Successful Yoga Therapy for Chronic Fatigue Syndrome

by Ram

Resting in Bed by James McNeill Whistler

Chronic fatigue syndrome (CFS) is a medical condition characterized by persistent and ongoing fatigue, exhaustion, non-restorative sleep, and unexplained muscle and joint pain in an individual who hitherto has been an healthy and active person. The exact cause of CFS is not understood. About one million Americans have CFS and it occurs more often in women. While some clinicians view CFS as a central nervous system disorder, others debate over whether it is a strictly metabolic, infectious or post-infectious, cardiovascular, or psychiatric disorder. The name "chronic fatigue syndrome" itself is so controversial that patient advocacy groups are canvassing for a name change as they feel that the term “CFS” underestimates the seriousness of the condition. Whatever the nature of the disease, however, there is a general agreement that CFS poses genuine threat to the overall wellbeing of the individual. 

The onset of the disease is sudden and is generally accompanied by a flu-like fever. A majority of CFS cases have also been observed in patients who are chronically stressed and struck by an infection. The most common symptoms as declared by CDC Atlanta include:

1. Severe fatigue for more than six consecutive months that is unrelated to exertion, not relieved by rest, and has not stemmed from other known medical conditions
2. Significant reduction in activity levels due to the fatigue
3. Impaired memory
4. Failure to concentrate on a task
5. Prolonged and unexplained exhaustion and malaise
6. Poor quality/unrefreshing/non-restorative sleep
7. Unexplained muscle pain (myalgia)
8. Unexplained joint pain in multiple areas (arthralgia)
9. Recurrent headaches, sore throat and tender lymph nodes
10. Brain fog
11. Difficulty maintaining balance
12. Dizziness
13. Allergies and/or sensitivity to food, odors, noise, chemicals, medications
14. Digestive disturbances
15. Mood swings and panic attacks
16. Light sensitivity

Notice that many of these symptoms are also seen in other disease conditions, including lupus, multiple sclerosis (MS), Lyme disease, hypothyroidism, diabetes, and mononucleosis, among others. It is for this reason that many names have been associated with this disease in different countries, and clinicians are advised to use differential diagnosis before concluding it as CFS.

Depending on the intensity and the gamut of symptoms, patients with CFS either lead painful but relatively normal lives or are totally bed-ridden and unable to care for themselves. Owing to chronic and disabling pain, patients with CFS experience a sudden reduction in physical activity. Since CFS affects people in many different ways, the key to living is treating specific set of symptoms exhibited by the patient and starting on medications to treat the worst symptoms first. Medications include: antidepressants, sleeping pills, pain killers (steroidal or non-steroidal), and narcotics. Therapeutic interventions that can help with CFS pain include: acupuncture, massage, or yoga. 

A recent study Methods and isometric asana poses Isometric yoga improves the fatigue and pain of patients with chronic fatigue syndrome who are resistant to conventional therapy: a randomized, controlled trial describes in detail how yoga is helpful for CFS patients. I was impressed with this study because they modified the yoga sequence to suit the patient needs. In the study, the researchers introduced “Isometric Yoga,” which was developed by Dr. Keishin Kimura, to their patients. In this method, the asanas consist mainly of isometric muscle contractions, which patients are allowed to change depending on their fatigue level (skipping a certain pose or decreasing the number of repetitions of poses, depending on the severity of their fatigue and the pain associated with the pose). Since CFS patients experience a reduced physical flexibility, isometric poses would be easy on the patients, prevent over-stretching and be painless. Most of the poses are sitting poses and in this particular study it was a three-part program:

1. Patients were asked to be aware of their natural breathing for one minute
2. Patients performed six isometric sitting asanas (shown in figure below)
3. Patients practiced abdominal breathing for one minute

Why did the authors choose this modified yoga series? Firstly, because patients with CFS have severe fatigue, they needed to be strengthened with a suitable program that would not leave them totally exhausted. Secondly, since CFS patients experience brain fog with memory lapses, they had to be taught asanas that were simple to do and easy to remember. 

(For more details on the methods and isometric asana poses see Isometric yoga improves the fatigue and pain of patients with chronic fatigue syndrome who are resistant to conventional therapy: a randomized, controlled trial.) 

