 1990s, requiring patients who were tired to stay in bed strictly. But it's wrong to do so: Numerous studies have shown that regularly training yourself to do some exercise is an excellent thing, and it's also true for those who feel tired. But be careful: For people with chronic fatigue, cfS for short, that is, people who are not tired because of cancer, multiple sclerosis or rheumatism, more exercise will aggravate the condition. Therefore, the following is aimed at those who can benefit from exercise, not those with CFS.

For many diseases, sport acts like a universal drug: Those who remain active strengthen the heart and vessels, stimulate the metabolism and keep their brains young. He sleeps better and strengthens the immune system, because active muscles release anti-inflammatory messenger substances. This is especially important for patients with inflammatory diseases such as rheumatoid arthritis and MS. In the case of cancer, it is also known that exercise not only inhibits tumor growth and reduces the risk of relapse. A strengthened body also tolerates the demanding treatment better.

Exercise is a panacea for many diseases: exercise keeps people active, cardiovascular, metabolism, and brain rejuvenation. It improves sleep quality and also strengthens the immune system, as active muscles disperse anti-inflammatory substances. This is especially important for patients with inflammation in the body, such as rheumatoid arthritis and multiple sclerosis. It is well known that for cancer patients, exercise not only curbs tumor growth, but also reduces the chance of recurrence. A strong body can also better withstand a variety of harsh treatments.

Even on a psycho-social level, the positive effect is noticeable. Not only because the training counteracts stress, which alone would be reason enough to get started. The decisive factor is the feeling of regaining more control over one's own body. "Anyone who has the impression that they can do something about their disease themselves will find a better way to deal with it," says the neuroscientist and director of the Cogito Center in Düsseldorf, Iris-Katharina Penner. "For some of those affected, this is too exhausting. But those who get involved can benefit greatly from it." This feeling of self-efficacy prevents anxiety and depression. In addition, many patients experience themselves as more alert, and they can follow conversations better. Instead of falling into bed at eight in the evening, they meet friends more often and can participate more in social life. This improves the quality of life enormously.

Positive effects also lie at the psycho-social level. It's not just that athletic training eliminates stress, it's enough to start training right away. It's more important to let people feel in control of their own body again. Those who think they can achieve some kind of effect in fighting disease can better manage their relationship with the disease. Says Iris Katarina Penner, a neuroscientist and director of the Cogito Center in Düsseldorf. "Those patients do struggle with exercise training, but as long as they are involved, they can benefit from it" This sense of post-exercise achievement can prevent anxiety and depression. In addition, patients also feel that their minds are clearer and their conversations with others are smoother. It is no longer necessary to go to bed on time at eight o'clock in the evening, but to meet friends more frequently and participate in social life more. This greatly improves the quality of life.

But how to start? Sometimes the rehab gives the necessary impetus, as with Julian Ruiz Pontones, who spent a few weeks in a clinic on the Müritz last winter after his chemotherapy. "I was always on the move," says the 67-year-old. "At first I didn't think it was so great because sometimes I'm a bit lazy. But I quickly realized that it was good for me." For others, it is more difficult to get started, which is partly due to the lack of care for those affected in Germany. Doctors often do not know fatigue well enough, which can lead to misdiagnosis, for example if they only suspect a psychological or psychosomatic cause. And there are only a few specialized contact points.

But how do you get started? Sometimes rehabilitation comes with more of the necessary motivation, as in the case of Julian Ruiz-Pontons, who spent a few weeks in a clinic in Miritz after chemotherapy last winter. "I was always exercising and never stopped," says the 67-year-old. "I didn't think much better at first because I was a little lazy sometimes. But I quickly realized that training was good for me" For others, it was difficult at first, mainly due to the lack of attention paid to patients in Germany. Doctors often don't know enough about fatigue, which can lead to misdiagnosis. For example, they will only suspect that it is a psychological or psychosomatic medical cause. And there are very few professional consultation points.

