By Jennifer Green, MS

If you have ever trained or known someone with chronic fatigue syndrome (?CFS?), you know it can be a very difficult and challenging disease for the individual. CFS, also known as chronic fatigue and immune dysfunction syndrome (?CFIDS?), is defined only by its symptoms because of the absence of any known confirming diagnostic criteria. this syndrome is characterized by persistent debilitating fatigue, not relieved by rest, and not accounted for by any specifically identified medical or psychiatric condition.

although the etiology of this syndrome is idiopathic, there are some possible causes, which include viral infection, immunologic dysfunction, abnormal hypothalamic-pituitary-adrenal (?HPA?) axis activity, neutrally mediated hypotension, nutritional deficiency, and profound psychological stress. in addition to fatigue, symptoms of CFS may include frequent sore throats, painful lymph nodes, headache, difficulty with concentration and memory, and a low-grade fever. this syndrome was originally thought to mostly affect well-educated Caucasian women; however, evidence now shows that CFS affects all racial and ethnic groups and both sexes.

A common complaint from individuals with chronic fatigue syndrome is that their fatigue and other symptoms are noticeably worse in the days following any amount of physical exertion. Attempts at exercise conditioning may be frustrated by this circumstance, and a successful exercise prescription needs to respect this occurrence. Despite the increase levels of fatigue on days following an exercise program, overall improvements in symptoms caused by exercise have been reported in people with CFS. Additionally, people who have been educated on the benefits and are encouraged to participate in regular physical activity tend to show significant improvements in functional capacity and quality of life.

Overall, general recommendations regarding exercise programming for individuals with CFS are difficult to make for a variety of reasons, including levels and times of fatigue. However, when creating a program, there are some general guidelines that offer a conservative approach and that take into account some of the unique difficulties and characteristics of working with this population. the first and main consideration is that the goal of the exercise program should be to prevent further deconditioning that could compound the disability of chronic fatigue. As a trainer, you should avoid adopting the traditional model of training aimed at optimizing aerobic capacity, and should instead focus on modest goals of preventing further deconditioning. As a trainer, it is important that you also discuss with your client the possibility of feeling increased fatigue in the first few weeks of the exercise program. by having this conversation with your client; and finding ways to help avoid large levels of fatigue following the program, the greater the chances your client will stick with the program. Exercise should also generally be initiated at very low levels and based on your client?s activity tolerance.

Aerobic exercise should utilize a familiar activity, such as walking that can be started at a low level. If using RPE to measure intensity, it is suggested that clients be at a 9-12 on the Borg scale. Aerobic activity should be done 3-5 days per week and can be done in 1-2 sessions per day. it may be necessary to start with very small increments of time, eventually progressing to 60 minutes per day as tolerated. Just as in any other program, flexibility exercises are suggested to preserve normal range of motion, and strength training should focus on preservation of strength and on muscles that assist in activities of daily living. Strength-training activities that may cause delayed-onset muscle soreness should be avoided. Finally, progression of exercise activity should focus primarily on increasing the duration of moderate-intensity activities as opposed to increasing intensity. Overseeing this progression will be one of the most challenging aspects of training an individual with chronic fatigue syndrome, and clients should be coached to not overexert themselves on days when they are feeling well, and to reduce their exercise intensity when their symptoms are increased.

There are some special considerations when training clients with this condition. CFS is often accompanied by depression. although treating depression is not in the scope of practice for a fitness professional, it is important to be able to recognize the symptoms and know where to refer your client if need be. also, because of the limited understanding regarding the etiology of CFS, some clients may express frustration with the health and medical care communities, which in the past may have been less than sympathetic to their problems. it is important as a health professional that you talk to your client, and be empathetic to what they are feeling during each training session; a supportive and understanding environment is important when creating programs and educating individuals with CFS. Finally, clients with CFS typically plan their day?s activities ahead of time in order to ?budget? their energy levels. it is crucial that you plan your exercise program around these activities, and that you keep open communication between you and your client so that you are aware of any other activities throughout the day that may require using large amounts of energy.