Eligible participants were randomized into two groups of 15 people to receive either an isometric yoga practice together with conventional pharmacotherapy or just conventional pharmacotherapy alone. The isometric yoga practice consisted of biweekly, 20-minute sessions with a yoga instructor and daily in-home sessions. The intervention period lasted for nearly 9 weeks. All subjects completed the intervention. The results from the 9 weeks program were fascinating. The fatigue score decreased significantly in the patients who did yoga. In addition to the improvement of fatigue, some patients also reported relief from pain. No serious adverse events were noted in the yoga group. Additionally, several of the yoga members reported that they felt warm and light after practicing isometric yoga. Thus, patients with CFS could benefit from isometric yoga as an add-on therapy. 

In addition to the above-mentioned research study, a Yoga Journal article Relief for Chronic Fatigue Through Yoga provides personal accounts of a couple of individuals who describe their harrowing health condition owing to CFS and their recovery primarily through a personalized and modified yoga practice. These stories are not only moving but empowering as well as they describe miraculous recoveries thanks to yoga. These incidents, together with what we have written before in this blog, reinforce the notion that yoga for CFS is therapeutic at all levels.

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Friday Q&A: Chronic Fatigue Syndrome, Part 2

Road by Melina Meza

Q: I find that there are not many yoga teachers with an awareness of yoga practice specifically for Chronic Fatigue Syndrome (CFS). I was diagnosed with CFS 6 months ago and am doing graded exercise therapy, which includes walking. I would love to practice yoga every day, but am lost as to where to begin. Any help would be much appreciated!

A: We received this follow-up inquiry recently from one our readers following an earlier post I did on CFS. Just so everyone out there reading this is on the same page, start by checking out my Nov 5th blog post Chronic Fatigue Syndrome and Yoga.

Now I’ll recap by giving you the Mayo Clinic’s LINK list of CFS symptoms:

“Chronic fatigue syndrome has eight official symptoms, plus the central symptom that gives the condition its name:

•    Fatigue
•    Loss of memory or concentration
•    Sore throat
•    Enlarged lymph nodes in your neck or armpits
•    Unexplained muscle pain
•    Pain that moves from one joint to another without swelling or redness
•    Headache of a new type, pattern or severity
•    Unrefreshing sleep
•    Extreme exhaustion lasting more than 24 hours after physical or mental exercise

And to meet the diagnostic criteria of chronic fatigue syndrome, you must have unexplained, persistent fatigue for six months or more, along with at least four of the above signs and symptoms”

Next, I’ll recap what the folks at the Mayo Clinic have to say about CFS, and explain how I think yoga fits in (in italics):

1. CFS is a condition that does not improve with rest, so gentle yoga movements could help. 
2. Even though the cause is not known, it is theorized that stress may play a role, and yoga is great at reducing the effects of stress.
3. Because the fatigue may worsen with physical or mental activity, a yoga practice for CFS should have several types of practices to take into account the variability of symptoms from day to day.  More on this in a moment!

In addition, I recommend that you read the posts we have done here at YFHA on yoga for pain, yoga for insomnia, and yoga for headaches to get some additional ideas on how to address those symptoms of CFS.

Because our reader mentioned that she has been prescribed “graded exercise therapy,” meaning that the type and intensity of her exercise is slowly and gradually increased, usually in response to how she would be doing from day to day, I would add that such an approach would also have practices that could step things back and down if flares occur. This day-by-day approach to things like walking could be extended to yoga practices as well. And although I mentioned some of these ideas back on Chronic Fatigue Syndrome and Yoga, I am presenting them in a slightly different way today.

On a day when mental fatigue is an issue, longer supported restorative poses would be a good choice, with the easiest of mental focuses, such as simply following your inhales and exhales. A supported Savasana with a recorded yoga nidra might also be appropriate on these days. Remember, conscious relaxation for 10 minutes or for longer times, as in yoga nidra, can provide a different kind of “rest” than typical sleep or napping, which could be beneficial for both physical and mental fatigue.

When increased pain is occurring, gentle yoga practices or restorative practices that don’t aggravate or increase the pain levels while they are being done could keep the body moving and active. The more intense the pain, the more likely restorative poses with a meditation on breath or mantra—so as to remove the “thinking about pain” from the actual experience of pain—should be employed.

As fatigue lessens, you would then start to gradually modify your daily asana practice to slowly and deliberately challenge your endurance, strength and flexibility. If the next day results in more fatigue, you would downgrade your practice to meet the symptoms that are there that day. If all is well, I’d do a few days at a given level of increase in intensity before the next advance of challenge.

