Exercise Therapy or Cognitive Behavioral Therapy Improves Fatigue and Physical Functioning in Patients with Chronic Fatigue Syndrome

DynaMed Weekly Update - Volume 6, Issue 8

Chronic fatigue syndrome is a chronic illness that can be difficult to treat. A recent trial randomized 641 adults with chronic fatigue syndrome (all receiving specialized medical care) to treatment for 24 weeks in one of four groups: graded exercise therapy vs. cognitive behavioral therapy (CBT) vs. adaptive pacing therapy vs. no additional therapy. Patients were followed for 1 year. Specialized medical care was provided by doctors in at least 3 sessions and included information, advice, and medication for symptoms. Graded exercise therapy included incremental increase in duration, followed by gradual increase in intensity and aerobic nature of exercise. Adaptive pacing therapy employed strategies for optimizing adaptation to illness via planning, pacing, prioritizing activity and promoting natural recovery. Patients in therapy groups attended 12-15 sessions.

Primary outcomes were self-reported assessments of fatigue (Chalder fatigue questionnaire) and physical function (Short form-36 physical function subscale). Clinically meaningful improvement in both fatigue and function scores were achieved by 61% of the graded exercise group and 59% of the CBT group, compared to 42% of the adaptive pacing group and 45% of the specialized care only group (level 1 [likely reliable] evidence). Compared to specialized care only, the NNT was 7 for graded exercise (p = 0.004) and 8 for CBT (p = 0.015). Addition of adaptive pacing therapy to specialist medical care did not result in significant differences in fatigue and physical function (Lancet 2011 Feb 17 early online).

For more information, see the Chronic fatigue syndrome topic in DynaMed.