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.


Have you altered your diet in response to living with chronic fatigue syndrome? While I don't have it, I do struggle with fatigue during the work day (mostly mid afternoon, prime meeting time, not good when you boss busts you for nodding off).

I recently started juicing, cutting carbs, and daily doses of Goji berries, in juice and dried berry form. I really feel a difference! Last week I was able to complete a 3 day, 150 mile bicycle trip with my family through extremely hot and hilly NE Kansas and for once, didn't feel like a Mack truck ran over me at the end of the day...

There is a terrific article about the benefits of Goji berries in the June 2007 issue of Breakthroughs in Health...I was able to purchase it at the Barnes and Noble last week, so it may still be on the stands...

Chronic Fatigue Syndrome, the illness, is not caused by's possibly a combination of genetics and a viral infection. But of course, eating healthier can improve your health no matter if you are sick or not.

For me - and apologies to the vegetarians out there - I need red meat sometimes to get more energy. I tend towards anemia and my acupuncturist recommended it. It can make a huge difference in my energy.

I've been trying to figure out my own fatigue for years and finally got rid of it in no time flat once I knew "the secret". The problem lies with heavy metals. Mercury prevents iron from being absorbed. Mercury is at the heart of candida and all of the problems associated with it. You can (and should) eat organic & healthy foods but it will not reverse the fatigue fully until you remove heavy metals from the body. It's been shown that minerals, even without supplementation, will increase in the body once mercury, cadmium, lead and other toxic metals are removed. Stephanie, we should talk! I also do EFT and while I certainly "cured" my PMS and emotional issues, the things that EFT couldn't permanently get rid of are gone now after effective detox with Natural Cellular Defense. Listen to the recording on my website: I've helped many people in the last year now with CFS and a multitude of other issues.

Have an awesome day!


Hi Sharon,

Thanks for sharing what worked for you. I had a friend who had heavy metal poisoning and she went through a lot to get rid of it and that made a huge difference in her health. The fatigue she had is not the same as chronic fatigue syndrome (CFS), however.

"Fatigue" as a general symptom does not mean you had CFS. I'm not saying that heavy metals are definitely NOT an issue for some people with CFS, but I don't think that's "the answer." The reason why I say this is that I've been around the block a lot in regards to CFS, and I don't think people realize how frustrating it is for PWCs (People with Chronic Fatigue) to be constantly hearing about other people's "miracle cures."

Trust me - most people with CFS have explored multiple solutions to the problem. We also know our bodies best and we know what happened when we got sick. In my case, I clearly became sick from catching mononucleosis. I was fine before that.

I've been told by various well-meaning folks that if I just try "their" cure or their friend's cure then all will be well. This includes mega-doses of vitamins, banning all microwave use, chelation therapy, candida cleansing, you name it.

I know what works for me, and that is a simple program of regular, graded exercise therapy and energy work such as acupuncture. This may or may not be the answer for everyone.

I'm not saying you don't have information that can help people, but I'm suggesting (for you and any PWC who may read this) that what worked for you may not in fact be "the secret" for everyone. CFS is complex (as well as fibromyalgia) and I believe it overlaps with many syndromes such as chemical sensitivity and heavy metal poisoning. There is no "cure all" for all these related syndromes. That's because they may, in fact, be different illnesses entirely.

Thank you for sharing, however.
:-) Stephanie

I like reading everyone’s comments about exercise, recovery, and CFS. I have been battling CFS for about 5 to 6 years and post-exercise malaise has been the defining symptom to my illness. I too feel that exercise is important to recovery even though, that has been said, it is a chicken before the egg dilemma. I've been an active weightlifter since high school (now I'm 30) and began noticing intolerance to this form of exercise. Running was even more debilitating needing days if not weeks sometimes of rest before trying it again. I thought I could cure it by working out harder by getting those endorphins going. I was actually digging myself into the worst rut. Just in the last year or so I've made improvement by leaps and bounds through controlled exercise, diet, supplements, and rest.

I too agree with the dietary restriction that we must stick to in order to remove all variables that could cause ancillary fatigue symptoms. While heavy metals are not good for anyone, PWCFS should eliminate refined/processed foods, all stimulants such as caffeine, eat frequently as they may be more prone to hypoglycemia, and stay hydrated. I found being on Creatine has helped retain water and facilitate my overall well being. PWCFS will all have different supplements and regimes that work for them, but I think that there are some core supplements and diets (as discussed) that we should follow. I found L-Carnitine to be one of those foundations for improved energy and increases tolerance to exercise. Adhering to adequate rest is imperative to recovery. I have also found some things that worked for me but may not work for everyone. Through a dozen doctors I've explored unsuccessfully, the last one I tried before almost giving up believed in CFS prescribed myself Wellbutrin. Wellbutrin is an anti-depressant, but in the case of CFS it helps with overall wellbeing by increasing serotonin production.

The road to recovery is slow because you have to first make changes in your lifestyle to baseline yourself by getting that foundation with diet, exercise, and rest. Then there are vast improvements that can be made with the right supplements. But you should only try one at a time as you can't determine which is making the improvement if you have too many variables and try each for at least a month. I'm confident that I have the right recipe for recovery and even after 6 years of severe symptoms, I know I can get to a livable but not cured state with CFS.

I would like to hear about everyone's paths of treatments....

Working out is the best way to be healthy and keep in shape too. Not taking pills or any treatment that can make you an addict. First a pill that two and so on, and after some time you will find yourself in a drug addiction treatment center trying to get away for a habit that started from nothing.

Sorry but I disagree. I myself cannot function in the work world without the drugs. If I had the leisure of not working I would be able to take care of myself. However I have to eat and I have to have insurance so I work. I have been taking low level narcotics for about 6 years and am not "addicted". I keep my drugs at the lowest possible level, (lower than the doctor perscribes) and I know they are not the answer or a cure, but they are what I have to do right now to get by. Yes I am paying a price for this and my body will pay a higher price later, but any other choice is unacceptable to me at this time.

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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.70-565 | 70-567 | 70-568 | 70-569 | 70-571 | 70-577 | 70-281 | 70-282 | 70-237 | 70-238