Cooper, Charlotte, Papadopoulos, Konstantinos · Journal of bodywork and movement therapies · 2025 · DOI
This review compared two common treatment approaches for ME/CFS: pacing therapy (learning to manage activity carefully) and graded exercise therapy (gradually increasing exercise). Researchers looked at six studies involving 2,280 patients to see which approach helped most with fatigue, pain, and quality of life. The results suggest both therapies helped more than standard care alone, though they worked differently—pacing therapy showed more symptom improvement in most patients, while graded exercise therapy was better for reducing pain and improving physical function.
ME/CFS patients and clinicians urgently need evidence about which treatments work best and safest. This systematic review directly compares the two most commonly recommended behavioral therapies, helping patients and providers make informed decisions about treatment approaches. Understanding that different therapies may help different symptoms is important for personalized care planning.
This review does not prove that either therapy is a cure for ME/CFS, nor does it establish causation regarding improvements. The high reported adverse event rates (>50% across groups) raise important questions about study definitions and reporting. The small number of studies and variable quality mean these findings may not apply equally to all ME/CFS patients.
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
Cooper, Charlotte & Papadopoulos, Konstantinos (2025). 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.. Journal of bodywork and movement therapies. https://doi.org/10.1016/j.jbmt.2025.05.048
BibTeX
@article{mecfsatlas-cooper-2025-evaluating-pacing,
author = {Cooper, Charlotte and Papadopoulos, Konstantinos},
title = {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.},
journal = {Journal of bodywork and movement therapies},
year = {2025},
doi = {10.1016/j.jbmt.2025.05.048},
note = {PubMed: 40954597},
url = {https://www.mecfsatlas.com/evidence/cooper-2025-evaluating-pacing},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/cooper-2025-evaluating-pacing
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