Those who are in treatment or aftercare for cancer, rheumatism or MS usually have more luck, as fatigue is usually familiar to the corresponding specialists. Often, however, patients with their exhaustion go to their family doctor, who may be over-questioned, and sometimes hear that they should go for a run more often. That is of little help. "With fatigue, the movement must be dosed well," says Irene Fischer of the German Fatigue Society. The motto is: challenge yourself without overtaxing yourself. The training should be based on the individual load limits. That means something different for everyone. Each patient has different physical requirements, underlying diseases and preferences, in addition to disease-typical limitations.

Those who have cancer, rheumatism, or multiple sclerosis and are being treated or are receiving follow-up care usually receive more attention because the relevant specialists are generally familiar with this type of fatigue. When these patients ask their family doctor, because the family doctor is so familiar with the condition, the patient occasionally hears from the doctor that they should run more. It doesn't really work. "Exercise must be done in moderation in a state of fatigue," says Irene Fischer of the German Fatigue Association, and the correct slogan should be: There are demands, but not excessive demands. Athletic training should depend on the limits of an individual's abilities. This means that everyone's amount of exercise is different. Each patient has a different physical condition, underlying medical condition and preference, plus case-related limitations.

Thus, fatigue as a concomitant symptom must be distinguished from myalgic encephalomyelitis/CFS. With this clinical picture, the condition of those affected deteriorates enormously after little effort, and they need days or weeks to recover from it. Before these people can think about exercise, doctors and therapists need to try to determine their load limits. On the one hand, the body should be demanded so much that the training is useful and, for example, prevents muscle loss. But not so much that it can cause a "crash".

Fatigue must therefore be distinguished from chronic fatigue syndrome/CFS. Even with a small amount of exercise, the condition can make the patient's condition worse drastically, and it will take them days or weeks to recover. Before these people consider training, doctors and physiotherapists should determine their limits. On the one hand, the body should be able to complete some exercise, which is beneficial for developing training, such as preventing muscle atrophy. But you can't do too much exercise and cause your body to collapse.

For post-Covid patients with fatigue, it is also important to be careful. Doctors at the Charité in Berlin have recently discovered that some severely affected patients receive insufficient oxygen during training, but do not notice this. "Our body usually reacts to such an undersupply. We get palpitations, the pulse races, we breathe faster. With these people, this is not the case. We don't yet know why, but it's dangerous for the nerves and other cells," says Max Emanuel Liebl, senior physician in Physical and Rehabilitative Medicine and one of the authors of the corresponding study. It is important to exclude this silent hypoxia before the start of training.

It is also important to pay attention to patients who have had COVID-19 and are in a state of fatigue. Berlin's Charité Hospital recently discovered that some severely ill COVID-19 patients do not have access to adequate oxygen during training, and they are unaware of this. "Our bodies usually respond back to this lack of oxygen. We will feel palpitations, a quick pulse, and shortness of breath. These people don't want to exercise. We don't yet know why this is the case, but exercise is harmful to these people's nerves and other cells," said Max Emanuel Liebl, senior physician in physical and rehabilitation medicine and one of the authors of the related study. It is necessary to exclude such potential hypoxic patients before training begins.

In MS, in turn, heat can exacerbate symptoms, also known as Uhthoff's phenomenon. Many patients avoid training, especially in the summer. They wonder if they are allowed to do sports at all. "Yes, they are allowed to sweat and also go to their performance limit. The body needs stimuli so that anything can change at all," says psychologist Penner.

On the other hand, in multiple sclerosis, heat exacerbates the condition, which is known as the Uhthoff phenomenon. Many patients avoid exercise, especially in the summer. They want to know if they can actually play sports. "Yes, they can sweat and touch the highest level they can. Psychologist Penner said: "The body needs stimulation, so that there will be fundamental changes."

Experts recommend fatigue patients above all endurance training, three times a week 30 to 40 minutes, in addition to strength training twice a week. Untrained people start with smaller units and work their way up at their own pace, ideally accompanied by a doctor and physiotherapy. Walking movements are optimal because they train the entire body, such as light jogging, fast walking or Nordic walking. But those who prefer cycling or rowing should not be deterred. It is crucial to find something that gives pleasure, otherwise it will be difficult to motivate yourself.

