A self–help approach to a graded exercise programme, supervised by a specialist physiotherapist over the phone or Skype™, is safe and may reduce fatigue for some people with chronic fatigue syndrome (CFS), according to a new trial of 200 people published in The Lancet. The intervention, undertaken over 12 weeks, had a smaller effect on reducing physical disability.

In this study, patients with CFS were randomly assigned to receive GES (107 patients) in addition to specialist medical care, or receive specialist medical care alone (104 patients). Specialist medical care could involve prescriptions or advice regarding medication to treat accompanying symptoms such as insomnia, pain or depressive illness.

Participants in the GES group were given a self–help booklet describing a 12–week, 6–step programme (developed with patient input) to gradually and safely increase physical activity levels. During the first eight weeks, participants in the GES group were also given up to four guidance sessions with a specialist physiotherapist over the phone or Skype™ to discuss progress and so that the physiotherapist could provide feedback and answer any questions.

In GES, patients first stabilise a routine to spread usual daily activities throughout the week. Once a routine is established, patients choose a physical activity they would be able to do on 5 days per week in addition to usual daily activities.

Most people chose walking, and it could be for a little as one minute per day. Once this is consistently achieved, participants then start to make a small increase (no more than 20 per cent per week) in the time they spend being physically active. For instance, someone walking for 5 minutes a day would increase that to 6 minutes a day. The time spent being active is slowly increased, and later on the intensity (e.g. walking a bit faster).

Importantly, if participants feel their symptoms increase after an incremental change in physical activity, they are advised by their specialist physiotherapist to maintain that activity level for longer than a week, until the symptoms have settled, before considering another increase.

All participants completed questionnaires to assess their levels of fatigue and physical function at the start of the trial and at 12 weeks, roughly 4 weeks after the GES guidance with the physiotherapist had ended. Nearly half (42 per cent) of the participants in the GES group adhered to the programme well or very well.

Overall, at 12 weeks, the mean fatigue score in the GES group was 4 points lower than in the control group, consistent with a moderate size effect. The mean physical function score was 6 points higher in the GES group than in the control group, consistent with a statistically significant but relatively small effect.

When rating their overall health, about 1 in 5 people in the GES group (18 per cent) reported feeling “much better” or “very much better”, compared to 1 in 20 (5 per cent) in the control group. This suggests that the self–help approach helped more people than specialist medical care alone, but still only helped a minority of patients to feel much better.

There were no reports of any serious adverse reactions to GES, after scrutiny by independent clinicians. When rating their overall health, only one person out of 97 participants reported feeling “much worse” or “very much worse” in the GES group, compared to eight people (8/101) in the specialist medical care group.

Dr Lucy Clark, lead author, Queen Mary University of London, said: “We found that a self–help approach to a graded exercise programme, guided by a therapist, was safe and also helped to reduce fatigue for some people with chronic fatigue syndrome, suggesting that GES might be useful as an initial treatment for patients to help manage symptoms of chronic fatigue syndrome. We are now looking at whether the effect