• Amy Sumner

5 Steps to Create Your Own Graded Exercise Therapy Program for Chronic Fatigue Syndrome

Healing from chronic fatigue syndrome (CFS) or fibromyalgia is no easy feat.

Graded exercise therapy is a powerful modality for CFS recovery, and a concept that I believe every person on their recovery journey needs to understand and put into action.

Please watch the whole video or read the entire blog before you start, and get professional help with this if you can. If you have additional severe health concerns or take medications, seek advice from your appropriate health professional before starting.

Graded exercise therapy is a structured way of using exercise as a healing modality to improve cellular function and recover from chronic fatigue syndrome. Essentially, one starts with very low intensity, low volume exercise and would then build this up gradually over time.


  • Increases circulation, which brings more oxygen and nutrients to the cells, while also improving the removal of wastes from the cells.

  • Increases the production of mitochondrial enzymes and can increase mitochondrial replication. Mitochondria are the organelles inside cells that make energy, so by increasing the number of mitochondria we can increase energy production and reduce fatigue.

  • Reduces the perception of pain, increases the creation of new neural connections in the brain and boosts mood through the production of endorphins.

  • Increases muscle strength and function.

Sounds like the perfect remedy for chronic fatigue, right?

Before you get too excited, it’s important to understand that the way we need to approach exercise in CFS is completely different than how most of us would normally exercise.

You may have been very fit and athletic in the past, and learned that in order to get fitter and stronger, you need to work harder and push yourself more.

This is NOT the case if you have CFS.

CFS is a whole different ball game. Pushing yourself is the worst thing you can do, and will actually prevent you getting fitter and stronger.

Being sedentary is unlikely to be a cause of CFS - most people who get CFS are people who have previously been very hard workers, and quite physically active.

That said, being sedentary is a MAJOR maintaining factor of CFS.

If you stay sedentary, your condition will worsen, and it will be harder and harder for you to get moving again.

It’s completely UNFAIR.

And a very difficult cycle to break.

Pain and fatigue make it difficult to exercise. But not exercising creates more ischaemia (lack of oxygenation), oxidative stress and inflammation in the body; leading to more pain and fatigue. So then it’s even harder to exercise. And around we go.

Muscle deconditioning worsens fatigue, because many of our mitochondria are in the muscles. As the muscles decondition, our ability to produce ATP (the energy molecule) reduces, as well as our muscle strength.

Just to add some confusion in here, exercise actually creates inflammation and oxidative stress while you are exercising and for a short period of time after. (This happens in healthy people too, not just those with CFS). Usually, this is actually a good thing.

A small amount of cellular stress triggers glutathione production (an antioxidant that mops up free radicals) and the production of protective proteins. So over time, the cell becomes stronger and more effective. This is what we want to aim for.

The 5 Steps to Creating Your Graded Exercise Therapy Program

1. Reduce oxidative stress and inflammation before you start.

For one month prior to starting your exercise program, focus on reducing your body's oxidative stress and inflammation. Otherwise, your body won't cope with the stress created by exercising.

  • Eat an antioxidant and antiinflammatory diet.

  • Take antioxidant nutrients - Coenzyme-Q10 (CoQ10) and N-acetylcysteine (NAC), as well as magnesium (glycinate or citrate form).

  • Take antiinflammatory herbs - turmeric*, boswellia and ginger. (*Turmeric should not be taken if you are on blood thinners, have a bleeding disorder or are about to have surgery, as it is a mild blood thinner.)

2. Do less than you think you can.

Figure out what amount and type of exercise you could do every single day without feeling any worse afterwards.

Halve it. And that’s all you do.

It’s better to underdo it than to overdo it. Avoid the push and crash cycle at all costs.

This could be extremely minimal - perhaps only 2 push ups a day, or 5 minutes of yoga.


Your mind will struggle to believe that you are doing enough. Find a safe place to start from.

Walking, yin yoga, qi gong, tai chi, stretching and body weight exercises are good options.

3. Be consistent.

Consistency beats intensity. Ideally do the same type, intensity and duration of exercise every day, at the same time every day if you can. If you find that you’re feeling worse than usual, don’t push yourself to doing the full exercise. Ideally, do a little bit of stretching and movement on that day if you can.

4. Keep a record.

Keep a journal and make a daily note of:

  • How you’re feeling emotionally

  • Rate your energy out of 10

  • What exercise you did and for how long

  • Symptoms

  • Sleep, naps

  • Activities and work

Use this record to notice how the exercise is affecting your symptoms, and to draw connections between specific activities and changes in how you feel.

5. Gradually increase over time.

If you have had 2 weeks of doing the same exercise with no worsening of symptoms, you can increase your exercise duration or intensity slightly. No pushing! Keep it in the safe zone.

Eg. You might do 2 minutes of walking every day for 2 weeks, and if that’s ok then you do 3 minutes a day for a week. Then maybe 4 minutes a day for a week.

Start super low. It doesn’t matter if it takes you a year to build up to a ‘normal’ level. The quickest way to climb the mountain to wellness is to take slow and steady small steps, and avoid ever going backwards.

Things that will make you go backwards are pushing too hard with your exercise, eating foods that your body doesn't like, experience emotional distress or anything else that stresses your body.

Do your best to keep your exercise in the Goldilocks zone - not too little and not too much.

If you do feel your symptoms are worsening, scale it back to what you were doing the previous week or just do your stretches for today.

You can do this.

For my two BONUS tips, watch the video from 17:46.

If you need more support with this, please book a consultation with me.

Everyone has different needs and through discussing your case properly, we can figure out the best next steps for you personally, which might also include herbs, dietary changes or supplements.

You can book a free compatibility call here to learn more about how I can help you, or go ahead and book your online consult or in-person consultation now.

You can also email me at

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