White, P D, Etherington, J · Journal of psychosomatic research · 2021 · DOI
This study reviewed 10 previous trials involving 1,279 people to examine whether graded exercise therapy (GET) causes harm in ME/CFS patients. Researchers compared how many people reported feeling much worse, stopped treatment, or dropped out of follow-up appointments between those doing GET and those receiving other treatments. The study found no clear evidence that GET caused more people to report feeling worse than other treatments, though more GET participants did drop out of follow-up appointments.
Safety concerns about GET are significant for ME/CFS patients considering this treatment. This comprehensive review directly addresses whether GET causes harm, providing evidence that informs patient decision-making and clinical practice. The findings help distinguish between actual adverse outcomes and dropout patterns, which may reflect different reasons for leaving studies.
This study does not prove GET is universally safe or effective for all ME/CFS patients—evidence certainty was low and results show no difference from controls in harm measures, not necessarily that GET is beneficial. It does not identify who might be at higher risk of negative outcomes or why dropout rates increased. The findings reflect published trials only, which may not capture all adverse events from clinical practice.
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
White, P D & Etherington, J (2021). Adverse outcomes in trials of graded exercise therapy for adult patients with chronic fatigue syndrome.. Journal of psychosomatic research. https://doi.org/10.1016/j.jpsychores.2021.110533
BibTeX
@article{mecfsatlas-white-2021-adverse-outcomes,
author = {White, P D and Etherington, J},
title = {Adverse outcomes in trials of graded exercise therapy for adult patients with chronic fatigue syndrome.},
journal = {Journal of psychosomatic research},
year = {2021},
doi = {10.1016/j.jpsychores.2021.110533},
note = {PubMed: 34091377},
url = {https://www.mecfsatlas.com/evidence/white-2021-adverse-outcomes},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/white-2021-adverse-outcomes
Contribute
Private, reviewed by a human. Not a public comment thread.