Activity pacing self-management program helps in optimizing participation in desired life activities in women with CFS   January 1st, 2015

People with chronic fatigue syndrome (CFS) may be limited in activity performance and role fulfilment to a large extent. A lot of them enter a vicious circle of inactivity, leading to increased levels of fatigue. It is therefore important to break this negative process. One of the approaches is to facilitate people with CFS in self-managing their daily activity levels.

In a study with 33 women with CFS, an activity pacing self-management intervention to improve performance of daily life activities in women with chronic fatigue syndrome (CFS) was evaluated in a randomized controlled trial. The activity pacing self-management (, van Eupen et al., 2010) was compared to a relaxation program.

The activity pacing self-management program was delivered by an occupational therapist and consisted of a stabilization phase and a grading phase. In the first phase clients were coached how to perfor daily life activities within the limits of their actual performance in the areas of personal and child care, domestic care, productivity, and leisure. Once clients were able to control their daily life activities without excessive feelings of fatigue, the grading phase started where activity level increased gradually. Participants set achievable and relevant goals, based on prioritized activities. They worked on these goals using home-based techniques and equipment, reflections and logs. 
The relaxation program, delivered by a physical therapist, was organized similarly, and also used goal setting, home-based assignments and a stress-reaction diary. The focus was to practice and apply several relaxation techniques. Both programs were organized in three individual face-to-face meetings at the center.

To measure the effectiveness, an occupational or physical therapist used a semi-structured interview (Canadian Occupational Performance Measure, COPM) to explore problems in performing daily activities in the domains of self-care, productivity, and leisure. Participants scored their perceived performance of and satisfaction with relevant daily life activities (COPM) and self-reported feelings and consequences of fatigue (Checklist Individual Strength, CIS) before and after the intervention period of 3 weeks. Subjects who participated in the activity pacing self-management program, showed a significant improvement in performance of and satisfaction with relevant daily activities and perceived decreased feelings and consequences of fatigue, compared to those in the relaxation program.

This study supports the evidence of a feasible and effective activity pacing self-management program to reduce fatigue and improve participation of women with CFS. Further research is needed to explore the effectiveness in a larger sample and with longer follow-up period.

The self-management program studied here may be part of a multidisciplinary rehabilitation program ( Future research would need to clarify whether a combination of self-management and relaxation techniques would lead to increased effectiveness in activity performance and satisfaction.

Link to the publication:

References and further reading:

• Kos, D., van Eupen, I., Meirte, J., Van Cauwenbergh, D., Moorkens, G., Meeus, M., & Nijs, J. (2015). Activity pacing self-management in chronic fatigue syndrome: A randomized controlled trial. American Journal of Occupational Therapy, 69, 6905185090. 
• van Eupen I., Meeus M., Nijs J., Kos D. Chronischevermoeidheidssyndroom (CVS) en ergotherapie. In: Vlaams Ergotherapeutenverbond & Van Handenhove W. (red.). Jaarboek Ergotherapie 2010,17-32. 
• Kos D, Nijs J, Meeus M, Bihiyga S (eds) (2013). Revalidatie van chronische vermoeidheid bij CVS, MS en vermoeidheid na kanker. Leuven: Acco. 

Daphne Kos