Yoga for Chronic Fatigue Syndrome

Exercise is one of the toughest things to take on when you have chronic fatigue syndrome (ME/CFS). A primary symptom is post-exertional malaise, which is an abnormal and extreme reaction to small amounts of exercise. Symptoms can be severe and include a massive increase in fatigue, pain, cognitive dysfunction, flu-like symptoms and more.

For some people, it takes an incredibly small amount of exertion to trigger post-exertional malaise. The sickest people may not be able to sit up in bed for very long. Some people may be able to walk a few blocks. However, others may be able to tolerate significantly more activity. It's important for each person with this disease to understand and stick to their limits.

At the same time, we know that not exercising causes its own set of problems, from stiffness and joint pain to increased risk of a heart attack.

The benefits of yoga, in general, include loosening up muscles, joints, and connective tissues, and improving strength and balance. But is it right for ME/CFS, with post-exertional malaise plus other problematic symptoms such as dizziness and muscle pain? We don't have a lot of research on yoga for ME/CFS, but what we do have suggests that it just might be – at least in some cases, and when done a certain way.

Keep in mind that research is extremely limited and that no treatment is right for everyone. Always check with your healthcare provider to make sure any exercise regimen you attempt is safe for you. It's also essential for you to pay attention to the signals your body gives you and tailor your activity level appropriately.

Yoga: Special Considerations for ME/CFS

In a typical yoga session, people do poses in multiple positions: sitting, standing, lying down. Some poses push the limits of balance and strength. Some forms of yoga include a lot of movement and provide a cardiovascular workout.

Anyone who knows much about ME/CFS can see potential problems there, beyond just the fact that it takes energy:

• Orthostatic intolerance (OI), which causes dizziness when you first stand up, could make it dangerous to do poses in which it's hard to balance;
• OI can also make it a bad idea to go from sitting to standing during a session;
• If your illness has led to deconditioning (a physical and/or psychological reduction in function), which it frequently does, it can make it hard to get down on the floor and get back up again;
• The more energy you spend moving and changing position between poses the more likely you are to trigger post-exertional malaise;
• Complicated instructions can be hard to follow due to cognitive dysfunction;
• Cognitive dysfunction can make it difficult to remember a routine or the proper way to do a pose.

All this means that a yoga regimen for people with this disease would have to specifically tailored to the condition. Because every case of ME/CFS is unique, with symptoms and severities that vary widely, it would need to be further tailored to the individual.

In the study below, researchers took all of this into account.

Isometric Yoga for ME/CFS

In a study published in 2014 (Oka), Japanese researchers set out to see whether yoga would help people with ME/CFS that was resistant to conventional treatments. First, they had to design a yoga routine that would work for someone with the condition.

After consulting with yoga experts, they settled on isometric yoga, which is done in a stationary position and primarily involves flexing of the muscles while maintaining a position. They say a benefit of isometric yoga was that participants could flex more or less depending on their individual abilities.

Researchers also wanted the regimen to help counter deconditioning while keeping it simple and easy to follow.

The yoga program they designed included six poses which were all done while sitting in a chair. Patients met one-on-one with an experienced instructor. Music, which is commonly used in yoga sessions, was not allowed due to the possibility of noise sensitivity. The 20-minute program was modified on an individual basis, such as by skipping a pose that caused pain or doing fewer repetitions due to more severe fatigue.

Exercise studies of sick populations can be problematic, especially when exercise intolerance is a major part of the disease in question. That meant that study participants had to be carefully selected.

Subjects were chosen based on the Fukuda diagnostic criteria, then further narrowed down to those who hadn't responded well to conventional treatments. To ensure that they were able to take part in the study, they had to be able to sit for at least 30 minutes, visit the medical facility every few weeks, and fill out the questionnaire without assistance. Also, they had to be fatigued enough to miss school or work several days a month but not enough to need help with basic activities of daily life. That means these results may not apply to more severe cases.

This was a small study, involving 30 subjects with ME/CFS, 15 of whom did yoga and 15 of whom were given conventional treatments. After the first session, two people said they felt tired. One reported being dizzy. However, these things were not reported after subsequent sessions and none of the participants withdrew.

Researchers say yoga appeared to significantly reduce fatigue. Also, many participants reported feeling warmer and lighter after yoga sessions.

In the end, what we know is that this particular approach to yoga helps people with ME/CFS who are not among the most severely ill. That might not seem like a lot, but it's a start. We can hope that more researchers use this yoga protocol or something similar to replicate the study. If this is a regimen that can improve symptoms without triggering post-exertional malaise, it could be extremely valuable.

Yoga and Related Lifestyle Changes

In 2015, the two-year follow-up to a case study (Yadav) was published that had promising information about yoga and related practices for ME/CFS.

The subject was a 30-year-old man with what researchers describe as "compromised quality of life and altered personality." The intervention program consisted of:

• Yoga postures,
• Breathing exercises,
• Meditation,
• Group discussions,
• Individual advice on stress management,
• Dietary changes,
• Additional physical activity.

He attended six sessions. Two years later, these lifestyle changes appeared to have made considerable improvement in his personality, well-being, anxiety, and illness profile.

So what does this tell us? It worked for one man, but that doesn't mean it would work for everyone. Also, we don't know how much yoga, or any other single element, contributed to his overall improvement. Still, it's often cases like this that lead to further research.

And that sums up the research to date.

What Does it Mean for ME/CFS?

Research on yoga for other conditions shows that it may lessen fatigue, but we don't know if that applies to the unique fatigue states of ME/CFS.

We have more research on yoga for fibromyalgia, which is extremely similar to ME/CFS. For example, one study (Carson) suggests that yoga may increase the stress-hormone cortisol in people with fibromyalgia. Both fibromyalgia and ME/CFS often feature abnormal cortisol function.

Another study (Mithra) showed improvement of physical and psychological symptoms in fibromyalgia as well as several other neurological conditions, including multiple sclerosis, Alzheimer's disease, epilepsy, and stroke. ME/CFS is believed to be, at least in part, neurological.

However, it's impossible to know if the results would be the same for ME/CFS. We don't yet know enough about the common physiology between fibromyalgia and ME/CFS and the specific symptoms it causes to say that what's good for one is good for the other.

Beyond that, we have to rely on anecdotal evidence, which is always a mixed bag when it comes to physical activity and ME/CFS. Some (but not all) healthcare providers recommend yoga and some (but not all) people report success with it.

In the end, it's up to you (with guidance from your health-care team) to determine whether yoga is something you should try.

Getting Started With Yoga

You've got a lot of options when it comes to doing yoga. You can take a class or find a personal instructor, but that's not a good option for many — the exertion of getting there may be too much. However, you can also buy a video or find free ones online, or design your own routine. If you're new to yoga, it may be a better idea to have a class or video so you can benefit from the instructor's knowledge.

No matter where you're doing it, it's best to proceed very slowly. Some simple passive stretching might be the way to start, or you may want to start with just a single pose or two a day. Take your cues from the Japanese research discussed above and see if those poses work for you. Then, if you're confident that it's not making you feel worse, you can start increasing your yoga time.

Rather than making sessions longer, you might try adding a second session to your day. By working in short bursts with long periods of rest in between, you may find you're able to do more without triggering post-exertional malaise.