Exercise and Therapy Sessions Are Effective for Treating Chronic Fatigue Syndrome
The exact cause of Chronic Fatigue Syndrome (CFS), a condition that most commonly affects women ages 30 to 50, is unknown and there is no cure. Overall, the best strategy for treatment is to deal with the symptoms. A large UK trial has found that cognitive behavioral therapy (CBT) and graded exercise therapy (GET) are the most effective methods for treating patients with CFS.
Gradual Increase of Physical Activity Improved Fatigue Symptoms
Chronic Fatigue Syndrome is characterized by prolonged (6 months or more) and severe tiredness or fatigue that is not relieved by rest and is not directly caused by other conditions. Some researchers suspect that it may be caused by a virus or inflammation of the nervous system or that factors such as prior illness, stress, environment or genetics may be involved.
Researchers from Queen Mary University of London, King’s College London and the University of Edinburgh led a study that assessed four separate treatments for CFS, also known as Myalgic Encephalomyelitis (ME). These included adaptive pacing therapy, cognitive behavior therapy, graded exercise therapy, and specialized medical care. The study, called PACE, included 641 patients with CFS/ME who were able to attend hospitals and clinics in England and Scotland.
All patients met the “Oxford criteria” for CFS, set in 1990 which defines CFS/ME as a syndrome in which there is a definite onset (ie, it is not lifelong); fatigue is the main symptom; that fatigue is severe, disabling and affects both physical and mental functioning; the fatigue has been present for 6 months at least 50% of the time; and other symptoms may be present such as mood and sleep disturbance.
The participants were randomized into one of four treatment groups. The first received only specialist medical care – medical advice about how to manage the illness and prescription drugs for symptoms such as insomnia and pain - while the other three received specialist medical care in addition to one other therapy.
In the Adaptive Pacing Therapy group, an occupational therapist helped patients match their level of activity to how much energy they had, with the intention being to help the patients adapt to the illness rather than assume they could gradually do more.
In the Cognitive Behavioral Therapy group, a clinical psychologist or nurse trained in CBT helped patients understand how their thinking affected their symptoms and how to cope with them. They were also encouraged to experiment with increasing levels of activity.
In the Graded Exercise Therapy group, a physiotherapist helped patients gradually exercise more in a program that was tailored to their individual symptoms, fitness, and activity levels. The therapy is based on the theory that deconditioning and exercise intolerance contribute to fatigue.
The researchers found that CBT and GET benefitted up to 60% of patients after one year of therapy. These treatments were associated with less fatigue and better physical function than those receiving APT.
The researchers say their findings support current guidelines from the National Institute for Health and Clinical Excellence (NICE) and suggest that "CBT and GET can safely be added to SMC to moderately improve outcomes for chronic fatigue syndrome, but APT is not an effective addition."
"Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial."
PD White, KA Goldsmith, et al.
The Lancet, published online 18 February 2011.