by Jones P

Cognitive Therapy and Graded Exercise May Decrease Fatigue and Improve Function in Patients with Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) is a long-lasting, debilitating fatigue that is not relieved by rest. The fatigue can be increased by physical or mental activities and can interfere with daily activities from basic daily tasks to job functions. Since there is no cure for CFS, treatment focuses on reducing the symptoms of CFS, reducing anxiety, and decreasing the impact on daily life. Treatment approaches may include medical care, mental health support, and lifestyle changes.
Researchers from London examined the benefits of cognitive and physical therapies for patients with CFS. The study, published in Lancet, found that exercise therapy and cognitive behavioral therapy can help reduce fatigue when added to standard medical treatment.

About the Study

The randomized trial included 641 adults with CFS. All of the participants received specialist medical care including information leaflets, advice, and medication to help manage symptoms. They were then randomized to one of four treatment groups:
  • Graded exercise therapy (gradual increase in duration and intensity of aerobic exercise)
  • Cognitive behavioral therapy (a form of therapy that focuses on how you feel and respond to thoughts)
  • Adaptive pacing therapy (strategies to help adapt to illness with planning, pacing, prioritizing activity)
  • No add on therapy
Participants that had graded exercise therapy or cognitive behavior therapy had greater improvement in fatigue and physical function compared to adaptive pacing therapy or specialist medical care alone. Adaptive pacing therapy alone did not show greater improvements compared to specialist medical care alone.

How Does This Affect You?

The quality of a study can help to determine the reliability of the results. In this case, the design of the study and the methods used to complete the study are of high quality. This means the results are very reliable and cognitive behavior therapy and graded exercise should be considered for people with CFS.
The exact impact of CFS can vary from person to person, as well as your reaction to treatment. A gradually-increasing exercise program can help improve your physical stamina and health to lessen the impact of CFS, while the behavioral therapy can help you develop coping strategies to manage current fatigue. Work with your doctor or therapists to tackle the symptoms that are most troublesome, and adapt your therapy as your symptoms change.


Centers for Disease Control and Prevention
Chronic Fatigue and Immune Dysfunction Syndrome Association of America


White PD, Goldsmith KA, Johnson AL, et al. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet. 2011;377(9768):823-836.

Revision Information

Health Library Search

Only show results from the selected categories.

Adhesive capsulitis is a tightening in the shoulder joint. It decreases the range of motion in the shoulder and causes pain. This condition is also known as frozen should...

12 Oxygen Therapy procedure

Oxygen therapy is a method of passing extra oxygen to the lungs. It is done to increase the level of oxygen in your blood....

13 Exercise natural & alternative treatment - alternative therapy
14 Types of Prenatal Testing condition indepth
15 Laceration Repair procedure

A laceration is a tear or cut in the skin, tissue, and/or muscle. They can vary in length, depth, and width. A laceration repair is the act of cleaning, preparing, and cl...

Hyperbaric oxygen therapy (HBOT) involves breathing 100% oxygen in a sealed chamber. This concentration is 5 times higher than the normal air we breathe. The chamber is a...

17 Massage Therapy lifestyle - alternative health

There is no doubt that massage relieves pain and induces relaxation at least temporarily; and even better, it feels good! Whether it offers any lasting benefits, however,...

18 Osteopathic Manipulative Treatment natural & alternative treatment - alternative therapy
19 Electromyography procedure

Electromyography (EMG) measures and records the electrical activity of a muscle. The test can record a muscle's electrical activity at rest and during a muscle contractio...

20 Stuttering Can Be Stopped lifestyle - men's health

Stuttering is up to 4 times more common in men than in women. Learn how speech therapy can help stop you or your child from stuttering....