Sanal-Hayes, Nilihan E M, Mclaughlin, Marie, Hayes, Lawrence D et al. · Journal of translational medicine · 2023 · DOI
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.
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.
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 →
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
Sanal-Hayes, Nilihan E M, Mclaughlin, Marie, Hayes, Lawrence D, Mair, Jacqueline L, Ormerod, Jane, Carless, David, et al. (2023). A scoping review of 'Pacing' for management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): lessons learned for the long COVID pandemic.. Journal of translational medicine. https://doi.org/10.1186/s12967-023-04587-5
BibTeX
@article{mecfsatlas-sanal-hayes-2023-scoping-review,
author = {Sanal-Hayes, Nilihan E M and Mclaughlin, Marie and Hayes, Lawrence D and Mair, Jacqueline L and Ormerod, Jane and Carless, David and Hilliard, Natalie and Meach, Rachel and Ingram, Joanne and Sculthorpe, Nicholas F},
title = {A scoping review of 'Pacing' for management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): lessons learned for the long COVID pandemic.},
journal = {Journal of translational medicine},
year = {2023},
doi = {10.1186/s12967-023-04587-5},
note = {PubMed: 37838675},
url = {https://www.mecfsatlas.com/evidence/sanal-hayes-2023-scoping-review},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/sanal-hayes-2023-scoping-review
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