Even though the Mayo Clinic only recommends yoga for addressing pain in CFS, as I mentioned above, I think a regular “graded” yoga practice can address many of the symptoms of CFS. And although the research to date is almost non-existent, I hope that the trend towards more research on Yoga and Health will produce more studies to bear out Yoga’s benefit for CFS.

Research Resource: Dr. Timothy McCall lists this study A controlled study of the effect of a mindfulness-based stress reduction technique in women with multiple chemical sensitivity, chronic fatigue syndrome, and fibromyalgia in his 75 Conditions that yoga helps. 

—Baxter

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Chronic Fatigue Syndrome and Yoga

by Baxter

Floating Leaves by Melina Meza

As we once again pass through the man-made time shift that is daylight savings time (ughh!), I always notice a general malaise and sluggishness in many of my students.  The frequency with which my folks report colds and flu goes way up, and the request for longer Savasana at the end of class is a regular phenomenon. But on occasion, a student will report ongoing fatigue that goes way beyond the seasonal shifts or illness exposure of the fall and winter season. Some of these students return from a visit to their doctor with a tentative diagnosis of Chronic Fatigue Syndrome (CFS). 

It is very likely you know someone with this condition. According to a 2003 study in the Annals of Internal Medicine, the prevalence—the total number of cases of a disease in a given population at a specific time—of CFS is 235 per 100,000 people, with women three times more likely to develop CFS than men.

But just being tired a lot does not get you the diagnosis of CFS. The Mayo Clinic defines chronic fatigue syndrome as:

“a complicated disorder characterized by extreme fatigue that can't be explained by any underlying medical condition. The fatigue may worsen with physical or mental activity, but doesn't improve with rest.”

In fact you have to have significant fatigue for at least 6 months, along with 4 of the following other signs or symptoms, according to the Mayo Clinic:

• loss of memory or concentration
• sore throat
• enlarged lymph nodes in your neck or armpit
• unexplained muscle pain
• pain that moves from one joint to another without swelling or redness
• headache of a new type, pattern or severity
• unrefreshing sleep
• extreme exhaustion lasting more than 24 hours after physical or mental exercise

The cause of CFS is still unknown, although there are many theories about how and why it develops, including post-viral infection complication, abnormal immune system function or endocrine system function. And there are no specific tests to “prove” you have CFS, so it is important to rule out other conditions that can be associated with fatigue, like sleep apnea, certain medical conditions (like anemia, diabetes or hypothyroidism) and mental health conditions (like depression and bipolar illness, to name a few). 

Patients with CFS can a lot of variability in their symptoms, with some days better than others, and flares of symptoms can happen with minor increases in activity. However, because the condition does not get better with rest, the recommendations for treatment by your doctor will include medications, physical therapy and lifestyle modifications. Encouragingly, the Mayo Clinic site actually recommends yoga to help manage the pain symptoms of CFS. And although the studies of the effects of yoga for CFS are yet to be done, the Centers for Disease Control does recommend yoga as a part of treatment approach for CFS.

Many of the yoga recommendations I have made for other chronic illness would apply here as well.  Start out slowly, with small, gentle yoga practices, even done in bed. Working with an experienced teacher or yoga therapist initially will give you the greatest chance of gaining benefits from adding yoga to your treatment. Since yoga has been shown in studies to have benefits for stress reduction (an aggravating factor for CFS), and improvements in both endocrine and immune function, systems that can be out of balance in CFS, yoga will likely affect more than just the pain symptoms.

And, as we always advocate here at YFHA, “yoga” implies using as many of the tools of yoga as are appropriate for each individual. If you added in an Ayurvedic perspective, attention to diet and sleep would be included in as well. And on days when a more active physical practice seems daunting or counterproductive, breath work, guided imagery and meditation, including yoga nidra, will allow you to still “practice.” Just the ability to do some sort of practice regularly can give the person with CFS a greater sense of control over their health, which can foster a greater sense of healing and improve their outlook. And as the student progresses to greater levels of ability with the physical poses, which a physical therapist would refer to as “graded exercise,” attendance in a gentle yoga class would be recommended to combat the tendency to social isolation that can often accompanies the lives of those with CFS. Due to the uncertainty of how long CFS may be around, establishing a yoga practice as an ongoing, daily part of your life will have benefits far beyond its effect on only one aspect of your health. 

If any of our readers have personal experiences with the pros and cons of yoga for CFS, please write in and share this valuable information with your fellow YFHA readers. Thanks!

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