Fatigue

Warning
Warning:

This site gives you information NOT medical advice. You should consult your medical practitioner if you have any unexplained symptoms of illness or concerns about treatment. Do not stop a prescribed conventional treatment without consulting a doctor. Tell all the practitioners you're working with, conventional or complementary, about any medicines, remedies, herbs or supplements you are taking or considering using.

What is chronic fatigue?

Tiredness in your mind or your body is normal after you've been working hard. And prolonged stress, whether at work or at home, can lead to unexpected tiredness. Poor sleep will make you feel tired too, of course.

Ordinary tiredness is common. In about 25% of all general practitioner (GP) consultations, patients complain of feeling tired all the time, and it is the main reason for seeing the doctor in 6.5% of consultations. Of those who visit their doctor because of persistent tiredness, fewer than 30% will have an actual disease. About half will have a mainly psychological cause - tiredness is often a symptom of depression. The National Institute for Clinical Excellence (NICE) suggests that perhaps 1 in 250 people in the UK have chronic fatigue syndrome.

Chronic fatigue syndrome (CFS) is a disorder that causes extreme fatigue. This fatigue is not the kind of tired feeling that goes away after you rest. Instead, it lasts a long time and limits ability to do ordinary daily activities.

Symptoms of CFS include fatigue for six months or more and experiencing other problems such as muscle pain, memory problems, headaches, pain in multiple joints, sleep problems, sore throat and tender lymph nodes. Since other illnesses can cause similar symptoms, CFS is hard to diagnose.

The Centres for Disease Control and Prevention in the US say: 'No one knows what causes CFS. It is most common in women in their forties and fifties, but anyone can have it. It can last for years. There is no cure for CFS, so the goal of treatment is to improve symptoms. Medicines may treat pain, sleep disorders and other problems.'

If you have been feeling exhausted for more than six months, and have been able to do a lot less because of this, you should talk to your doctor and consider having some simple tests done. Your GP will want to find out what is making you feel so exhausted. If the test results are normal, you may have chronic fatigue syndrome (CFS). This is sometimes also called myalgic encephalomyelitis (ME), but the name myalgic encephalomyelitis suggests that the brain is inflamed, which isn't actually what happens in most people who have CFS.

In fact CFS does sometimes come on after a viral illness but the reasons why aren't fully understood. Though depression can make people feel achy and tired all the time, not everyone who has CFS is depressed. Many experts believe there are different kinds of CFS, so no single treatment will be suitable for everyone who has it. Most doctors would agree that CFS is hard to diagnose and treat, and that good self-care plays a very important part in recovery.

Other information that might be helpful

Even if you don't have CFS, but often feel tired, this leaflet may offer you some ideas on how to improve your well-being:

When to see your doctor

Immediately:

As soon as you can:

If you have recently started taking new medication, speak to your doctor about whether this might be the cause of your problems.

simplechangesMake Some Simple Changes


pencil Eating a healthy diet

OverviewIt is always important to have a healthy diet. This means a diet that includes enough vitamins and minerals, and plenty of fruit, vegetables and whole grains. Your diet should also be low in fat, sugar and salt. If you have sleep problems, it is better to avoid eating large meals late in the evening, and you should definitely avoid stimulating drinks such as tea, coffee, colas and fizzy 'energy drinks'.

The Food Standards Agency has eight tips for eating well:

1 Base your meals on starchy foods.
2 Eat lots of fruit and vegetables.
3 Eat more fish.
4 Cut down on saturated fat and sugar.
5 Try to eat less salt - no more than 6 g a day.
6 Get active and try to keep to a healthy weight.
7 Drink plenty of water.
8 Don't skip breakfast. It sets you up for the day and it helps get your body and mind going first thing.

pencil Exercise

OverviewBeing active and getting gradually fitter can boost your energy levels. But if you have chronic fatigue syndrome, simply going to the gym or exercising more, without expert help, may make you feel worse. You will need to increase your physical exercise slowly and gradually. Research has shown that regular weekly exercise sessions for people with CFS can reduce fatigue and improve quality of life.

The important thing is to pace yourself. People with CFS have found that pacing themselves (knowing when to stop and rest by paying attention to the body's signals, and not overdoing it) is helpful. On the other hand, it is very important to avoid resting too much, as this can reduce your fitness. You should also try not to get isolated. If you find you aren't managing to do all this, you should definitely get some medical advice.

