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Evidence summaries

Exercise Therapy for Chronic Fatigue Syndrome

Exercise therapy may have a positive effect on fatigue in adults with chronic fatigue syndrome (CFS) compared to usual care or passive therapies. Level of evidence: "C"

A Cochrane review [Abstract] 1 included eight studies on the effectiveness of exercise therapy for chronic fatigue syndrome (CFS), with a total of 1518 subjects. All studies were conducted with outpatients diagnosed with 1994 criteria of the Centers for Disease Control and Prevention or the Oxford criteria, or both. Exercise therapy lasted from 12 to 26 weeks. Seven studies used variations of aerobic exercise therapy such as walking, swimming, cycling or dancing whilst one study used anaerobic exercise. Control groups consisted of passive control (eight studies, 971 patients; e.g. treatment as usual, relaxation, flexibility) or CBT (two studies, 351 participants), cognitive therapy (one study), supportive listening (one study), pacing (one study), pharmacological treatment (one study) and combination treatment (one study).

Exercise therapy compared with 'passive' control. Exercise therapy probably reduces fatigue at end of treatment (SMD 0.66, 95% CI 1.01 to 0.31; 7 studies, 840 participants). There is uncertainty if fatigue is reduced in the long term and about the risk of serious adverse reactions.

Exercise therapy compared with CBT. Exercise therapy may make little or no difference to fatigue at end of treatment (MD 0.20, 95% CI 1.49 to 1.89; 1 study, 298 participants), or at longterm followup (SMD 0.07, 95% CI 0.13 to 0.28; 2 studies 351 participants).

Exercise therapy compared with adaptive pacing. Exercise therapy may slightly reduce fatigue at end of treatment (MD 2.00, 95% CI 3.57 to 0.43; scale 0 to 33; 1 study, 305 participants; lowcertainty evidence) and at longterm followup (MD 2.50, 95% CI 4.16 to 0.84; scale 0 to 33; 1 study, 307 participants; lowcertainty evidence).

Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison).

    References

    • Larun L, Brurberg KG, Odgaard-Jensen J et al. Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev 2019;(10):CD003200. [PubMed]

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