What the evidence does and does not show
- The Levine group's programmes improved fitness and symptoms for many participants over three months, but the studies are small and largely uncontrolled, with selected patients and meaningful dropout.
- The CHOP modification of the Dallas programme is widely circulated and clinically popular, but it has never been separately validated.
- Chronic fatigue conditions are multi-faceted and very individual, so even genuinely evidence-based protocols can be unsuitable for a given person. Take things slowly, in your own time, and let your body and how you are feeling be the guide.
For a fuller plain-language review of these programmes, see the CHOP and Levine protocols: what the evidence shows.
Sources
- Fu, Levine et al., Hypertension 2011
- George et al., community implementation, 2016
- Dysautonomia International: CHOP modified Dallas programme (PDF)
This page describes those sources in its own words and reproduces nothing from them.
How this tool works
This page scaffolds your decisions. It does not make them. You pick a tier, you set your own session structure and ceiling, and you log what you did. Two days after each session it asks how you actually were, because in orthostatic and post-viral illness the delayed answer is the honest one. It never moves you up a tier by itself: repeating a week is the normal outcome, and advancing is a button you press, which only unlocks after a completed week whose 48-hour checks showed no worsening.
The ladder
Published programmes run from horizontal training to upright endurance over several months. Pick where you are, not where a calendar says you should be. Starting lower than you think you need is the cheap mistake; starting higher is the expensive one.
Stretching and range-of-motion work done lying down. Slow leg movements in bed. Very short, very easy.
Short spells on a recumbent bike, rowing machine, or in a pool, at an easy, conversational effort.
Longer steady recumbent sessions. Light leg resistance work (bodyweight or light bands), still horizontal or seated.
Upright stationary bike or seated workouts. The body is more vertical but still supported.
Short bouts of walking or gentle elliptical work, broken up with recovery.
Longer walking or elliptical sessions. The end of the published calendars, not a requirement.
Where do people with my functional score tend to sit? (extrapolation, not a rule)
Nothing computes your tier from these scores, because no published mapping exists. This table is an extrapolation to orient yourself with, alongside the Bell scale and the PCFS grade. Your own judgement, and your clinician's, outrank it.
| Bell scale | PCFS grade | Ballpark starting tier |
|---|---|---|
| 0 to 30 | 4 | Tier 1, if activity is appropriate at all: ask your clinician |
| 30 to 50 | 3 | Tiers 1 to 2 |
| 50 to 70 | 2 | Tiers 2 to 4 |
| 70 and up | 0 to 1 | Tiers 4 to 6 |
Your session structure
You set every number. The published figures beside each field are reference values from the protocols this page learns from, shown for orientation only.
Stop and reconsider
Your logged symptom scores have risen for two weeks in a row. That pattern is the tool's signal to stop progressing, not push through. Sensible next moves: step back a tier or two, cut session length, or move back to pacing for a while and let things settle. If the rise continues while you rest, talk to your clinician and take your exported log with you.
48-hour checks due
Two days after each session, how were you really? This is the question a paper calendar cannot ask.
This week
Repeating is a normal outcome, not a failure. The published calendars themselves expect weeks to be repeated, and holding at a tier that works is a success state.
Log a session
Stored on this device only, never sent anywhere. Clearing browser data or switching device loses the record, so an occasional export is worth doing.
Symptom trend
Each point is a session's symptom score: the 48-hour check score where completed, otherwise the same-day score. Lower is better. A flat or falling line while activity holds steady is the pattern you want. Useful to show a clinician.
Your data
Everything here lives in your browser's local storage on this device. Export or print it now and then so the record survives a cleared browser and can go to appointments.
About this page
This page explains the structure of published exercise programmes for orthostatic intolerance and gives you a place to keep your own record against that structure. It does not prescribe a programme, and no part of it calculates what you should do. If you work with a clinician or physiotherapist, this record is designed to be shown to them.