Avoid exercising immediately before going to bed because it stimulates your heart, brain and muscles, and this is likely to make it harder to get to sleep.
Find out moreSee the attending classes section for some of the types of exercise you can learn at classes.

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simplechanges Breathing Techniques

OverviewSome people who feel stressed or fatigued tend to over-breathe (irregular, shallow, fast breathing, using the upper chest). Breathing like this can increase anxiety, fatigue, lack of stamina and muscle pain. Learning breath-awareness and how to breathe from the diaphragm can help prevent over-breathing. What's more, gentle, slow rhythmic breathing can help trigger the relaxation response. The 'relaxation response' happens when the body and mind do the opposite of what they do when you feel stressed. Breathing exercises and techniques have been used for thousands of years in Eastern health practices and are part of many complementary therapies.

Some things to try include slow diaphragmatic breathing (using the diaphragm to breathe, rather than the rib-cage) and 7/11 breathing (inhaling to a count of 7 and exhaling to a count of 11).
EvidenceTwo small studies of people with chronic fatigue found different results when people with CFS were taught better breathing. More research is needed before we can be sure about its effectiveness.
SafetyBreathing exercises are safe, although some people actually 'over-breathe' when they try this approach. This can make you feel dizzy or tingly when you try to use rhythmic breathing to relax. Not breathing so deeply and breathing more slowly should help. In any breathing exercise you try, aim to breathe out fully and let the in-breath happen naturally.
CostThere are no costs.
Find out moreSee our leaflet on Stress and Anxiety.
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simplechanges Cutting down caffeine

OverviewWhen you feel tired it's tempting to reach for stimulating drinks such as tea, coffee, colas or so-called 'energy drinks'. They can give you a quick lift, but if you rely on them they will only keep you going until your energy stores run down further. They will also stop you sleeping well (and many people with CFS have sleep problems). Generally speaking, when you are 'running on empty', stimulants will only drain your energy further.
EvidenceThere is very little research on the effects of limiting caffeine on people with fatigue. But too much caffeine during the day or late at night can affect sleep. And lack of sleep increases tiredness and fatigue.
SafetyIf you are cutting down on large amounts of caffeine, headaches might be a problem for two or three days. It is better to reduce the amount of caffeine slowly, over a few days.
CostThere are no costs. In fact you will save money.
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simplechanges Cutting down on alcohol and stopping smoking

OverviewWhatever the causes of CFS, it makes good sense to use your body's own healing resources. In fact your recovery depends on them. Since smoking and excessive drinking undermine your overall health (and can affect how tired you feel), there is every reason to cut down on them or, better still, cut them out completely.

Moderate drinking means no more than two drinks a day for men and one drink a day for women. A unit of alcohol is half a pint of ordinary strength beer, lager or cider or a small pub measure (25 ml) of spirits or a standard pub measure (50 ml) of fortified wine such as sherry or port (20% alcohol by volume). A small (125ml) glass of basic wine is 1 and a 1/2 units.
EvidenceThere is little research on the effects of limiting alcohol on fatigue.
SafetyCutting down on smoking and alcohol is safe, but if you are cutting down from heavy use, there can be side effects including loss of appetite and difficulty sleeping. There are unlikely to be side effects if you are cutting down a moderate alcohol intake. If you are a very heavy drinker, it is better to get help from your GP with cutting down.
CostThere are no costs. In fact you will save money.
Find out moreFor more information see the NHS information sensible drinking.

If you are giving up or cutting down on smoking you can order a Quit Kit from SmokefreeNHS. You can also phone the NHS Free Smoking Helpline on 0800 022 4332
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simplechanges Following special diets

OverviewWhile there is no 'magic diet' that works for everyone with CFS, certain diets may help some people feel better and more energetic. Cutting out particular foods has not been found to be generally helpful for people with CFS, but keeping a food diary might help you find out whether certain foods seem to make you feel more tired, or upset your digestion. Write down what you eat and make a note of how you feel a couple of hours afterwards, bearing in mind that you might feel the effects of certain foods some time after you have eaten them.
EvidenceSome people find that certain foods don't agree with them and try to cut out foods to see if they have an allergy or intolerance. This is called an 'exclusion diet'. This sort of diet may help with irritable bowel symptoms such as diarrhoea, constipation or bloating. But there is very little research evidence as to how these diets affect people with fatigue. Some people say that a low-sugar, low-yeast diet helps them, so it may be worth trying this type of diet for two or three weeks.
SafetyIt can be quite difficult to exclude certain foods and still have a balanced diet. If you want to make big changes to what you eat, it is a good idea to see a dietician. They can help you make sure you are still eating a healthy diet and getting all the nutrients you need.
CostEating a healthy diet and excluding some foods need not cost you anything. But if you consult a dietician there will be a charge, unless this is a service provided by your GP's practice.
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simplechanges Meditation

