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

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

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.

• Journal Article Type: Article
• Acceptance Date: Nov 14, 2024
• Online Publication Date: Nov 29, 2024
• Deposit Date: Dec 9, 2024
• Publicly Available Date: Dec 9, 2024
• Journal: Fatigue: Biomedicine, Health & Behavior
• Print ISSN: 2164-1846
• Electronic ISSN: 2164-1862
• Publisher: Taylor and Francis
• Peer Reviewed: Peer Reviewed
• Pages: 1-18
• DOI: https://doi.org/10.1080/21641846.2024.2433390