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!