2016 Cochrane review of exercise therapy for CFS: Exercise therapy for chronic fatigue syndrome. Larun L, Brurberg KG, Odgaard-Jensen J, Price JR Cochrane Database Syst Rev. 2016 Jan 1;6. link to article The Fine trial (PACE’s ‘sister study’, looked at more severe patients): Nurse led, home based self help treatment for patients in primary care with chronic fatigue syndrome: randomised controlled trial. Wearden AJ, Dowrick C, Chew-Graham C, Bentall RP, Morriss RK, Peters S, Riste L, Richardson G, Lovell K, Dunn G. BMJ. 2010 Apr 23;340:c1777. link to article The published study protocol is available here. This trial has been called the “sister trial” to PACE. Nearly 300 individuals diagnosed with Oxford-defined CFS (which considers only fatigue) took part, including a sizeable number described as “non-ambulatory”. The group was, on average, more severely affected than the group that participated in PACE. Participants were assigned to three groups: a) pragmatic rehabilitation; b) supportive listening; or c) medical treatment as usual. The two therapy programmes consisted of 10 sessions and were delivered at home by general nurses. At the completion of the programmes, self-assessed fatigue – but not physical function - was marginally better for the pragmatic rehabilitation group than for the other two groups. However, at the trial’s primary endpoint which was a year later, there were no longer any significant group differences. A 2015 paper attempted to explore the psychological factors that predicted improvement at the primary endpoint (which is puzzling, given that the trial did not yield any reliable treatment effects).This also reported that there were no group differences on an objective measure of fitness (based on the step test). The SMILE Trial (Trial evaluating the effectiveness of the Lightning Process for kids and teenagers) Clinical and cost-effectiveness of the Lightning Process in addition to specialist medical care for paediatric chronic fatigue syndrome: randomised controlled trial. Crawley EM, Gaunt DM, Garfield K, Hollingworth W, Sterne JA, Beasant L, Collin SM, Mills N, Montgomery AA. Archives of Disease in Childhood. 2017 Sep 20:archdischild-2017. link to article Published Trial protocol can be found here, and the published feasibility study here. Feasability study for the proposed MAGENTA Trial (Trial of CBT/GET for kids and teenagers) Managed Activity Graded Exercise in Teenagers and pre-Adolescents (MAGENTA) feasibility randomised controlled trial: study protocol. Brigden A, Beasant L, Hollingworth W, Metcalfe C, Gaunt D, Mills N, Jago R, Crawley E. BMJ open. 2016 Jul 1;6(7):e011255. link to article Guided graded exercise self-help plus specialist medical care versus specialist medical care alone for chronic fatigue syndrome (GETSET): a pragmatic randomised controlled trial. Clark LV, Pesola F, Thomas JM, Vergara-Williamson M, Beynon M, White PD. The Lancet. 2017 Jul 22;390(10092):363-73. link to article Neurocognitive improvements after best-practice intervention for chronic fatigue syndrome: Preliminary evidence of divergence between objective indices and subjective perceptions. Cvejic E, Lloyd AR, Vollmer-Conna U. Comprehensive Psychiatry. 2016 Apr 30;66:166-75. link to abstract 25 CFS patients (Fukuda definition) completed a short graded exercise therapy (GET) programme. After the GET, participants reported some improvements on fatigue and cognitive symptoms. They also performed better on several demanding cognitive tasks (on some of these, their heart rate was also less elevated during the task, and returned to resting level faster, suggesting they were exerting less mental effort). However, the study did not have a control group, so all these effects could be down to spontaneous improvement - and in the case of the cognitive tasks, recent practice on the tasks. Finally, the study found that self-reported cognitive function did not correlate well with actual task performance. The authors conclude that self-reports are not that reliable in CFS, and they recommended the inclusion of more objective cognitive measures in future studies.