OverviewMeditation is a state of mind, not a religion, though it features in most major religions, especially Eastern ones. Meditation seems to harmonise the activity between the two sides of the frontal brain, and encourages a 'relaxation response'. The relaxation response happens when the body and mind do the opposite of what they do when you feel stressed. In meditation the body is relaxed while the mind is alert. You don't need an experienced teacher or a spiritual faith in order to take up meditation. You can learn the basics from a book or a podcast. Meditation is easily accessible, and it is remarkably effective, both for rapid stress reduction and as a way of promoting long-term health.
EvidenceFew studies have looked at whether meditation helps with chronic fatigue. Several studies of mindfulness meditation training suggest that mindfulness meditation might be helpful for CFS.
SafetyThere are generally no safety problems with meditation unless you have a severe or long-standing mental health problem.
CostMeditation involves certain simple techniques which are easily practised at home. There are many books and audio aids available and some people find it useful to join a class initially. Once you have learned how to meditate, there are no ongoing costs.
Find out moreVisit The British Holistic Medical Association for podcasts and leaflets. Also see the information about Yoga in the 'Classes' section.
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simplechanges Relaxation Techniques

OverviewRelaxation techniques generally ask you to focus your attention on breathing or muscle tension, or to focus your thoughts on an image or a memory of feeling calm and peaceful. They can certainly help with some of the problems associated with chronic fatigue, including pain, poor sleep, stress and anxiety.
EvidenceResearch shows that these techniques have some effect on fatigue itself, but not as much as cognitive behavioural therapy (see Psychological therapies).
SafetyThere are no safety problems with relaxation techniques.
CostRelaxation techniques are easily practiced at home. There are many books and audio aids available and some people find it useful to join a class initially.
Find out moreVisit www.bhma.org for podcasts and leaflets. See also the Stress and Anxiety leaflet.
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buysomethingBuy Something


pencil Before You Buy

OverviewFor safe use of over-the-counter medicines, herbal remedies and supplements:

Consult a qualified person (such as a pharmacist) before buying or taking any medicine, remedy or supplement:
- if you have a serious medical condition
- if you are breast-feeding, pregnant or planning to become pregnant
- if you are already taking other medicines, herbal remedies or supplements
- if you suffer from allergies

Always read the package insert before taking any product.
Avoid taking the product if you think you may be allergic to any of the ingredients.
Do not combine any over-the-counter medicines, remedies or supplements with other medicines, remedies or supplements unless you have first checked with a qualified person (such as the pharmacist in your local chemist).

Seek advice from your doctor or pharmacist:
- If your symptoms do not get better
- if your symptoms get worse
- if you get new symptoms or have a side effect

The information here, including dosages, only applies to adults (over 16 years). Keep all medicines out of the reach of children.

pencil Food supplements and Herbal Remedies

OverviewMany modern drugs started as medicinal plants and people have been using herbs to treat illnesses for thousand of years. We think these 'natural medicines' work by improving the functioning of the nerves, muscles, brain and digestion.

pencil Over-the-counter medicines

OverviewThere are no standard medicines, which you can buy from a chemist without a prescription, that are likely to help with fatigue. Mild painkillers may help with pain but should only be used for a short time (see our leaflet on Sore Muscles).

pencilTreatment Options:


buysomething Evening primrose oil (EPO)

OverviewEvening primrose is a yellow, flowering plant that blooms in the evening. It contains gamma-linolenic acid (GLA), an omega-6 essential fatty acid required by the body for growth and development. The body can't make GLA so we need to get it from our food.
EvidenceTwo small studies showed different results so it is not clear whether evening primrose oil is helpful for fatigue.
SafetyEPO is generally safe in recommended doses. Reported side-effects are rare and mild. Stomach pain and loose stools may mean you are taking too much.

