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The symptoms of chronic fatigue syndrome, including physical
deconditioning and abnormal circadian rhythm, may be perpetuated by
avoiding exercise. Powell et al (p 387) performed a randomised controlled trial of a structured educational intervention that provided
patients with a physiological rationale for graded exercise. At one
year follow up patients who had received the intervention showed
substantial clinical improvement compared with those who did not. The
authors say that the programme may be more cost effective than
cognitive behavioural therapy.