Graded exercise therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective and unsafe. Re-analysis of a Cochrane review



By Mark Vink and Alexandra Vink-Niese in Health Psychology Open.



The analysis of the 2017 Cochrane review reveals flaws, which means that contrary to its findings, there is no evidence that graded exercise therapy is effective. Because of the failure to report harms adequately in the trials covered by the review, it cannot be said that graded exercise therapy is safe. The analysis of the objective outcomes in the trials provides sufficient evidence to conclude that graded exercise therapy is an ineffective treatment for myalgic encephalomyelitis/chronic fatigue syndrome.

Keywords: chronic fatigue syndrome, Cochrane review, graded exercise therapy, myalgic encephalomyelitis


A recent Cochrane review of graded exercise therapy (GET) for chronic fatigue syndrome (CFS) concluded that GET is effective and safe (Larun et al., 2017). The review was to determine the effects of exercise therapy for patients with CFS as compared with any other intervention or control. It included eight randomised controlled studies and reported data from 1510 participants: Fulcher and White (1997) (66), Wearden et al. (1998) (136), Powell et al. (2001) (148), Wallman et al. (2004) (61), Moss-Morris et al. (2005) (49), Jason et al. (2007) (114), Wearden et al. (2010b) (296) and White et al. (2011) (640) (number of patients in each study between parentheses).

Larun et al. (2017) state that CFS is sometimes called myalgic encephalomyelitis (ME), but in the rest of their document, the term CFS is used. The same has been done here to avoid any confusion.

The review has been subject to criticism, for example, Kindlon (2015) and Courtney (2016). Here, we analyse the review and find seven general issues. We also identify a number of problems revealed in the original studies, including a failure to report harms. Our analysis shows the review’s conclusion that GET is effective and safe is not supported by the evidence. When the objective outcomes of the trials are considered, it is possible to state that GET is ineffective for CFS.


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