Exercise programming is not only science, but an art form. As a health professional, you must be creative in your exercise programming, not only to accommodate your clients, but also to keep them interested in the program. Trainers must regularly be more than a source of health information, but often act as a counselor, friend, and support system to their clients. it is especially important with not only clients with CFS, but all individuals, that they have a supportive and understanding environment to work in when it comes to fitness.

Sources:

Chronic fatigue syndrome (CFS). (2010). Retrieved April 7, 2011, from cdc.gov/cfs/general/treatment/managing_activity.html

Clapp, L., et al. (1999). Acute effects of thirty minutes of light-intensity, intermittent exercise on patients with chronic fatigue syndrome. Phys Therapy; 79(8), 749-756.

Simmonds, M. J., Ph.D., PT., MCSP., & Derghazarian, T. P. (2009). Muscular dystrophy. in J. L. e. a. Durstine (Ed.), ACSM’s exercise management for persons with chronic diseases and disabilities (3rd ed., p. 306). Champaign, IL: Human Kinetics.

VanNess, J.M., et al. (2000). Exercise testing in patients with chronic fatigue syndrome (CFS)?Diagnostic tool? Fed Amer Soc for Exp Bio J., 14(4), LB41.

Please send any questions or comments to Jennifer Green at Jennifer Green.

this fact sheet was last updated on 04-11-2011.

Please. I need help.

Many men with gonorrhea may have no symptoms at all, some men have some signs or symptoms that appear two to five days after infection. Symptoms can take as long as 30 days to appear. the incubation time varies from 2 to 14 days with most symptoms occurring between days 2 and 5 after being infected from an infected partner. a small number of people may be asymptomatic for up to a year.

Symptoms and signs include a burning sensation when urinating, or a white, yellow, or green discharge from the penis. sometimes men with gonorrhea get painful or swollen testicles. In men, inflammation of the epididymis, prostate and urethral structure can result from untreated gonorrhea.

In both sexes, disseminated gonococcal infection can occur, leading to multiple distant sites of infection which can include the brain, heart and joints. When joints become involved, gonococcal arthritis can develop. Gonococcal arthritis occurs after primary infection of the genitalia, anus, or throat.

If left untreated, serious and permanent damage to the reproduction system can occur. the best treatment is to start an antibiotic regimen with the help of your doctor. Many local health clinics can also help treat gonorrhea. the sooner treatment is started, the less damage will be done.

Good Luck and good Health!

Burning when you urinate is the most common symptom. I don't know why you would want to fight it.

U will feel like u need to pee so bad, but when U get to the bathroom, it will just be a little drop, and sometims blood comes out after the pee. I dont know about how long it takes to fight it, u need 2 go to the clinic though.

GC isn't called the "drip" for nothing–you drip pure pus constantly–it's a classic symptom. but you can not fight this yourself –you need antibiotics AND to be tested for additional STDs–where there is one, there often are many…..

basic symptoms:
-burning / itching sensation
-wear white briefs, if at the end of the day you see greenish or yellowish slimy stuff on your brief.

I had this before, went to the doctor, gave me a shot, and prescribed a certain atibiotic for 2 weeks.

I was well in 1 week but still continued the antibiotic for assurance.

I'M TELLING YOU!
GO SEE a DOCTOR IF YOU DONT WANT IT TO DROP OFF!

Go to the doctor. I don't think something like that will just go away on it's own. on ER the TV show it spread to another part of the body and made the person sick.

go to the doctor. you need meds for this. you can't "fight" without them.

The longer you wait to get treated the worst the disease will get. It could cause you to be sterile and even death.

Fight this disease? Whomever has it, needs to see a doctor and get treated. Check out the website.

menshealth.about.com/od/sexualdis…

I dunno sorry. I just heard that in a system of a down song. It said "Gonorrhea Gononzala" or something like that

Antibiotics should do the trick.