Casson, Sally, Jones, Matthew D, Cassar, Joanne et al. · Disability and rehabilitation · 2023 · DOI
This review looked at 14 high-quality studies on activity pacing—a strategy where people with ME/CFS gradually increase their daily activities at a sustainable pace. The research found that activity pacing, especially when combined with slowly increasing both physical and cognitive tasks, helped reduce fatigue and tiredness, improved people's ability to do daily activities, and decreased anxiety and depression compared to no treatment.
Activity pacing is widely recommended in ME/CFS management, yet evidence for its effectiveness has been inconsistent. This high-quality systematic review provides robust evidence that activity pacing—particularly when structured to include gradual increases—can meaningfully reduce fatigue and improve function, supporting its use as part of collaborative, individualized treatment approaches.
This review does not establish whether activity pacing is superior to other ME/CFS interventions, nor does it prove that activity pacing works equally well for all ME/CFS patients or disease subtypes. The review also cannot distinguish whether observed improvements are due to activity pacing alone or to concurrent interventions in multi-component programs, and it does not clarify optimal pacing protocols or intensity thresholds to avoid post-exertional exacerbation.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Casson, Sally, Jones, Matthew D, Cassar, Joanne, Kwai, Natalie, Lloyd, Andrew R, Barry, Benjamin K, et al. (2023). The effectiveness of activity pacing interventions for people with chronic fatigue syndrome: a systematic review and meta-analysis.. Disability and rehabilitation. https://doi.org/10.1080/09638288.2022.2135776
BibTeX
@article{mecfsatlas-casson-2023-effectiveness-activity,
author = {Casson, Sally and Jones, Matthew D and Cassar, Joanne and Kwai, Natalie and Lloyd, Andrew R and Barry, Benjamin K and Sandler, Carolina X},
title = {The effectiveness of activity pacing interventions for people with chronic fatigue syndrome: a systematic review and meta-analysis.},
journal = {Disability and rehabilitation},
year = {2023},
doi = {10.1080/09638288.2022.2135776},
note = {PubMed: 36345726},
url = {https://www.mecfsatlas.com/evidence/casson-2023-effectiveness-activity},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-25. https://www.mecfsatlas.com/evidence/casson-2023-effectiveness-activity
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