If you get seizures (e.g. epileptic fits) be careful with omega-6 supplements such as EPO. They may make seizures more likely. EPO should be taken cautiously if you have bleeding problems or a blood disorder.
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buysomething Ginseng

OverviewGinseng is a plant whose root is traditionally used as a tonic in some Eastern cultures. According to traditional Chinese medicine, different types of ginseng have different healing properties. Chinese (and Korean) ginseng is said to help the body fight stress, boost energy and activate the immune system. According to herbalists, these herbs are powerful. It is therefore recommended that, when taking ginseng for CFS, you start off with half the manufacturer's recommended dose.
EvidenceGinseng has been found to be helpful in treating fatigue in people with medical conditions such as cancer. However, research on the use of ginseng for CFS found it did not have any effect.
SafetyCorrect dosage is probably an important factor in using ginseng. The more fatigued you are, the less likely that higher doses will be helpful, and they may even be too stimulating.

Do not use Chinese ginseng if you have high blood pressure, or heart disease. If caffeine and other stimulants affect you easily, consult a qualified herbalist before using ginseng.
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buysomething L-carnitine

OverviewL-carnitine is a non-essential amino acid (one of the building blocks of protein) that is made in the body. It increases the use of fat as an energy source by transporting fatty acids into the mitochondria (part of the body's cells), where they are 'burned' to release energy for body functions. L-carnitine is found naturally in avocados, breast milk, dairy products, red meats (lamb and beef), and tempeh (a fermented soybean product).
EvidenceTwo studies on l-carnitine supplements suggest that they might help older people with fatigue. Two other small studies suggest a possible benefit for people with chronic fatigue but they were not well-designed studies.
SafetyL-carnitine may interfere with the efficiency of certain medications, including some medications for cancer and HIV. There is also some evidence to suggest that people who experience seizures should not use l-carnitine as well as people with thyroid problems. Speak to your doctor before using l-carnitine.
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buysomething NADH (nicotinamide adenine dinucleotide)

OverviewNADH is one of several nutrients known to stimulate the brain. NADH is found in meat, fish and poultry, but hardly at all in fruits and vegetables.
EvidenceTwo studies suggest that NADH might help people with CFS, although the relatively small number of people involved in these studies makes the results uncertain. A more recent study only found a possible effect on reducing anxiety.
SafetyThe usual dose of 2.5 or 5 mg of NADH seldom causes side-effects. Higher dosages can make you feel 'hyped up' and may disturb your sleep or make you feel anxious. As more people try taking NADH, it is likely that more side-effects will be noted.
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buysomething Vitamins and minerals

OverviewMany of us don't eat a properly balanced diet with all the right vitamins and minerals. A lot of people take a multivitamin supplement each day because they think it helps. Some people may have chronic fatigue because they lack enough vitamins and minerals, but this is probably quite unusual.

EvidenceThere is some research suggesting that some people have CFS because they are low in vitamins or minerals. However, when researchers have given supplements to people with CFS they have seldom benefited much, so taking supplements doesn't seem to help everyone. There is some suggestion that people with low magnesium levels benefit from supplements.
SafetyTaking vitamin and mineral supplements is generally safe when taken at the recommended dosage. High doses of vitamin and mineral supplements can upset the body and cause side-effects. Get advice if you intend to take large doses.
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attendvisitAttend Classes / Visit Practitioner


attendvisitTreatment Options:


attendvisit Acupuncture

OverviewAcupuncture is a traditional treatment that was first used in China thousands of years ago. Thin needles are inserted into the skin at certain points on the body, which practitioners believe will help restore health. The treatment sometimes also involves heat, pressure, electrical currents or soft-laser light. In the UK, acupuncture is most commonly used for pain relief.
EvidenceResearch from China suggests that acupuncture can be helpful but most studies are not conclusive. In China other treatments, such as herbs, are often given alongside acupuncture.
SafetyAcupuncture is generally safe if practised by a trained acupuncturist. The most common side-effects are slight discomfort (common) and bruising (occasionally).
CostA session may cost £35-£50. Frequency of treatment will depend on you and your practitioner.
Find out moreThe following professional organisations can help you find a qualified practitioner:
Acupuncture Association of Chartered Physiotherapists
British Academy of Western Medical Acupuncture
British Acupuncture Council
British Medical Acupuncture Society
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attendvisit Asian herbal medicine

