Effects of graded exercise therapy and medical care on chronic fatigue syndrome





Chronic Fatigue Syndrome / Myalgic Encephalomyelitis, graded exercise therapy, cognitive behavioral therapy, adaptive pacing therapy, specialist medical care, working population


Purpose: Chronic Fatigue Syndrome (CFS) / Myalgic Encephalomyelitis (ME) is a complex condition with debilitating symptoms that significantly impact individuals, particularly those in the working population. This study aims to investigate the effectiveness of Graded Exercise Therapy (GET) and Cognitive Behavioral Therapy (CBT) along with additional methods such as Graded Exercise Self-help (GES), Adaptive Pacing Therapy (APT), and Specialist Medical Care (SMC), in managing Chronic Fatigue Syndrome (CFS) / Myalgic Encephalomyelitis (ME) among the working population.

Methods: A systematic analysis of five randomized controlled trials conducted between 2013 and 2023, encompassing GET, CBT, APT, SMC, and GES was performed using PubMed.

Results: The selected studies consistently demonstrate that GET positively impacts physical functioning and reduces fatigue levels in working individuals with CFS. Additionally, CBT proves valuable, emphasizing the importance of addressing the mental aspects of CFS in occupational contexts.

Conclusion: This review underscores the need for further research, advocating for direct assessment methods like biomarkers to enhance our understanding of CFS and improve treatment outcomes. These insights are crucial for healthcare practitioners, researchers, and policymakers navigating the complexities of CFS within the workplace. Emphasizing the integration of psychological interventions with physical therapies is essential for a comprehensive approach to managing CFS among the working population.


Bergner, M., Bobbitt, R. A., Kressel, S., Pollard, W. E., Gilson, B. S., & Morris, J. R. (1976). The sickness impact profile: conceptual formulation and methodology for the development of a health status measure. International Journal of Health Services, 6(3), 393-415. https://doi.org/10.2190/RHE0-GGH4-410W-LA17

Chalder, T., Berelowitz, G., Pawlikowska, T., Watts, L., Wessely, S., Wright, D., & Wallace, E. P. (1993). Development of a fatigue scale. Journal of Psychosomatic Research, 37(2), 147-153. https://doi.org/10.1016/0022-3999(93)90081-P

Cella, M., & Chalder, T. (2010). Measuring fatigue in clinical and community settings. Journal of Psychosomatic Research, 69(1), 17-22. https://doi.org/10.1016/j.jpsychores.2009.10.007

Clark, L. (2009). Graded Exercise Therapy: A self-help guide for those with chronic fatigue syndrome/myalgic encephalomyelitis. London: Bart's and the London NHS Trust. Retrieved from https://www.researchgate.net/publication/256293990_Graded_Exercise_Therapy_A_self-help_guide_for_those_with_chronic_fatigue_syndromemyalgic_encephalomyelitis

Clark, L. V., McCrone, P., Pesola, F., Vergara-Williamson, M., & White, P. D. (2021). Guided graded exercise self-help for chronic fatigue syndrome: Long term follow up and cost-effectiveness following the GETSET trial. Journal of Psychosomatic Research, 146, 110484. https://doi.org/10.1016/j.jpsychores.2021.110484

Clark, L. V., Pesola, F., Thomas, J. M., Vergara-Williamson, M., Beynon, M., & White, P. D. (2017). Guided graded exercise self-help plus specialist medical care versus specialist medical care alone for chronic fatigue syndrome (GETSET): a pragmatic randomized controlled trial. The Lancet, 390(10092), 363-373. https://doi.org/10.1016/S0140-6736(16)32589-2

Faro, M., Sàez-Francás, N., Castro-Marrero, J., Aliste, L., de Sevilla, T. F., & Alegre, J. (2016). Gender differences in chronic fatigue syndrome. Reumatología clínica (English edition), 12(2), 72-77. https://doi.org/10.1016/j.reumae.2015.05.009

