Understanding Chronic Fatigue Syndrome: What It Is and How to Manage It

Before reading, if you haven’t already, please read the following disclaimer. And if reading a few hundred words is outside of your capacity at the moment, skip ahead to the end for a TL;DR (too long; didn’t read, i.e. summary).

Chronic Fatigue Syndrome (CFS), technically known as Myalgic Encephalomyelitis (try saying that three times fast), is a neurological disorder that can affect many different parts and systems of the body, for which there is currently “no diagnostic test, validated biomarker, clear pathophysiology, or curative treatment” (Sandler & Lloyd, 2020).

All this to say, the effects of CFS are wide ranging, we don’t understand why it occurs, and we don’t have any conclusive way to test for it. However, despite many opinions (both professional and non-professional) to the contrary, this does not detract from the fact that CFS is a real and debilitating condition that can significantly impact the quality of life of those living with it; and those people are not just tired or lazy. Fatigue is an entirely different feeling, one that can feel impossible to describe.

The hallmark symptom of CFS is Post-Exertional Malaise (PEM), which simply means that you experience an increase in your symptoms and a reduction in functional capacity after some level of physical or cognitive (including emotional, social or spiritual) activity. Both the level to which you experience PEM and how long it sticks around differs wildly from person to person depending on the severity of your condition and how challenging the activity was.

In the world of CFS, substantial reductions in functioning, accompanied by profound fatigue lasting for more than 6 months, post-exertional malaise, and unrefreshing sleep are The Big Three symptoms; the Federer, Nadal, and Djokovic (if you’re into sporting metaphors). However, in order to get a diagnosis of CFS, having The Big Three isn’t quite enough, you also need an Andy Murray. In this case, he takes the form of one or both of the following: cognitive impairment (aka brain fog), or orthostatic intolerance (symptoms like palpitations, dizziness, nausea, or sweating that improve when lying down).

There’s a laundry list of other symptoms that might tag along with The Big Three and Murray. And like most things CFS-related, everyone’s list is different—and usually comes with a big SUBJECT TO CHANGE sticker slapped on the bottom. Common symptoms may include chronic muscle or joint pain, muscle weakness, sensory sensitivities, and gastrointestinal issues. But this is far from an exhaustive list.

While there is currently no cure for CFS, there are strategies that can help manage symptoms and improve quality of life. A 2010 survey (if you’re interested, click the link to head to the PDF) of more than 4,000 people in the UK found that activity pacing was considered the most acceptable and effective approach, alongside rest and meditation. Activity pacing is a self-management strategy designed to help people balance their activity levels with their available energy. It recognises that every activity—whether physical, mental, or emotional—has an energy demand, and that spreading those demands out across the day or week can reduce the risk of crashes while still encouraging consistent activity.

Hopefully, this post has given you a clearer understanding of what chronic fatigue syndrome is and why it can be so challenging to manage.

Over the next two weeks, I’ll dive deeper into the concepts of energy demands and activity pacing, two of the most important tools for living better with CFS. I’ll also be sharing a completely free resource to help you track and understand your own energy patterns, so you can apply pacing more effectively in your day-to-day life.

Whether you’re newly diagnosed or have been navigating fatigue for years, my goal is to provide practical, easy-to-use guidance that meets you where you’re at.
As always, if you have any questions, concerns, feedback, or if you’d like to share your own experiences living with chronic fatigue syndrome, I’d love to hear from you! Feel free to shoot me an email at alex.burjan@ep360.com.au.

Alex

TL;DR – Understanding Chronic Fatigue Syndrome (CFS)

• CFS (aka Myalgic Encephalomyelitis) is a complex neurological condition with no known cause, test, or cure.
• It affects multiple systems in the body and varies significantly from person to person.
• CFS is real and debilitating—it’s far more than just being “tired” or “lazy.”
• The core symptom is Post-Exertional Malaise (PEM): symptom flare-ups after physical, mental, or emotional effort.
• The “Big Three” symptoms of CFS:
  • Significant functional impairment & persistent, profound fatigue (6+ months)
  • PEM
  • Unrefreshing sleep
• Diagnosis also requires one or both of:
  • Cognitive impairment (“brain fog”)
  • Orthostatic intolerance (dizziness, palpitations, etc. that improve when lying down)
• Many people experience additional symptoms, including:
  • Muscle/joint pain, weakness, sensory sensitivities, gastrointestinal issues
• There is no cure, but symptom management is possible.
• Activity pacing is one of the most effective self-management strategies:
  • Helps balance energy use across the day/week
  • Reduces crashes while maintaining consistent, manageable activity
• More on energy demands and pacing tools coming in the next two weeks—including a free resource to help you personalise your approach.
• You’re not alone—if you have feedback, questions, concerns, or want to share your story:
  ➤ Feel free to reach out via email: alex.burjan@ep360.com.au
• If you’re in the Inner West of Sydney and living with chronic fatigue, our Beyond Fatigue Program at EP360 Exercise Physiology in St Peters may be a good fit. Learn more here

References

Sandler, C., & Lloyd, A. (2020). Chronic fatigue syndrome: progress and possibilities. Medical Journal of Australia, 212. https://doi.org/10.5694/mja2.50553.