How to Build Endurance, When You Have Fatigue and Pain

“But those who trust in the Lord will find new strength. They will soar high on wings like eagles. They will run and not grow weary. They will walk and not faint.” -Isaiah 40:31

When I first got sick with fibromyalgia, I avoided exercise at all costs. It was extremely painful. I quickly declined and developed chronic fatigue syndrome. I was in bed or on the couch for most of my days for years. I felt very weak. Laying down all day was affecting my sleep quality. I thought to myself, “I can barely walk, so how am I going to rehabilitate myself?”

As an Occupational Therapist, I felt helpless. I should know how to manage the symptoms of fatigue. My Physical Therapists were only giving me specific therapeutic exercises for muscle weakness. I knew how to implement energy conservation techniques, but I was still declining while using them.

What Does the Research Say?


I turned to the research. According to a systematic review analyzing 34 randomized controlled trials (RCT), the gold standard for research, “there is a ‘gold’ level of evidence that supervised aerobic exercise training has beneficial effects on physical capacity and fibromyalgia symptoms” (Busch, Barber, Overend, Peloso, & Schacter, 2007).

Chronic Fatigue Syndrome

As for chronic fatigue syndrome, a systematic review of 8 RCTs “reported a positive effect of exercise therapy at the end of treatment with respect to sleep, physical functioning, and self-perceived overall changes in health” (Larun, Brurberg, Odgaard-Jensen, & Price, 2017). This study also suggests that “effectiveness of exercise therapy seems greater than that of pacing” (Larun et al., 2017). Pacing is the task of spacing out activities to be able to better accomplish them and conserve energy.

An older study, but still significant found that “fatigue, functional capacity, and fitness were significantly better after (graded) exercise than after flexibility treatment” (Fulcher & White, 1997).

This information was what I needed to know to push myself over the fear that exercise would hurt me more.

Finding Help

I reached out to an Exercise Physiologist at the University of Rochester, in Rochester, New York. She taught me how to build my endurance and energy, decrease fatigue, and improve cardiovascular functioning and sleep quality. This is important as I also had Raynauds, Antiphosolipid-Antibody Syndrome, and occasional insomnia.

Later I learned that I also have mitochondrial DNA depletion syndrome 11. For anyone with mitochondrial disease, “mitochondrial function improves as a result of exercise, as shown by a better use of oxygen, nutrients, and efficient energy production” (Balcells, 2012).

Often exercise could leave me depleted the next day. So, how could I find that “sweet spot” of building endurance, without depleting my energy for the next day? Below is the program that I learned.

Steps for Graded/Self-Directed Exercise Routine:


1.   First, you need to get a baseline of how much you are able to move without severe fatigue the following day. If you have a FitBit or Garmin fitness tracker, go about your normal routine and see on average how many steps you take in two weeks. If you do not have a fitness tracker, average the amount of minutes you are walking per day over the course of two weeks (fill out the provided Activity Tracker).

Prescribed Walking  

2.  Once you have your baseline, take on average your steps and add 200 steps or 3 minutes to your time for the next 2 weeks. You must try your hardest to walk that amount every day.

  • For example, my baseline was 5 minutes. For two weeks I walked 5 minutes everyday. Then, the next 2 weeks I walked 8 minutes a day.
  • This may not sound like a lot to some people, but the point is to walk everyday, versus not at all or sporadically. That is how you build endurance. It is slow and steady.
  • At first you may have a little extra fatigue the next day, but you should be able to manage by completing your self-care routines. If not, and the fatigue is too much, then you need to lower your steps or minutes by a few (lower by 100 steps or 2 minutes).  

Increasing the Prescribed Amount

3.    To continue to progress, you increase in intervals or 200 steps and 3 minutes every two weeks, until you reach 20-30 minutes or 7,000-10,000 steps (of walking at low-moderate pace). You may never get to 30 minutes or 10,000 steps, and that is ok. You will find your maximum minutes or steps that you are able to do daily to increase energy and still maintain daily activities (continue to use the provided Activity Tracker, to track your progress and to make modifications as needed).   

Increasing the Intensity

4.    If you are able to get to 20-30 minutes of walking for 1-2 weeks and tolerate it (not feel depleted but actually energized the next day), then and only then can you modify the intensity of your walking. Intensity would be to increase your pace from low to moderate, and then from moderate to high. Once you have been walking for about 20-30 minutes at a high pace, then you can consider if you would like to try jogging or running.

ex.)  To move from low or moderate intensity of walking to high intensity walking, I lowered my target to 10 minutes of moderate to fast walking. Then, 2 weeks later, 13 minutes of moderate to fast walking. You escalate this slowly, and you may eventually get to 20-30 minutes. Once you are at 20-30 minutes of high or fast walking, you can try to jog or run. It is possible! I am able to run for 2 minutes and walk quickly for 10 minutes.

Alternative Cardio Activities

You can also go biking or swimming, as your cardio activity for building endurance. Instead of measuring steps, you will measure the activity by minutes.

I cannot stress the importance of maintaining walking daily. If you experience a terrible flare or illness, and cannot walk for a few days, start back at your baseline and begin the process again. When I am terribly sick, I would try to just walk for 5 minutes (it is better than nothing), or even just standing for 5 minutes. I had to “start over” countless times. I did not get discouraged, because I trusted the process would yield results. All I cared about were the results of building my energy reservoir and fighting to keep walking. It didn’t matter to me how many months it would take or if I had to start all over. I took “one day at a time.”

What I learned from the Exercise Physiologist was life changing. My strength, endurance, and sleep quality have all improved from this daily endurance routine. It is important for me to share it with you, along with the hope that you can build endurance. It requires patience, consistency, and self-compassion. These tips do not replace the advice of your doctor. Please consult with a doctor prior to any exercise or therapy routine, or if your symptoms worsen.

Please see attachments for an Activity Tracker, Rate of Perceived Exertion Scale (RPE), and Pain Scale to help you create your own routine.


Balcells, C. (2012). Living Well with Mitochondrial Disease. Bethesda, MD: Woodbine

Busch, A. J., Barber, K. A., Overend, T. J., Peloso, P. M., & Schacter, C. L. (2007).
Exercise for treating fibromyalgia syndrome. Cochrane Review.

Fulcher, K. Y., & White, P. D. (1997). Randomised controlled trial of graded exercise in
patients with chronic fatigue syndrome
. British Medical Journal, 314, 1647-1665.

Larun, L., Brurberg, K. G., Odgaard-Jensen, J., & Price, J. R. (2017). Exercise therapy
for chronic fatigue syndrome
. Cochrane Review.

Copyright @healingfaithfully 2019.