TREATMENT DATABASE

Exercise includes any systematic program of body movement that is designed to strengthen, tone, or stretch muscles. It has been an important component of school health programs since the early 1960s when President Kennedy called for a new era of "vigor." Since then, exercise has become a perpetual preoccupation for health-conscious Americans, many of whom incorporate jogging, running, swimming, and regular visits to a health club into busy work schedules.

The three basic types of exercise are aerobic, subaerobic, and anaerobic. Aerobic exercise induces systemic changes. In concrete terms, aerobic exercise is any exercise that lasts at least 12 minutes, involves deep breathing, and uses major muscle groups (thighs and buttocks). Jogging and hiking are examples of aerobic exercise because they affect heart rate and breathing, and utilize major muscle groups.

Subaerobic exercise, such as walking, golfing, nonstrenuous hiking, light weight lifting, and swimming, is what most clinicians mean by "gentle" exercise. All of these can be done without pushing the heart rate past 50% of its maximum capacity. None of these forms of exercise will produce metabolic changes unless the person is out of shape or is ill.

Anaerobic exercise is any form of aerobic exercise that pushes heart rate to its limit. A runner who reaches a point of breathlessness is exercising anaerobically. Metabolic changes induced by anaerobic exercise include increased production of lactic acid (causing burning pain in muscles), lowered ATP production, and decreased dependence on the Krebs cycle.

USES IN ME/CFS: One of the ongoing debates among clinicians, as well as their patients, is whether exercise is good or bad for patients with ME/CFS. The Centers for Disease Control and Prevention (CDC) maintains that patients with ME/CFS need to maintain a steady, low-impact exercise regimen to avoid becoming deconditioned. Some physicians recommend exercise as one of their chief ME/CFS therapies. Other clinicians disagree, noting that exercise is contraindicated in viral illnesses (e.g., poliomyelitis). They point out that exercise intolerance is a hallmark symptom of ME/CFS and that symptoms invariably worsen after any form of exercise.

According to Dr. Charles Lapp, exercise is the proverbial "double-edged sword." On the positive side, people mention that exercise increases their strength and helps keep them mentally alert. It also seems to have beneficial effects on the immune system. Some physicians believe gentle exercise can help reverse some of the immune system malfunction of chronic ME/CFS. Dr. Benjamin Natelson, of the New Jersey CFS Center, points out that natural killer cells decline with inactivity. He contends that with a "very, very gentle training program," immune markers may improve.

On the negative side, single-photon emission computed tomographic (SPECT) scans have shown that in ME/CFS patients who exercise, brain blood volume is reduced one to three days after exercising. In patients who are acutely or seriously ill, this could have profoundly deleterious effects on immune and endocrine system regulation. In patients with ME/CFS, exercise also lowers cortisol levels, which makes it more difficult for the body to control inflammation.

In addition, exercise in this population increases erratic breathing and leads to a rapid progression to anaerobic metabolism, which produces ammonia and lactic acid. (These results are the opposite of what would normally be expected in a healthy population.) Given the results of the Peckerman studies on cardiac insufficiency in ME/CFS patients, it would be quite risky for those who are severely ill to embark on any kind of exercise program.

Treatment rating for Exercise