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Exercise and cognitive behaviour therapy are best treatments for chronic fatigue syndrome

Zosia Kmietowicz, London

A review which found that exercise and cognitive behaviour therapy are the most effective treatments for chronic fatigue syndrome (CFS) is likely to split even further the two camps of patients, carers, and doctors who strongly disagree about the cause of the condition.

Simon Wessely, professor of epidemiological psychiatry at King's College, London,described the review as a "reasonable step forward that can help many people." But he added that the majority of the chronic fatigue syndrome community does not believe in the type of approach that was found to be the most helpful treatment option and would try to discredit the research.

The review was conducted by two independent teamsone from the NHS Centre for Reviews and Dissemination at the University of York and another from the San Antonio Evidence-based Practice Center at the University of Texas Health Science Center. It looked at 44 trials that included a total of 2800 patients (JAMA 2001;286:1360-8).

Overall, cognitive behaviour therapy (CBT) and graded exercise therapy (GET) showed the most promising results. Immunoglobulin and hydrocortisone showed some limited effects, but no definite conclusions could be drawn about them.

Professor Wessely expressed anger at the level of publicity the research has attracted, and said it would further damage the public's prejudice towards people with chronic fatigue. "If this review was about fatigue following treatment for cancer it would not be controversial, but because it is chronic fatigue it's a different story," he said.

In an editorial accompanying the review, Professor Wessely wrote: "It is regrettable but likely that this review article will not be universally welcomed. Some consumers, and researchers alike, will make it their mission to discredit the authors and their conclusions. Others may see the findings, especially related to the benefits of CBT, as confirming their prejudices as to the mental instability of patients with CFS."

He added that "such views are misguided" but widespread among the public, health professionals and employers.

Rather than argue about the cause of the condition the chronic fatigue syndrome community should, Professor Wessely said, build on the research by cooperating to perform more rigorous studies with more valid outcome measures than those used in the past.

"Despite years of trying we do not seem to be able to move away from the controversy that surrounds CFS and I have become depressed and despondent about the whole issue," he said. "People who have tried CBT and GET have high levels of satisfaction, but their availability within the NHS is pathetic and shameful."

Patient groups and clinicians should put aside their differences to try and improve the situation for the patients, he added.