Author, Year Country | Intervention (I) | Comparison (C) | Participants details (I/C) Number allocated (N), Mean age (year) Gender (% female) | Diagnostic criteria | Duration Session duration Frequency No. of sessions (ss), period (# weeks) | Outcome measure momentsa (weeks) | Main outcome measures 1 Primary 2 Secondary | Adverse events Treatment withdrawn (I/C) ITTb | Results (benefits), compared to controlc Concl.—Authors own conclusion |
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Kos et al. 2015 [64] Belgium | Activity pacing self-management (APSM) | Relaxation therapy | N = 33 (16/17) Age: 41 100% | CDC-94/Fukuda | 60–90 min weekly 3 weeks | Post | COPM, CIS, SF-36, CFS symptom list | No 1/3 No | Post: CIS p < 0.05, SF-36-PF and other scores ns No adverse events ASPM is feasible and effective in increasing participation in daily life activities and decreasing fatigue in women with CFS |
Taylor et al. 2004 [75] USA | Immediate program group: peer-based, education, including activity pacing using the envelope theory | Delayed program group | N = 47 (23/24) Age:47 91%/100% | CDC-94/Fukuda | 8 Biweekly group sessions over 16 weeks + 7 months peer counseling | 52, from baseline | CFSSRF (incl CFQ), QoL index | No ? Yes | Long: Time × condition interaction: QoL, CFSSRF-Symptom severity: p < 0.05, CFQ. not reported, other items ns Concl.: Patient driven programs like this can have a positive effect on symptom severity and QoL over time in CFS/ME |
Meeus et al. 2010 [65] Belgium | Pain physiology education | Pacing and self-management education | N = 48 (24/24) Age: 40 92%/75% | CDC-94/Fukuda | Once 30 min education | Post | 1: NPT 2: PCI, PCS, TSK, pressure pain threshold | No None No | Post: NPT p < 0.001, PCS-rumination, -worry, -distraction p < 0.05, other PCI-scales, TSK, Pain thresholds ns Pain education results in better understanding of pain and less catastrophizing at short term |
Wallman et al. 2004 [73] Australia | GET with pacing | Flexibility and relaxation | N = 68 (34/34) Age: 43 77% | CDC-94/Fukuda | max 30 min/ss 3–4 ss/week 12 weeks | 4 post | PGIC, HADS, CFQ, Activity levels, Stroop test, physiological assessments (HR, BP, VO2,RER, net blood lactate production), RPE OAESI | No 2/5 No | Post: CFQ, HADS-depr, physiological assessments resting (except diastolic BP) and exercise, Stroop test p < 0.05/ns, HADS-anx, RPE, PGIC−/ + r: 0/60%, activity level: ns Concl: GET was associated with improvements in physical work capacity, as well as in specific psychological and cognitive variables |
Thomas et al. 2008 [61] UK | Multi-convergent therapy (MCT), including CBT, GET and pacing | Relaxation therapy (+ non-randomized control) | N = 31 (17/14) Age: 48/45 71% | CDC-94/Fukuda | 10 1 h ss, 10 weeks | Post 26 | 1: Karnofsky performance scale 2: PGIC overall, function, fatigue | Yes 5/0 No | Post: Karnofsky (83% vs 21% normal score, consultant-rated), PGIC overall p < 0.001, PGIC fatigue p < 0.001, PGIC function p < 0.05 Short: PGIC p < 0.001, PGIC fatigue p < 0.001, PGIC function p < 0.05 No adverse events Concl: MCT seemed more effective than relax therapy |
Vos-Vromans et al The Netherlands | MRT (CBT, gradual reactivation, body awareness therapy, pacing, social reintegration) | CBT | N = 122 (60/62) Age: 40 80% | CDC-94/Fukuda criteria | CBT: 45–60 min, 16 ss, 6 months MRT: 33 h, 10 weeks | 26 basel (post) 52 basel | 1: CIS-f, SF-36 2: SES, SCL-90, MAAS, SIP-8, CAL, LSQ, EET, PSCG, activity monitor | Yes, but no reported 6/12 Yes | Short: CIS: ns, SF-36-MCS ns, SF-36-PCS ns, SES p < 0.05, PSCG < 0.001, all others ns Long: CIS p < 0.05, SF-36-MCS ns, SF-36-PCS ns, SES p = 0.01, PSCG < 0.001, EET < 0.05 all others ns Concl: MRT is more effective than CBT in reducing long-term fatigue severity in CFS |
