Home > Research > Publications & Outputs > ‘Pacing’ for management of myalgic encephalomye...

Associated organisational unit

Links

Text available via DOI:

View graph of relations

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

Research output: Contribution to Journal/MagazineReview articlepeer-review

Published
  • 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
Close
<mark>Journal publication date</mark>31/01/2025
<mark>Journal</mark>Fatigue: Biomedicine, Health Behavior
Issue number1
Volume13
Number of pages18
Pages (from-to)36-53
Publication StatusPublished
Early online date29/11/24
<mark>Original language</mark>English

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.