Feb. 17, 2011 -- Cognitive behavioral therapy and exercise, in conjunction with medical care, are safe and effective ways to treat some of the symptoms of chronic fatigue syndrome (CFS), finds a new study published online in The Lancet.
CFS is characterized by severe, debilitating fatigue, pain, difficulty concentrating, and other symptoms that last for six months or longer. There is little consensus about the cause of CFS and how best to treat it.
In the study, called the PACE trial, 640 people with CFS received specialized medical care including disease education and medication to treat CFS symptoms, alone or in combination with:
- Cognitive behavioral therapy (CBT). This form of therapy aims to change how people think about CFS and its symptoms.
- Graded exercise therapy. This is a tailored program that gradually increases levels of physical activity.
- Adaptive pacing therapy. This treatment involves planning and pacing activities based on fatigue patterns.
After one year, those individuals who received CBT and graded exercise in addition to specialized medical care showed greater improvements in fatigue and physical functioning than their counterparts in the other two groups, the study showed. What's more, these treatments were safe, and serious adverse events were rare across all groups.
First, Do No Harm
In an accompanying editorial, Gijs Bleijenberg and Hans Knoop of the Expert Centre for Chronic Fatigue of Radboud University Nijmegen Medical Center in Nijmegen, Netherlands point out that many CFS advocacy groups have expressed concerns about the risks associated with CBT and graded exercise therapy, including further muscle fatigue.
"Few patients receiving cognitive behavior therapy or graded exercise therapy in the PACE trial had serious adverse reactions, and no more than those receiving adaptive pacing therapy or standard medical care," they write. "This finding is important and should be communicated to patients to dispel unnecessary concerns about the possible detrimental effects of cognitive behavior therapy and graded exercise therapy, which will hopefully be a useful reminder of the potential positive effects of both interventions."
CBT, Exercise Part of CFS Treatment
Nancy G. Klimas, MD, professor of medicine, microbiology, and immunology and director of the Chronic Fatigue Syndrome Research Center at the University of Miami Miller School of Medicine, says that CBT and exercise can be an important part of the treatment for CFS but should not be looked at as a cure-all.
"If this helps them a little, that's great, and if we can find something that gets at the underpinnings of the illness itself, that's great as well," she says.
In the U.K., where the study was conducted, CBT and exercise are both recommended in national treatment guidelines, and are all that are offered to people with CFS there, she says.
"If you come to see me for CFS, I can give you CBT and exercise, but that is not my primary focus," Klimas says. "I will look at your sleep disorders, check your immune function, and look for and treat active infections that are treatable."
Ronald Kanner, MD, chairman of neurology at North Shore-LIJ Health System in New Hyde Park, N.Y., agrees with Klimas. "I treat CFS with graded exercise, antidepressants, and CBT when possible," he says.
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