Evaluating pacing therapy (PT) versus graded exercise therapy (GET) for improving fatigue, pain, and quality of life in adults with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): A systematic review. — CFSMEATLAS
Evaluating pacing therapy (PT) versus graded exercise therapy (GET) for improving fatigue, pain, and quality of life in adults with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): A systematic review.
Cooper, Charlotte, Papadopoulos, Konstantinos · Journal of bodywork and movement therapies · 2025 · DOI
Quick Summary
This review compared two common treatment approaches for ME/CFS: pacing therapy (learning to manage activity carefully) and graded exercise therapy (gradually increasing exercise). Researchers looked at six studies involving 2,280 patients to see which approach helped most with fatigue, pain, and quality of life. The results suggest both therapies helped more than standard care alone, though they worked differently—pacing therapy showed more symptom improvement in most patients, while graded exercise therapy was better for reducing pain and improving physical function.
Why It Matters
ME/CFS patients and clinicians urgently need evidence about which treatments work best and safest. This systematic review directly compares the two most commonly recommended behavioral therapies, helping patients and providers make informed decisions about treatment approaches. Understanding that different therapies may help different symptoms is important for personalized care planning.
Observed Findings
Graded exercise therapy showed higher recovery rates (33% on CFQ, 53% on SF-36PF) compared to pacing therapy (21-22%, 35-41%)
Pacing therapy showed greater symptom improvement in 44% of patients versus 12% in GET (p<0.001)
Both graded exercise therapy and pacing therapy showed more improvement than standard medical care alone
Serious adverse events were reported in over 50% of participants across all treatment groups
Graded exercise therapy participants had 4.2 points lower fatigue (CFQ) and 6.3 points higher physical function (SF-36PF) compared to standard care
Inferred Conclusions
Pacing therapy and graded exercise therapy are more effective than standard medical care for ME/CFS
Greed exercise therapy may be particularly beneficial for pain reduction and physical function improvement
Both therapies appear safer than standard care alone, despite high adverse event reporting
Different therapies may benefit different symptom domains (e.g., pacing for symptoms; GET for pain and function)
Remaining Questions
Why do pacing therapy and graded exercise therapy show different patterns of benefit, and which approach is best for individual patients?
What This Study Does Not Prove
This review does not prove that either therapy is a cure for ME/CFS, nor does it establish causation regarding improvements. The high reported adverse event rates (>50% across groups) raise important questions about study definitions and reporting. The small number of studies and variable quality mean these findings may not apply equally to all ME/CFS patients.
Tags
Symptom:PainFatigue
Method Flag:PEM Not DefinedWeak Case DefinitionMixed Cohort
What explains the >50% serious adverse event rate, and how do these adverse events relate to therapy-specific effects versus natural disease progression?
How do these results generalize to the broader ME/CFS population given the small number of studies and variable methodological quality?
What mechanisms explain symptom improvement in pacing therapy versus functional improvements in graded exercise therapy?