beth israel deaconess medical center a harvard medical school teaching hospital

To find a doctor, call 800-667-5356 or click below:

Find a Doctor

Request an Appointment

left banner
right banner
Smaller Larger

Cognitive Therapy and Graded Exercise May Decrease Fatigue and Improve Function in Patients with Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) is a long-lasting, debilitating fatigue that is not relieved by rest. The fatigue can be increased by physical or mental activities and can interfere with daily activities from basic daily tasks to job functions. Since there is no cure for CFS, treatment focuses on reducing the symptoms of CFS, reducing anxiety, and decreasing the impact on daily life. Treatment approaches may include medical care, mental health support, and lifestyle changes.

Researchers from London examined the benefits of cognitive and physical therapies for patients with CFS. The study, published in Lancet, found that exercise therapy and cognitive behavioral therapy can help reduce fatigue when added to standard medical treatment.

About the Study

The randomized trial included 641 adults with CFS. All of the participants received specialist medical care including information leaflets, advice, and medication to help manage symptoms. They were then randomized to one of four treatment groups:
  • Graded exercise therapy (gradual increase in duration and intensity of aerobic exercise)
  • Cognitive behavioral therapy (a form of therapy that focuses on how you feel and respond to thoughts)
  • Adaptive pacing therapy (strategies to help adapt to illness with planning, pacing, prioritizing activity)
  • No add on therapy

Participants that had graded exercise therapy or cognitive behavior therapy had greater improvement in fatigue and physical function compared to adaptive pacing therapy or specialist medical care alone. Adaptive pacing therapy alone did not show greater improvements compared to specialist medical care alone.

How Does This Affect You?

The quality of a study can help to determine the reliability of the results. In this case, the design of the study and the methods used to complete the study are of high quality. This means the results are very reliable and cognitive behavior therapy and graded exercise should be considered for people with CFS.

The exact impact of CFS can vary from person to person, as well as your reaction to treatment. A gradually-increasing exercise program can help improve your physical stamina and health to lessen the impact of CFS, while the behavioral therapy can help you develop coping strategies to manage current fatigue. Work with your doctor or therapists to tackle the symptoms that are most troublesome, and adapt your therapy as your symptoms change.




  • White PD, Goldsmith KA, Johnson AL, et al. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet. 2011;377(9768):823-836.

Last reviewed March 2011 by Brian P. Randall, MD

All EBSCO Publishing proprietary, consumer health and medical information found on this site is accredited by URAC. URAC's Health Web Site Accreditation Program requires compliance with 53 rigorous standards of quality and accountability, verified by independent audits. To send comments or feedback to our Editorial Team regarding the content please email us at

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Search Your Health