Evaluating Pacing Therapy (PT) versus Graded Exercise Therapy (GET) for improving fatigue, pain, and quality of life in adults with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): A Systematic Review

This study aimed to evaluate the effectiveness of Pacing Therapy (PT) and Graded Exercise Therapy (GET) in improving fatigue, pain, and Quality of Life in adults with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), while also considering adverse events. Data were sourced from PubMed Central, Academic Search Complete, CINAHL, MEDLINE, Cochrane Library, Google Scholar, and manual citation searches from 2013 to 2023. Studies were related to PT, GET, and outcomes of fatigue, pain, and QOL. Out of 925 studies, six met the inclusion criteria, analyzing a total of 2280 participants. The methodological quality of these studies, assessed using the PEDro scale, ranged from good to poor. GET showed the highest recovery rates for ME/CFS, with 33% on the CFQ and 53% on the SF-36PF, compared to 21-22% and 35-41% for APT and SMC. Symptom improvements were reported by 44% post-PT, compared to 12% in GET (p<0.001). GET also resulted in less frequent muscle and joint pain compared to APT and SMC. GES participants scored 4.2 points lower on the CFQ and 6.3 points higher on the SF-36PF than SMC. APT and SMC showed significant improvements in fatigue and physical function at 2.5 years (p<0.0001). Adverse events were reported in two studies, with over 50% experiencing NSAEs, and serious deteriorations in fatigue and physical functioning noted across all groups. In conclusion, PT and GET are more effective than SMC, with GET being particularly favoured for improving pain, fatigue, and physical function. Adverse effects suggest that GET and PT are safer options than SMC.