Clark et al UK | Guided graded exercise self-help (GES) and four guidance sessions with physiotherapist | SMC | N = 211 (97/102) Age: 38 82%/76% | NICE (71% CDC-94 and 81% Oxford) | 8 weeks | 12 rand 52 rand | 1: SF-36-PF, CFQ 2: PGIC-health adverse outcomes, PGIC, HADS, PHQ-13, WSAS, IPAQ, | Yes 29%/– Yes | Short: CFQ p < 0.001; SF-36-PF p < 0.01, WSAS p < 0.05, HADS p < 0.01, IPAQ p < 0.001, PHQ-13, PGIC−/+ : 0/14%, ns Long: not reported (yet?) No serious adverse reactions, serious deterioration: ns Concl: GES is a safe intervention that might reduce fatigue and, to a lesser extent, physical disability for CFS |
Moss-Morris et al. 2005 [74] New Zealand | GET | SMC | N = 49 (25/24) Age: 41 71% | CDC-94/Fukuda | 12 weeks | Post 42 basel | PGIC, CFQ, SF-36-PF, VO2 peak (treadmill), IPQ-R, IMQ | No 3/– Yes | Post: PGIC−/ + : –/56% p < 0.05, CFQ: p < 0.05, IMQ-symptom focus p < 0.05 SF-36-PF, VO2 peak, IPQ-R: ns Short: Phys. CFQ < 0.05, mental CFQ, SF-36-PF ns Concl: GET appears to be an effective treatment for CFS and it operates in part by reducing the degree to which patients focus on their symptoms |
Nùñez et al. 2011 [68] Spain | MRT (group CBT- and GET, and conventional pharmacological treatment) | Exercise counselling (and conventional pharmacological treatment) | N = 120 (60/60) Age: 43 93% / 14% | CDC-94/Fukuda criteria | CBT: 90 min, 9 ss, GET: 60 min, 9 ss 10–12 weeks | 52 post | 1: SF-36 2: HAQ, HADS, FIS | SF-36 reduced 2/3 No | Long: SF-36-BP: (C) (p < 0.05), other results ns Concl: MRT was not superior to usual treatment at 12 months in terms of HRQL (SF-36). The combination of GET and CBT is ineffective and might be harmful to some patients |
Sutcliffe et al. 2010 [62] UK | Home orthostatic (tilt) training (HOT) | Sham training | N = 38 (19/19) Age: 48 84% / 79% | CDC-94/Fukuda | 40 min. 26 weeks | 4 rand (mid treatment) Post | 1: Compliance/tolerability 2: FIS, hemodynamic parameters | Yes, but not reported 5/5 No | Short: FIS: ns, systolic blood pressure drop with active stand p < 0.05, other hemodynamics ns Concl: HOT is well tolerated and generally complied with |
Oka et al. 2014 [72] Japan | Isometric sitting yoga (and pharmacotherapy) | Waitlist (pharmacotherapy alone) | N = 30 (15/15) Age: 38 80% | CDC-94/Fukuda | 20 min 5.8x/week, 9.2 weeks (mean 5.6ss with instruction) | Post 8 | POMS (F and V), CFQ, SF-8, occurrence | Yes None No | Post: POMS-F p < 0.001, POMS-V p < 0.01 Short: CFS p < 0.01, SF-8 total ns. Absence of serious adverse events or PEM Concl: Isometric yoga reduced fatigue and improved vigor |
Chan et al. 2014 [69] Hong Kong | Qigong (Baduanjin) | Waitlist | N = 150 (75/75) Age: 39 46%/62% | CDC-94/Fukuda | 16 lessons of 1.5 h over 9 weeks | Post 12 post | PSQI, CFQ, HADS, PGIC | Yes 4–49/– Yes | Short: PSQL: ns, CFQ: p < 0.001, HADS < 0.05/ < 0.001. PGIC−/ + : –/68%. Except muscle ache, adverse events were uncommon Concl: Qigong was an efficacious and acceptable treatment for sleep disturbance in CFS |
Chan et al. 2013 [70] Hong Kong | Qigong | Waitlist | N = 154 (77/77) Age: 42 72% / 82%) | CDC-94/Fukuda | 2 times/week 5 weeks + 12 weeks home-based practice | Post | CFQ, HADS | Yes 5/12 Yes | Post: CFQ, HADS p < 0.001 No adverse events were reported Concl: Qigong may not only reduce the fatigue symptoms, but also has antidepressive effect |
Ho et al. 2012 [71] Hong Kong | Qigong | Waitlist | N = 70 (35/35) Age = 42 76% / 84% | CDC-94/Fukuda | 5 weeks group qigong + 12 weeks home-based practice | Post | CFQ, SF-12 | Yes 8/10 Yes | Post: SF-12-PF: ns CFQ, SF-36 MF: p < 0.001 No adverse effects were reported Concl: Qigong exercise may improve CFS and mental functioning |