Johnston, S., Brenu, E. W., Staines, D., & Marshall-Gradisnik, S. (2013). The prevalence of chronic fatigue syndrome/myalgic encephalomyelitis: a meta-analysis. Clinical epidemiology, 5(1), 105-110. https://doi.org/10.2147/CLEP.S39876

Larun, L., Brurberg, K. G., Odgaard-Jensen, J., & Price, J. R. (2019). Exercise therapy for chronic fatigue syndrome. Cochrane database of systematic reviews, (10). https://doi.org/10.1002/14651858.CD003200.pub8

Maksoud, R., Magawa, C., Eaton-Fitch, N., Thapaliya, K., & Marshall-Gradisnik, S. (2023). Biomarkers for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): a systematic review. BMC medicine, 21(1), 189. https://doi.org/10.1186/s12916-023-02893-9

Nacul, L. C., Lacerda, E. M., Pheby, D., Campion, P., Molokhia, M., Fayyaz, S., ... Drachler, M. L. (2011). Prevalence of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in three regions of England: a repeated cross-sectional study in primary care. BMC medicine, 9(1), 1-12. https://doi.org/10.1186/1741-7015-9-91

Prins, J. B., van der Meer, J. W., & Bleijenberg, G. (2006). Chronic fatigue syndrome. Lancet, 367, 346-355. https://doi.org/10.1016/S0140-6736(06)68073-2

Sandler, C. X., & Lloyd, A. R. (2020). Chronic fatigue syndrome: progress and possibilities. Medical Journal of Australia, 212(9), 428-433. https://doi.org/10.5694/mja2.50553

Shahid, A., Wilkinson, K., Marcu, S., & Shapiro, C. M. (Eds.). (2012). STOP, THAT and one hundred other sleep scales. Springer Science & Business Media.

Sharpe, M., Goldsmith, K. A., Johnson, A. L., Chalder, T., Walker, J., & White, P. D. (2015). Rehabilitative treatments for chronic fatigue syndrome: long-term follow-up from the PACE trial. The Lancet Psychiatry, 2(12), 1067-1074. https://doi.org/10.1016/S2215-0366(15)00317-X

Smith, M. B., Haney, E., McDonagh, M., Pappas, M., Daeges, M., Wasson, N., ... Nelson, H. D. (2015). Treatment of myalgic encephalomyelitis/chronic fatigue syndrome: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Annals of Internal Medicine, 162(12), 841-850. https://doi.org/10.7326/M15-0114

Valdez, A. R., Hancock, E. E., Adebayo, S., Kiernicki, D. J., Proskauer, D., Attewell, J. R., ... Proskauer, C. (2019). Estimating prevalence, demographics, and costs of ME/CFS using large scale medical claims data and machine learning. Frontiers in pediatrics, 6, 412. https://doi.org/10.3389/fped.2018.00412

Walwyn, R., Potts, L., McCrone, P., Johnson, A. L., DeCesare, J. C., Baber, H., ... White, P. D. (2013). A randomised trial of adaptive pacing therapy, cognitive behaviour therapy, graded exercise, and specialist medical care for chronic fatigue syndrome (PACE): statistical analysis plan. Trials, 14(1), 1-23. https://doi.org/10.1186/1745-6215-14-386

White, P. D., Goldsmith, K., Johnson, A. L., Chalder, T., & Sharpe, M. (2013). Recovery from chronic fatigue syndrome after treatments given in the PACE trial. Psychological medicine, 43(10), 2227-2235. https://doi.org/10.1017/S0033291713000020

Wilshire, C. E., Kindlon, T., Courtney, R., Matthees, A., Tuller, D., Geraghty, K., & Levin, B. (2018). Rethinking the treatment of chronic fatigue syndrome—a reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT. BMC psychology, 6(1), 1-12. https://doi.org/10.1186/s40359-018-0218-3




How to Cite

Zličić, T., Korovljev, D., Šćepanović, T., & Milovanović, I. (2024). Effects of graded exercise therapy and medical care on chronic fatigue syndrome. Annales Kinesiologiae, 14(2), 143–154. https://doi.org/10.35469/ak.2023.425