OverviewPeople have been using herbs as treatments for thousand of years. Many modern drugs started as medicinal plants, and researchers are discovering that many herbal medicines do have powerful healing effects. We don't yet fully understand how they work but perhaps these 'natural medicines' relieve fatigue by improving the functioning of the nerves and brain.
EvidenceResearchers are unsure about the benefits of Chinese and Indian herbal medicine for people with fatigue. The evidence so far is not strong, though some traditional European herbal tonics have long been used to treat fatigue.
SafetyIf you decide to try Chinese and Indian herbal medicine for fatigue, it is important that you consult a member of one of the organisations mentioned below to ensure that the remedies you are prescribed are of good quality.
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Find out moreThe European Herbal and Traditional Practitioners Association is the umbrella body for herbal medicine in the UK. Make sure you see a practitioner who belongs to one of their member organisations.
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attendvisit Graded exercise therapy (GET)

OverviewGraded exercise therapy (GET) uses regular, slowly increasing physical activity (in its broadest sense) to encourage recovery from CFS. You and your physiotherapist can design an effective GET programme together. This programme will take into account your current levels of activity and other important features, such as sleep and the usual ups and downs of CFS. There is encouraging evidence that some patients may benefit from GET and so far there is no evidence that, on average, exercise therapy will make them any worse. However, some patients may prefer other management approaches such as rest or pacing.
EvidenceGraded exercise therapy (GET) is recommended in the NICE guidelines for CFS. But some patients find this treatment less acceptable than other approaches. In surveys, some people said they found GET helpful, while others said it made them feel worse.
SafetyIt is important to start at a level that is suitable for you, even if this is very low. GET programmes must be supervised by a specially trained physiotherapist. If you have not exercised for many months, you will inevitably feel achy once you start again. If your GET is being properly supervised, hurt shouldn't mean harm. Proceed with care and if it hurts a lot, stop and get advice.
CostThere is no cost if you get this type of help through the NHS.
Find out moreYour GP should be able to refer you to a specialist NHS team who work with CFS patients.
It is important to find a qualified physiotherapist to supervise your programme. Ask your GP to recommend one.
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attendvisit Homeopathy

OverviewThe basic principle of homeopathy is that 'like cures like'. Homeopaths use tiny amounts of medicine, which are supposed to jolt the body's self-healing processes into action. Homeopathy has been called 'unscientific' because homeopathic remedies are sometimes diluted (watered down) so many times that no detectable trace of medicine remains.
EvidenceTwo studies have looked at whether homeopathic treatment helps people with chronic fatigue. One of the studies was well designed, both reported some improvements.
SafetyHomeopathic medicines prescribed by trained professionals are safe. Some patients complain of mild worsening of their symptoms at first but this generally only lasts a short time.
CostThe monthly cost will depend on how regularly you receive treatment. A session with a qualified homeopath varies from £20-£50.
Find out more There are a number of professional organisations covering homeopathy:
The British Homeopathic Association
Faculty of Homeopathy
The Society of Homeopaths
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attendvisit Massage

OverviewThere are many different types of massage, some more vigorous and going deeper into the muscles than others. Massage has traditionally been used for relaxation. It may be just on one part of the body (for example, the back and shoulders), or it can be done on the whole body. Aromatherapy massage uses pleasant-smelling essential oils.
EvidenceOne very small trial showed that massage therapy helped with fatigue, pain, sleep problems and low mood.
SafetyMassage is safe if carried out by qualified massage therapists, and it rarely causes problems. Vigorous massage should be avoided if you have blood disorders, some forms of cancer, skin problems or are on blood-thinning medications (such as warfarin). Allergies or skin irritation can occur with some essential oils used in massage.
CostMonthly cost will depend on how regularly you receive treatments.
Find out moreIt is important to find a qualified practitioner such as one registered with
The General Council for Massage Therapies
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attendvisit Osteopathy

