Harvard Women's Health Watch

Cognitive behavioral therapy and exercise therapy help ease chronic fatigue symptoms

In the largest randomized trial comparing treatments for chronic fatigue syndrome, British researchers have found that graded exercise therapy and cognitive behavioral therapy (CBT) — when added to medical care from chronic fatigue specialists — are each better than specialist medical care alone at reducing fatigue and improving physical function. In the trial, called PACE, these strategies also worked better than specialist medical care combined with adaptive pacing therapy (APT), in which patients are taught how to reduce fatigue by adjusting their lifestyle and activity levels.

Chronic fatigue syndrome is characterized by otherwise unexplained debilitating fatigue that lasts for six months or more and isn't relieved by bed rest. Other symptoms are poor sleep, problems concentrating, and muscle or joint pain. There are no diagnostic tests for the disorder, and its cause is unknown, although laboratory and other studies have suggested that a virus or other infectious agent may be involved.

The trial investigators expected graded exercise and CBT to work better than APT, but they were surprised to find APT no better than specialist medical care alone. Results were published online (Feb. 21, 2011) and in print (March 5, 2011) in The Lancet.

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