Conceptual model for physical therapist management of chronic fatigue syndrome/myalgic encephalomyelitis

Phys Ther. 2010 Apr;90(4):602-14. doi: 10.2522/ptj.20090047. Epub 2010 Feb 25.


Fatigue is one of the most common reasons why people consult health care providers. Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is one cause of clinically debilitating fatigue. The underdiagnosis of CFS/ME, along with the spectrum of symptoms that represent multiple reasons for entry into physical therapy settings, places physical therapists in a unique position to identify this health condition and direct its appropriate management. The diagnosis and clinical correlates of CFS/ME are becoming better understood, although the optimal clinical management of this condition remains controversial. The 4 aims of this perspective article are: (1) to summarize the diagnosis of CFS/ME with the goal of promoting the optimal recognition of this condition by physical therapists; (2) to discuss aerobic system and cognitive deficits that may lead to the clinical presentation of CFS/ME; (3) to review the evidence for graded exercise with the goal of addressing limitations in body structures and functions, activity, and participation in people with CFS/ME; and (4) to present a conceptual model for the clinical management of CFS/ME by physical therapists.

MeSH terms

  • Cognition Disorders / physiopathology
  • Exercise / physiology*
  • Exercise Test
  • Exercise Tolerance / physiology
  • Fatigue Syndrome, Chronic / diagnosis
  • Fatigue Syndrome, Chronic / physiopathology
  • Fatigue Syndrome, Chronic / rehabilitation*
  • Humans
  • Oxygen Consumption / physiology