Summary of findings 3. Exercise therapy versus adaptive pacing therapy for chronic fatigue syndrome.
| Exercise therapy versus adaptive pacing therapy for chronic fatigue syndrome | ||||||
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Patient or population: men and women aged over 18 years with chronic fatigue syndrome Intervention: exercise therapy Comparison: adaptive pacing Setting: outpatient/primary care | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Adaptive pacing | Exercise | |||||
|
Fatigue Measured at end of treatment, 24 weeks Measured with Chalder Fatigue Scale, 0‐33 points Low score means less fatigue |
Mean fatigue score was 23.7 points | Mean fatigue score in the exercise group was 2.00 lower (3.57 lower to 0.43 lower) | 305 (1 study) | ⊕⊕⊝⊝ Lowa,b | Exercise therapy may slightly reduce fatigue after 12‐26 weeks | |
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Fatigue Measured at end of treatment, 52 weeks Measured with Chalder Fatigue Scale, 0‐33 points Low score means less fatigue |
Mean fatigue score was 23.1 points | Mean fatigue score in the exercise group was 2.50 lower (4.16 lower to 0.84 lower) | 307 (1 study) |
⊕⊕⊝⊝ Lowa,b | Exercise therapy may slightly reduce fatigue after 52 weeks | |
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Participants with serious adverse reactions Measured after 52 weeks Measured according to European Union Clinical Trials Directive by recording the number of serious reactions |
Study population | RR 0.99 (0.14 to 6.97) | 319 (1 study) | ⊕⊝⊝⊝ Very lowc,d,e | The impact of exercise therapy on serious adverse reactions is uncertain | |
| 13 per 1000 | 12 per 1000 (2 to 87) | |||||
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Pain End of treatment and long term |
‐ | No studies looked at pain | ||||
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Physical functioning Measured at end of treatment, 24 weeks Measured with SF‐36 physical functioning subscale, 0‐100 points High score means better physical functioning |
Mean physical functioning score was 43.2 points | Mean physical functioning score in the exercise group was 12.20 points higher (7.17 higher to 17.23 higher) | 305 (1 study) | ⊕⊕⊝⊝ Lowa,b | Exercise therapy may slightly improve physical functioning after 24 weeks | |
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Physical functioning Measured at end of treatment, 52 weeks Measured with SF‐36 physical functioning subscale, 0‐100 points High score means better physical functioning |
Mean physical functioning score was 45.9 points | Mean physical functioning score in the exercise group was 11.80 points higher (6.05 higher to 17.55 higher) | 307 (1 study) |
⊕⊕⊝⊝ Lowa,b | Exercise therapy may slightly improve physical functioning after 52 weeks | |
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Quality of Life (QOL) End of treatment and long term |
‐ | No studies looked at quality of life | ||||
|
Depression Measured at end of treatment |
‐ | No studies looked at depression at end of treatment | ||||
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Depression Measured after 52 weeks HADS depression score, 0‐21 points Low score means fewer symptoms |
Mean depression score was 7.2 points | Mean depression score in the exercise group was 1.10 points lower (2.09 lower to 0.11 lower) | 293 (1 study) | ⊕⊕⊝⊝ Lowa,b | Exercise therapy may slightly reduce depression after 52 weeks | |
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Sleep Measured at end of treatment |
‐ | No studies looked at sleep at end of treatment | ||||
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Sleep Measured after 52 weeks Jenkins Sleep Scale, 0‐20 points Low score means better sleep |
Mean sleep score was 10.6 points | Mean sleep score in the exercise group was 1.60 points lower (2.70 lower to 0.50 lower) | 294 (1 study) |
⊕⊕⊝⊝ Lowa,b | Exercise therapy may slightly improve sleep after 52 weeks | |
| *The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; HADS: Hospital Anxiety and Depression Scale; QoL: quality of life; RR: risk ratio; SF‐36: Short Form 36; SMD: standardised mean difference | ||||||
| GRADE Working Group grades of evidence. High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. | ||||||
aRisk of bias (‐1): all studies were at risk of performance bias, as they were unblinded. bImprecision (‐1): single study, low numbers of events or wide confidence intervals. cRisk of bias (0): this outcome is unlikely to have been affected by detection or performance bias. dImprecision (‐2): single study and very wide confidence intervals. eThe only available trial was not powered to detect differences this outcome.