Do graded activity therapies cause harm in chronic fatigue syndrome?

J Health Psychol. 2017 Aug;22(9):1146-1154. doi: 10.1177/1359105317697323. Epub 2017 Mar 20.


Reporting of harms was much better in the PACE (Pacing, graded Activity, and Cognitive behavioural therapy: a randomised Evaluation) trial than earlier chronic fatigue syndrome trials of graded exercise therapy and cognitive behavioural therapy. However, some issues remain. The trial's poor results on objective measures of fitness suggest a lack of adherence to the activity component of these therapies. Therefore, the safety findings may not apply in other clinical contexts. Outside of clinical trials, many patients report deterioration with cognitive behavioural therapy and particularly graded exercise therapy. Also, exercise physiology studies reveal abnormalities in chronic fatigue syndrome patients' responses to exertion. Given these considerations, one cannot conclude that these interventions are safe and risk-free.

Keywords: adherence; adverse events; chronic fatigue syndrome; cognitive behavioural therapy; graded activity; graded exercise; graded exercise therapy; harms; myalgic encephalomyelitis.

MeSH terms

  • Cognitive Behavioral Therapy
  • Dissent and Disputes*
  • Exercise Therapy / methods*
  • Fatigue Syndrome, Chronic / psychology
  • Fatigue Syndrome, Chronic / therapy*
  • Female
  • Humans
  • Male
  • Outcome Assessment, Health Care* / methods
  • Randomized Controlled Trials as Topic