Chronic fatigue syndrome causes a lot of distress and disability. Despite much research, we don't really know what causes the condition. That makes it hard to find a cure. However, recent research has helped to clarify which treatments help most.
Two treatments aim to help people gradually increase the amount they can do, with the aim of helping them recover from their fatigue. One takes a physical approach and the other a psychological approach, and they seem to work about as well as each other.
If you have graded exercise therapy
, you work with a therapist to do a certain amount of gentle exercise (often walking, or maybe swimming) each day. The exercise is gradually increased, to help recondition muscles that may have been weakened, and get people used to exercise.
Cognitive behavioral therapy means working with a therapist to look at whether your own beliefs or misunderstandings are getting in the way of your body recovering. For example, if someone is scared to do anything in case they make themselves ill, they will gradually do less and less, which can lead to muscle weakness and a general loss of fitness.
These treatments don't cure everyone, but in a recent study 80 in 100 people who'd had exercise therapy, and 76 in 100 who'd had CBT, showed a real improvement in their symptoms of tiredness, and their ability to take part in activities. The improvement was measured after one year.
By contrast, a popular technique tested in the same study didn't seem to help much. Pacing, also known as adaptive pacing therapy, means restricting and planning activities so as to avoid getting tired. In the study, only 65 in 100 people showed an improvement after using pacing.
Pacing has become popular, after some patient groups raised concerns that CBT or exercise therapy might be harmful. The study looked at side effects from treatment, and at whether some people in the study were worse after treatment than before. It showed that there was no difference between the treatments, and that all of them are safe to use.
What you need to know. It's hard to accept treatment when doctors don't know what's caused your illness. But good-quality evidence suggests that both cognitive behavioral therapy and exercise therapy are safe and moderately effective for treating chronic fatigue. Pacing, while safe, is less likely to help you recover.
--Anna Sayburn, patient editor, BMJ Group
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