How to Build Up Your Tolerance to Post-Exercise Malaise

by Stephanie Brail

While this article is intended primarily for people with chronic fatigue syndrome, it might also be helpful to anyone who is struggling with severe fatigue after exercise or physical exertion.

What often separates a person who has symptoms of fatigue, versus someone who has full-blown chronic fatigue syndrome, is the phenomenon known as “post-exercise malaise.” Post-exercise malaise (also known as post-exertional malaise) is one of the key symptoms of chronic fatigue syndrome that is used to diagnose the illness. It is characterized by severe fatigue and the worsening of other symptoms for the days following the exertion.

For most people with chronic fatigue syndrome, this translates into the following: When you try to exercise, you end up back in bed with your symptoms aggravated for a day, if not more. In some cases, too much exertion can cause a severe chronic fatigue flare-up or relapse.

Post-exercise malaise is a particularly frustrating symptom, because what people will often tell you when you are tired is that you just need to go out and exercise to increase your energy. Well, if you do that while you are undergoing the throes of acute chronic fatigue syndrome, you are likely to make yourself worse.

For myself, I found that exercise made me sicker, especially when I was at the height of my illness. Strangely enough, however, I found that exercise also helped me get better. A paradox? Perhaps.

What I found is the following: Exercise is extremely tough to do when you are sick with chronic fatigue syndrome, and it will definitely make your symptoms worse. But – and here’s the important but – if you bite the bullet and exercise, especially once you are feeling a little better – exercise will put that chronic fatigue syndrome into remission – or at least make it more manageable.

Unfortunately, we have a chicken and egg problem here. You’re not feeling well, so you can’t exercise, even though exercise might make you feel well enough to exercise.

Here’s what to do: You must build up your tolerance to exercise.

The key point here is the concept of “building up tolerance.” You’ll often hear the phrase used when discussing drinking. For example, if someone builds up a tolerance to alcohol, they need to drink more than they used to in order to get drunk. Tolerance to alcohol increases the more you drink. Likewise, tolerance to exercise builds up the more you exercise. Once you start building up your tolerance to exercise, you will need to exercise more strenuously to get post-exercise malaise the next day.

Here’s how I did it. I really wanted to learn how to rollerblade, so I bought a pair of inline skates. I happened to live in Venice Beach at the time and the boardwalk was down at the end of my street. At first, I was only able to skate a few blocks along the bike path before I’d get really tired and have to come home.

The next day, I would be beat and have to sleep much of the day.

A few days later, I would go again. Once again, I would have to schedule in extra rest the day or two after.

After a while, I found that I could skate farther and farther during the exercise session. Over time, the amount of rest I needed the following day lessened.

Eventually, I was able to skate from Venice Beach up to the tip Malibu and back, which was probably a good six miles or so.

During the time, I was also practicing gentle yoga, which also made a huge difference.

Now, I don’t want to make this sound like it was easy. It was not. It took a few years before I really got stronger. Eventually, I became strong enough to learn how to surf, which is one of the most physically strenuous sports there is. If you think that meant I was completely over my post-exercise malaise, think again. Each time I went surfing, I would plan on having at least a two-hour mid-day nap the following day.

There’s a huge difference between a two-hour nap and a two-day chronic fatigue relapse, however. I am more than willing to pay the price of a two-hour nap in order to be able to exercise, because exercise gives me more energy and makes me stronger and healthier.

It is important to remember that you should never try to exercise when your symptoms are flaring up to the point where you are weak and bedridden. You will need to heal a little first before attempting physical activity. Cardio workouts were the hardest for me. Doing some light weights or gentle yoga may be the best thing to start with before cardio. Take it really easy, and don’t push yourself when you are feeling sick. Even now I will not exercise when I have a cold or any sort of flu-like symptom. At best I might walk or do a little bit of yoga stretching.

Walking is one of the best forms of exercise and perfect for someone with chronic fatigue who needs physical activity. You will also get the benefit of sunlight, which in small doses can be good for you, especially if you’ve been inside and in bed a lot. Start with short walks if you are very weak and build up from there. After some time, you will see a positive difference. Be patient with yourself.

Now I can go to the gym or a yoga class and not feel it the next day. Still, to this day I will often plan in naps the day after I have performed a particularly strenuous physical activity. These naps, however, are not debilitating or a huge inconvenience, thanks to my flexible schedule.

Please note that I have had to carefully structure my lifestyle to allow myself the ability to listen to my body’s needs. Working a day job is rarely the right thing to do for a person with active chronic fatigue syndrome. It can be done, but it probably won’t help you heal in the long run.

In order to truly conquer your post-exercise malaise, you will need the time to put in the exercise and then allow for downtime the following days to recover. It may not seem like it is worth it at first, but trust me, it is.

As always, check with your doctor before starting any major exercise program when you are having health issues.