A 6-month aquatic exercise programme for individuals with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: benefits for symptoms, health and physical capacity.

INTERVENTION: Brief name: Self‐paced Aquatic exercise Materials: A climate‐controlled pool with a temperature between 27°‐30°, and aquatic exercise equipment (e.g. buoyancy belts, pool noodles, kick boards, water dumbbells etc.). Water resistant heart rate monitors and printed RPE scales for participants to rate their level of exertion. Procedures: The exercise sessions will consist of: 1) A gentle 5‐minute warm‐up of range of motion exercises and stretches; 2) Approximately 10 – 15 minutes of low‐intensity aerobic, strength, balance and flexibility aquatic exercises. The duration may be progressed during the study if symptoms permit. 3) A gentle 5‐minute cool‐down of stretching. HR and RPE will be monitored before and after each session, and half‐way through each session. Fatigue and tiredness will be recorded using a 0‐10 Likert Scale after each session and 24‐ and 48‐hr post‐session. Participants will also be asked to keep a symptom and activity diary, with daily entries. Diaries will be collected at the end of each month, with responses collated for qualitative analysis. Who: the exercise intervention will be delivered by Accredited Clinical Exercise Physiologists (AEPs) with experience in the delivery of aquatic exercise and rehabilitation. They will also be assisted by a second AEP and/or exercise science students. Mode of delivery: The intervention will be delivered face to face and in a group setting. Number of times: Exercise sessions will take place 2 per week for the duration of 6 months. The duration of each session will be approximately 30 minutes (may vary depending on each participant's ability). Intensity: participants will pace themselves according to their ability and symptoms and will be rated by each individual's rate of perceived exertion. RPE will remain at <5 (0‐10 Borg scale). Location: the intervention will take place in two regional sites and will occur at a publicly‐accessibly pool which will be booked for the duration of the intervention. The same exercises will be provided to all individuals in the group with alternative suggestions/adaptations made for any individuals that might need it. Instructions on any adaptations will be provided by the clinical exercise physiologist delivering the exercise session. Adherence to the intervention will be assessed by the researchers (which includes the clinical exercise physiologists conducting the exercise sessions) by monitoring attendance as well as by the use of symptom and activity diaries which will be collected at the end of each month by the researchers. A follow‐up text message or call will be made to those participants who missed an exercise session without notifying the researchers. CONDITION: Chronic Fatigue Syndrome Myalgic Encephalomyelitis PRIMARY OUTCOME: Fatigue: ; This component will be assessed by the FACIT fatigue and tiredness scale Pain: ; measured by means of a visual analogue pain scale Physical capacity: ; This component will be assessed by performing a 6 minute walk test, SECONDARY OUTCOME: Physical capacity: Composite outcome ; ‐ as measured by exercise heart rate ( water resistant hear rate monitors) and RPE (measured on a 0‐10 RPE visual analogue scale). ; Primary outcome [4] ; Quality of life ‐ as measured by the SF‐36 Quality of life questionnaire. ; ; Symptoms: Composite outcome ; ‐ as measured by the FACIT fatigue and tiredness scale; and a VAS Pain scale, recorded in the participants' symptom and activity diaries INCLUSION CRITERIA: (1) Age range of 18‐80 years (2) GP diagnosis of CFS &/or ME, Post Viral Syndrome, Post Viral Fatigue Syndrome or Chronic Mononucleosis by means of the Canadian Consensus criteria or the Fukuda criteria (3) Does not currently participate in regular vigorous exercise or physical activity (4) Is able to communicate in English (5) Able to give informed, signed consent (6) Able to commit the time required for participating in this research