Graded Exercise Therapy for Chronic Fatigue Syndrome

We report the clinical and physiological outcome of a consecutive series of patients attending a chronic fatigue clinic in secondary care who were assessed for treatment with graded exercise therapy in a physiotherapy department. Our comparator was a previous research trial carried out in the same department ( Fulcher and White, 1997). Fifty-nine patients with chronic fatigue syndrome were routinely assessed and treated with graded exercise therapy. Patients also received appropriate treatments for sleep disturbance and/or mood disorders, when these were present. Of all patients assessed (intention to treat) 47% had a good clinical outcome, as judged by both self and therapist ratings (65 or 63% of those who actually completed treatment). This was a similar proportion to the 52% of patients with a good outcome in our comparative standard. Exercise capacity doubled and cardiovascular fitness also significantly improved with treatment: a better result than our standard in which exercise capacity increased by 18%, and 28% of patients dropped out of treatment prematurely, compared with 12% with our standard. Graded exercise therapy is a clinically useful treatment for chronic fatigue syndrome in about half of the patients referred to a physiotherapist, but a significant minority fail to complete their treatment successfully.