A scoping review of 'Pacing' for management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): lessons learned for the long COVID pandemic. — ME/CFS Atlas
A scoping review of 'Pacing' for management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): lessons learned for the long COVID pandemic.
Sanal-Hayes, Nilihan E M, Mclaughlin, Marie, Hayes, Lawrence D et al. · Journal of translational medicine · 2023 · DOI
Quick Summary
This review looked at 17 studies about 'pacing'—a strategy where people with ME/CFS carefully manage their activity level to avoid making symptoms worse. The researchers found that studies on pacing had very different designs and results: some showed pacing helped, some showed no benefit, and a few suggested it could be harmful. The evidence so far isn't strong enough to confidently say whether pacing works best for everyone.
Why It Matters
Pacing is widely recommended for ME/CFS but remains controversial due to insufficient evidence. This systematic review clarifies the current state of pacing research and identifies critical gaps, directly informing treatment recommendations for both ME/CFS and emerging long COVID populations while highlighting the urgent need for higher-quality research.
Observed Findings
Eleven of 17 studies reported benefits of pacing, while four reported no effect and two reported detrimental effects.
Studies used primarily educational sessions and activity diaries as the main pacing administration methods.
Highly variable study designs, durations, and outcome measures were used across the literature.
Methodological quality was generally poor to fair across included studies.
No consensus definition of 'pacing' existed within the reviewed literature or among healthcare providers.
Inferred Conclusions
Current evidence is insufficient to confidently recommend pacing as a standard treatment for ME/CFS due to heterogeneous findings and poor methodological quality.
Future research should employ randomized controlled trials with objective, digitized activity monitoring over longer durations.
Standardized outcome measures (core outcome sets) and rigorous methodology are essential for determining pacing efficacy.
Findings have implications for long COVID management, where similar pacing approaches are being considered.
Remaining Questions
What is the optimal definition and implementation method for pacing in ME/CFS?
What This Study Does Not Prove
This review does not establish whether pacing is definitively effective or ineffective for ME/CFS—the inconsistent findings and methodological limitations prevent firm conclusions. It does not clarify optimal pacing implementation methods or which patient subgroups might benefit most. The findings do not establish causation between specific pacing approaches and symptom outcomes.
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 →
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