Nijs, Jo, Roussel, Nathalie, Van Oosterwijck, Jessica et al. · Clinical rheumatology · 2013 · DOI
Many people with ME/CFS and fibromyalgia avoid physical activity because they fear it will make their symptoms worse—a concern that is often justified by their experience. This review looked at how common this fear and avoidance are, how they affect people's lives, and what treatments work best. The research found that fear of movement is very prevalent in both conditions and is linked to worse symptoms and lower quality of life.
Understanding fear of movement and avoidance behavior is critical for ME/CFS care because these responses significantly impact disability and quality of life, yet are potentially modifiable through targeted psychological and physical interventions. Identifying which patients exhibit these patterns may help clinicians personalize treatment strategies and improve clinical outcomes.
This review does not establish causality between fear of movement and symptom exacerbation, nor does it prove that graded exercise is universally safe or effective for all ME/CFS patients. The synthesis relies on existing literature quality, which may vary in rigor, and does not provide new primary evidence of treatment efficacy.
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
Nijs, Jo, Roussel, Nathalie, Van Oosterwijck, Jessica, De Kooning, Margot, Ickmans, Kelly, Struyf, Filip, et al. (2013). Fear of movement and avoidance behaviour toward physical activity in chronic-fatigue syndrome and fibromyalgia: state of the art and implications for clinical practice.. Clinical rheumatology. https://doi.org/10.1007/s10067-013-2277-4
BibTeX
@article{mecfsatlas-nijs-2013-fear-movement,
author = {Nijs, Jo and Roussel, Nathalie and Van Oosterwijck, Jessica and De Kooning, Margot and Ickmans, Kelly and Struyf, Filip and Meeus, Mira and Lundberg, Mari},
title = {Fear of movement and avoidance behaviour toward physical activity in chronic-fatigue syndrome and fibromyalgia: state of the art and implications for clinical practice.},
journal = {Clinical rheumatology},
year = {2013},
doi = {10.1007/s10067-013-2277-4},
note = {PubMed: 23639990},
url = {https://www.mecfsatlas.com/evidence/nijs-2013-fear-movement},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/nijs-2013-fear-movement
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