Marques, M M, De Gucht, V, Gouveia, M J et al. · Clinical psychology review · 2015 · DOI
This review looked at 16 studies testing whether combining talking therapy with gradually increased physical activity helps ME/CFS patients feel less tired and function better. The researchers found small to medium improvements in fatigue, daily functioning, and mood, especially when treatments involved less frequent face-to-face contact with providers or were delivered by psychologists in hospital settings.
This synthesis provides evidence that behavioral interventions with activity components show measurable benefits for ME/CFS fatigue and functioning. Identifying that minimal-contact and specialist-delivered interventions may be more effective could help guide future treatment development and resource allocation for ME/CFS patients.
This review does not establish that graded activity is safe or appropriate for all ME/CFS patients, particularly those with post-exertional malaise or severe disease. The small effect sizes and publication bias suggest benefits may be more modest than reported, and the heterogeneity means individual patients may respond very differently. Correlation between intervention and outcome does not confirm that activity itself (rather than other intervention components) drives improvement.
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
Marques, M M, De Gucht, V, Gouveia, M J, Leal, I, & Maes, S (2015). Differential effects of behavioral interventions with a graded physical activity component in patients suffering from Chronic Fatigue (Syndrome): An updated systematic review and meta-analysis.. Clinical psychology review. https://doi.org/10.1016/j.cpr.2015.05.009
BibTeX
@article{mecfsatlas-marques-2015-differential-effects,
author = {Marques, M M and De Gucht, V and Gouveia, M J and Leal, I and Maes, S},
title = {Differential effects of behavioral interventions with a graded physical activity component in patients suffering from Chronic Fatigue (Syndrome): An updated systematic review and meta-analysis.},
journal = {Clinical psychology review},
year = {2015},
doi = {10.1016/j.cpr.2015.05.009},
note = {PubMed: 26112761},
url = {https://www.mecfsatlas.com/evidence/marques-2015-differential-effects},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/marques-2015-differential-effects
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