‘Pacing’ for management of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): a systematic review and meta-analysis

Nilihan E.M. Sanal - Hayes, Marie Mclaughlin, Jacqueline L. Mair, Jane Ormerod, David Carless, Rachel Meach, Natalie Hilliard, Joanne Ingram, Nicholas F. Sculthorpe, Lawrence D. Hayes*

*Corresponding author for this work

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Abstract

Background
Pacing typically comprises regulating activity to avoid post-exertional neuroimmune exhaustion, the worsening of symptoms after an activity. Yet, the efficacy of pacing to improve symptomology is unclear.

Objective
We aimed to undertake a PRISMA-accordant meta-analysis concerning the effect of pacing on ME/CFS patients’ symptoms.

Data sources
Six electronic databases (PubMed, Scholar, ScienceDirect, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials [CENTRAL]) were searched; and websites MEPedia, Action for ME, and ME Action were also searched for grey literature.

Study selection
Studies (k = 5) selected from the 210 identified included randomised controlled trials (RCTs; k = 2), uncontrolled trials (UCTs; k = 1), intervention case series (k = 1), and sub-analysis of the PACE trial (k = 1), all of which had a pacing component, and an outcome measure reported pre- and post-pacing.

Study appraisal and methods
Three separate meta-analyses were conducted on changes in symptoms using standardised mean differences (SMDs) and random-effects models.

Results
The overall SMD showed pacing improved physical function (k = 4, SMD = 0.15 [95% CI = −0.39, 0.68], p = 0.5951). Pacing improved pain (k = 4, SMD = −0.11 [95% CI = −0.32, 0.10], p = 0.3090). Pacing improved fatigue (k = 4, SMD = −1.09 [95% CI = −2.38, 0.21], p = 0.0998).

Conclusions
Pacing exerted a trivial beneficial effect on physical function and pain. Fatigue was improved with a large effect, which did reach the p < 0.05 level. We cautiously conclude pacing likely exerts some beneficial effects on symptomology, particularly, fatigue, in people with ME/CFS. However, the level of empirical research is insufficient, and more high-quality RCTs are essential to support the NICE guidelines.
Original languageEnglish
Pages (from-to)36-53
Number of pages18
JournalFatigue: Biomedicine, Health & Behavior
Volume13
Issue number1
Early online date29 Nov 2024
DOIs
Publication statusPublished - 2025

Keywords

  • pacing
  • myalgic encephalomyelitis
  • chronic fatigue syndrome
  • physical function
  • pain, fatigue

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