Gaunt, Daisy M, Brigden, Amberly, Harris, Shaun R S et al. · European journal of pediatrics · 2024 · DOI
This study compared two types of treatment for children with ME/CFS: graded exercise therapy (gradually increasing physical activity) and activity management (focusing on managing daily activities at school, home, and socially). After 6 and 12 months, both treatments showed only small improvements, and there was no clear difference between them. In fact, children receiving exercise therapy showed a slightly higher risk of getting worse.
This large, rigorously designed pragmatic trial directly addresses a major clinical question in paediatric ME/CFS: whether exercise-based interventions benefit children with this condition. The findings challenge the use of GET as first-line therapy and suggest activity management may be a safer, equally effective alternative, potentially shifting clinical practice toward more conservative approaches.
This study does not prove that exercise is harmful in ME/CFS—only that structured graded exercise therapy was not superior to activity management in this population. It does not address whether different exercise protocols, durations, intensities, or patient subgroups might respond differently. The modest improvements in both groups also limit conclusions about optimal treatment for paediatric ME/CFS overall.
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
Gaunt, Daisy M, Brigden, Amberly, Harris, Shaun R S, Hollingworth, William, Jago, Russell, Solomon-Moore, Emma, et al. (2024). Graded exercise therapy compared to activity management for paediatric chronic fatigue syndrome/myalgic encephalomyelitis: pragmatic randomized controlled trial.. European journal of pediatrics. https://doi.org/10.1007/s00431-024-05458-x
BibTeX
@article{mecfsatlas-gaunt-2024-graded-exercise,
author = {Gaunt, Daisy M and Brigden, Amberly and Harris, Shaun R S and Hollingworth, William and Jago, Russell and Solomon-Moore, Emma and Beasant, Lucy and Mills, Nicola and Sinai, Parisa and Crawley, Esther and Metcalfe, Chris},
title = {Graded exercise therapy compared to activity management for paediatric chronic fatigue syndrome/myalgic encephalomyelitis: pragmatic randomized controlled trial.},
journal = {European journal of pediatrics},
year = {2024},
doi = {10.1007/s00431-024-05458-x},
note = {PubMed: 38429546},
url = {https://www.mecfsatlas.com/evidence/gaunt-2024-graded-exercise},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/gaunt-2024-graded-exercise
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