Experts recommend that people with fatigue get endurance training for 30 to 40 minutes three times a week, supplemented by strength training twice a week. Untrained people start in smaller units and gradually improve at their own pace, preferably accompanied by a doctor and physical therapist. Walking sports are the best option because they can train the entire body, such as light jogging, fast walking or Nordic walking. And those who enjoy cycling or boating should keep going. The key is to find something pleasant, otherwise it's hard to have the motivation to do it.

Go for a walk with your dog, even if you don't have one.

Gymnastics, yoga, tai chi and qigong are also good alternatives. When stretching and stretching, the muscles are stressed by gaining and relaxing with little effort. People with reduced mobility can also perform exercises while sitting or lying down. And for MS patients in wheelchairs, the motor-driven motomed motion device is an interesting option. It is similar to an exercise bike: patients perform circular movements on the device with their arms or legs, supported or under their own power.

Take your dog for a walk, even if you don't, gymnastics, yoga, tai chi and qigong are all good choices. When doing stretching and stretching, muscle tension and relaxation do not take much effort. Those who can only do limited exercises can also practice while sitting and lying down. For patients with multiple sclerosis, the lower limb rehabilitation exercise pedal is a good choice. It is similar to a sports bicycle: the patient's arm or leg does a circular motion on the machine, either by support or by his own strength.

In general, everything is better than being idle. Movement units can also be installed in everyday life. The usual thing: walk more often or take the stairs ... Psychologist Fischer recommends her cancer patients, among other things, to use a pedometer. They note the number of steps per day for a week and gradually increase the workload. "The ideal is 10,000 steps per day. If someone starts with 9,000, you can increase it at any time. But if it's only 500, you have to start with less," she says. The goal should be realistic. Nevertheless, it motivates to experience how one's own radius expands step by step. "I always say: Go for a walk with your dog, even if you don't have a dog." Cancer patient Julian Ruiz Pontones also bought a pedometer during his rehab and used it a lot. "I saw how I ran more every day – there was a visible result, and that motivated me a lot."

In general: it's better to do anything than to stand still. You can also find opportunities to exercise at any time in your daily life. In daily life, you can: often go for a walk or climb the steps... Psychologist Fisher also additionally recommends that her cancer patients use pedometers. This allows them to record the number of steps they walk each day for a week and then slowly increase their exercise. "Ideally, it would be ten thousand steps a day. Some people start with 9,000 steps a day and then improve each time. If you can only take 500 steps, you will start with fewer steps. She said. The goals set should be realistic and feasible. It is still very motivating to feel how your ability can be improved step by step. "I always say, "Take your dog for a walk, even if you don't have a dog." Cancer patient Julian Ruiz Pontones also bought himself a pedometer during his recovery and used it regularly. "I see that I walk more and more every day – the effect is visible and it motivates me a lot."

In a diary, patients can also record other activities and note how exhausted they were before and after. Over time, they get to know the factors that influence their fatigue positively or negatively. In the sense of good energy management, you can maintain the good and outsource the less good. "If I know that after an hour of mowing the lawn, I might ask someone next time if they can do it," says psychologist Fischer. Over time, you learn to set priorities, to better divide your forces or to save energy in everyday life. This reserve could be put into physical activity. "Basically, it's about accepting that while you're in a difficult situation, you can try to make the best of it."

Patients can also record other activities in a diary and indicate their level of fatigue before and after each activity. In this way, over time, they have mastered various factors that have a positive or negative impact on fatigue. With good energy management, people can retain good forms of exercise, while those that have little health benefit can be outsourced. "When I know that I'm too tired to do any other exercise all day after weeding, the next time I'll ask someone if he can afford to weed." Slowly people learn to set priorities, better allocate their energy, or save energy in their daily lives. The energy saved can be used in sports activities. "Basically, it's about accepting that even if people are in trouble, they still have to try to be the best."