OverviewOsteopathy is an established hands-on diagnosis and treatment method, whose main emphasis is on the way the muscles and joints work. Its main feature is that it recognises that pain and disability often stems from physical strains and tensions in the body, rather than from damage caused by disease. Osteopathy focuses on whole body health by treating and strengthening the musculoskeletal framework. This includes the joints, muscles and spine. The aim is to positively affect the body's nervous, circulatory and lymphatic systems.
EvidenceOne study showed that osteopathy might help some people with symptoms in chronic fatigue but more studies are needed before we can be more certain.
SafetySide-effects are rare and mainly linked to manipulation of the neck. Some people get mild after-effects (aches) from the treatment but they usually last less than 48 hours.
CostMonthly cost will depend on how regularly you visit your osteopath. An hourly session with an osteopath varies from between £25-£50.
Find out moreAll qualified osteopaths are registered with The General Osteopathic Council.
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attendvisit Psychological therapies

OverviewWhen people think of 'talking therapies' they usually mean either counselling or psychotherapy. Counselling and psychotherapy aim to help people change thoughts, feelings and attitudes. Counsellors help you talk about difficult feelings and understand conflict. It can be helpful just to have time alone with a counsellor to talk in confidence about how you feel. Spending time reflecting on problems often brings insight and puts things into perspective. Psychotherapy helps people learn better ways of thinking or behaving that can reduce their symptoms, disability and distress. Some psychotherapists are trained to help you explore possible causes of distress or symptoms in your past. Cognitive behavioural therapy (CBT) is the type of psychotherapy that is currently most widely available in the NHS.

Instead of exploring causes of distress or symptoms in the past (like many other types of therapy), CBT looks for ways to improve your state of mind right now. The therapist does this by helping you spot unhelpful thought processes and change them. The Royal College of Psychiatrists says "CBT can help you to change how you think ('cognitive') and what you do ('behavioural')". For instance, CBT can help you make sense of what seem like overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you.

CBT can help people with CFS change the ways they think and feel about their fatigue. Graded exercise therapy (GET) is sometimes used alongside CBT to help people get used to being more active and overcome the serious loss of fitness and strength that is bound to set in after months of resting and avoiding activity.
EvidenceA number of good studies have shown that CBT can help ease problems related to chronic fatigue. Many people (not all though) felt less fatigued after a course of CBT.
SafetyCBT techniques are generally safe if carried out by or under the guidance of a qualified counsellor or psychologist.
CostIn most areas your GP can refer you for CBT or a psychological therapist in the NHS. There are often long waiting lists. A session of CBT or psychological therapy may cost between £20-£50. Frequency will depend on you and your therapist. A typical course of CBT lasts between 6-12 weekly sessions.
Find out moreIt is important to find a qualified counsellor or psychologist. Contact The British Psychological Society
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attendvisit Tai chi

OverviewTai Chi is also known as 'moving meditation'. It is a series of slow, graceful, controlled movements, which develop strength, balance, posture and inner peace. It is a discipline that has to be learned in a class from a teacher and can then be practised at home.
EvidenceTai Chi has been recommended for people with fatigue but no studies have been carried out yet. But there is recent evidence that it can help people with fibromyalgia (FMS), which is a problem that a lot of CFS sufferers also have.
SafetyTai Chi is safe for most people, although at first you might feel more tired. Though Tai Chi is slow and gentle, the amount of exercise should be increased slowly until you can manage a moderate level. If you feel worse, cut back and build up more slowly. Anyone with severe osteoporosis, joint problems, acute back pain or recent injuries should avoid strenuous exercise.
CostOnce you have learned the movements, you can do this at home, at no cost.
Find out moreClasses are run in most areas by both private tutors and by adult education services or you can contact the The Tai Chi Union.
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attendvisit Yoga

OverviewYoga, as taught in the UK, generally includes physical postures or stretches, breathing techniques, meditation and relaxation. There are several different types of yoga. Some of them are mainly based on the physical exercises (some types are much more strenuous than others). Others focus more on meditation.
EvidenceOne study showed that yoga was helpful but more studies, based on larger samples, are needed to be certain of this.
SafetyYoga is generally safe when practiced appropriately and at the right level. Classes are run for different ability levels so look for one that is right for you. Yoga stretches should be increased slowly. If in doubt, check with your doctor, osteopath or physiotherapist. Avoid with severe osteoporosis or acute joint or back pain, or recent injuries. Very strenuous postures and extreme breathing exercises are not suitable if you have CFS.
CostOnce you have learned the techniques you can do this at home, at no cost.
Find out moreClasses are run in most areas by both private tutors and by adult education services. To find a qualified teacher near you see also the The Yoga Alliance
and the The British Wheel of Yoga.
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