Guided self-help approach to exercise may benefit chronic fatigue patients

A self-help approach to exercise that is supervised remotely by a specialist physiotherapist may help people with chronic fatigue symptoms (CFS) to manage their condition and feel better, according to a new study published in The Lancet.

The finding comes from a trial of 200 people with CFS who were assigned either guided graded exercise self-help (GES group) in addition to specialist medical care or specialist medical care alone (control group). GES involves patients gradually increasing their level of physical activity, while being offered information and advice by a physiotherapist over the phone or using Skype™.

The self-help approach eliminates the need for patients to physically attend a specialist clinic, as they currently do when prescribed graded exercise therapy. This can be costly and access to clinics offering the therapy is often limited.

Offering the therapy as a self-help approach, supervised by a physiotherapist, could increase access and avoid the fatiguing effects of travel for the intervention.”

Lucy Clark, Lead author, Queen Mary University of London, UK.

Patients in the GES group were handed a booklet detailing a 6-step programme designed to help patients slowly and safely increase their physical activity levels over the course of 12 weeks. During the first 8 weeks, the GES participants also received up to four guidance sessions with a physiotherapist who could discuss their progress and provide advice.

Patients were encouraged to choose an exercise (most chose walking) that they could engage in five days a week, in addition to their everyday daily activities. Once a daily routine was established, the patients started to gradually increase the amount of exercise they were getting by adding no more than 20% to the amount of time spent on the chosen physical activity every week.

According to questionnaires completed at baseline and at 12 weeks, the mean fatigue score among the GES participants was 4 points lower than that amongst controls and the mean physical function score was 6 points higher than amongst controls.

Around one-fifth (18%) of GES participants reported feeling “much better” or “very much better” when rating their overall health, compared with only one in 20 (4%) of those in the control group. No patients reported any adverse side effects as a result of GES.

“We found that a self-help approach to a graded exercise programme, guided by a therapist, was safe and also helped to reduce fatigue for some people with chronic fatigue syndrome, suggesting that GES might be useful as an initial treatment for patients to help manage symptoms of chronic fatigue syndrome. We are now looking at whether the effects were maintained beyond 12 weeks,” says Clark.

Sally Robertson

Written by

Sally Robertson

Sally graduated from Greenwich University with a first-class honours degree in Biomedical Science. After five years working in the scientific publishing sector, Sally developed an interest in medical journalism and copywriting and went on to pursue this on a freelance basis. In her spare time Sally enjoys cross-country biking and walking, tennis and crosswords.



  1. Phil Clarke Phil Clarke Australia says:

    The problem is always in my experience misdiagnosis.   A properly diagnosed CFS sufferer - and that means using proper criteria such as CDC Fukuda et al, not the Oxford Criteria and its derivatives - is likely to "hit the wall". What these programs can do is sort out the misdiagnoses and put them on a better path

    Sadly the failures are likely to be the ones correctly diagnosed.  Nothing wrong with programs such as this, and even CBT - but truly they don't address CFS only the misdiagnosis of the illness.  

    I remain - as a sufferer - convinced that is a cluster of physical illness whose diagnosis and treatment the medical profession have made a total dog's breakfast of.  The current best hope is to try to provoke a spontaneous remission by good diet, sensible pacing, lowering stress and any sensitivity or allergy assault and very carefully applied exercise that is not progressive in nature but rather , stable. - But keep trying and don't give up

    I have never felt that the Lancet has abandoned a deep seated belief "IAIYH"

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