Wiborg, J F, Knoop, H, Stulemeijer, M et al. · Psychological medicine · 2010 · DOI
This study looked at whether cognitive behaviour therapy (CBT) helps ME/CFS patients feel less tired by making them more physically active. Researchers tracked physical activity levels in three separate CBT trials using movement monitors (actigraphy) before and after treatment. Surprisingly, they found that while CBT did reduce fatigue, patients were not actually moving more after treatment—and the small amount of increased activity that did occur wasn't connected to feeling less tired.
This finding challenges the common assumption that CBT works for ME/CFS by encouraging patients to gradually increase physical activity. Understanding the actual mechanisms by which CBT reduces fatigue helps clinicians better tailor treatments and helps patients understand what to expect from therapy beyond simple activity increases.
This study does not prove that physical activity is harmful or that increasing activity cannot help some patients. It only shows that increased activity is not the primary mechanism through which CBT reduces fatigue in this population. The study also cannot determine what other factors (psychological, cognitive, or physiological) might actually be responsible for CBT's benefits.
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
Wiborg, J F, Knoop, H, Stulemeijer, M, Prins, J B, & Bleijenberg, G (2010). How does cognitive behaviour therapy reduce fatigue in patients with chronic fatigue syndrome? The role of physical activity.. Psychological medicine. https://doi.org/10.1017/S0033291709992212
BibTeX
@article{mecfsatlas-wiborg-2010-how-does,
author = {Wiborg, J F and Knoop, H and Stulemeijer, M and Prins, J B and Bleijenberg, G},
title = {How does cognitive behaviour therapy reduce fatigue in patients with chronic fatigue syndrome? The role of physical activity.},
journal = {Psychological medicine},
year = {2010},
doi = {10.1017/S0033291709992212},
note = {PubMed: 20047707},
url = {https://www.mecfsatlas.com/evidence/wiborg-2010-how-does},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/wiborg-2010-how-does
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