{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T10:24:46Z","timestamp":1769509486100,"version":"3.49.0"},"reference-count":181,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T00:00:00Z","timestamp":1743552000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>The British National Institute for Health and Care Excellence (NICE) published its updated guidelines for myalgic encephalomyelitis\/chronic fatigue syndrome (ME\/CFS) in October 2021. NICE concluded, after an extensive review of the literature, that graded exercise therapy (GET) is harmful and should not be used, and that cognitive behavioural therapy (CBT) is only an adjunctive and not a curative treatment. An article by White et al., which is written by 51 researchers, claims that there are eight anomalies in the review process and the interpretation of the evidence by NICE. In this article, we reviewed the evidence they used to support their claims. Their three most important claims are that NICE redefined the disease, that CBT and GET are effective, and that fixed incremental increases are not part of GET. However, our analysis shows that the disease was not redefined by NICE. Instead, it was redefined in the 1990s by a group of doctors, including a number of authors of White et al., when they erased the main characteristic of the disease (an abnormally delayed muscle recovery after trivial exertion, which, over the years, has evolved into post-exertional malaise) and replaced it with chronic disabling severe fatigue. Their own studies show that CBT and GET do not lead to a substantial improvement of the quality-of-life scores or a reduction in CFS symptom count, nor do they lead to objective improvement. Also, both treatments have a negative instead of a positive effect on work and disability status. Moreover, a recent systematic review, which included one of the authors of White et al., showed that ME\/CFS patients remain severely disabled after treatment with CBT. Our analysis of, for example, the PACE trial\u2019s GET manual for therapists exposes the fixed incremental nature of GET. Why the authors are not aware of that is unclear because eight of them were involved in the PACE trial. Three of them were centre leaders and its principal investigators, four others were also centre leaders, and another one was one of the three independent safety assessors of the trial. Moreover, many of these eight authors wrote, or were involved in writing, this manual. In conclusion, our analysis shows that the arguments that are used to claim that there are eight anomalies in the review process and the interpretation of the evidence by NICE are anomalous and highlight the absence of evidence for the claims that are made. Furthermore, our analysis not only exposes the fixed incremental nature of GET, but also of CBT for ME\/CFS.<\/jats:p>","DOI":"10.3390\/life15040584","type":"journal-article","created":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T07:47:44Z","timestamp":1743580064000},"page":"584","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The PACE Trial\u2019s GET Manual for Therapists Exposes the Fixed Incremental Nature of Graded Exercise Therapy for ME\/CFS"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1079-5647","authenticated-orcid":false,"given":"Mark","family":"Vink","sequence":"first","affiliation":[{"name":"Family and Insurance Physician, Independent Researcher, 1096 HZ Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katarzyna","family":"Partyka-Vink","sequence":"additional","affiliation":[{"name":"Independent Researcher, 49032 Osnabr\u00fcck, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,2]]},"reference":[{"key":"ref_1","unstructured":"(2025, January 23). NICE Myalgic Encephalomyelitis (or Encephalopathy)\/Chronic Fatigue Syndrome: Diagnosis and Management. Available online: https:\/\/www.nice.org.uk\/guidance\/ng206."},{"key":"ref_2","unstructured":"Institute of Medicine (IOM) (2015). Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome; Board on the Health of Select Populations, Beyond Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome: Redefining an Illness."},{"key":"ref_3","unstructured":"Gezondheidsraad (2025, January 23). ME\/CVS. Den Haag: Gezondheidsraad, 2018; Publicatienr. 2018\/07. Available online: https:\/\/huisartsvink.files.wordpress.com\/2021\/01\/gezondheidsraad-kernadvies_me_cvs.pdf."},{"key":"ref_4","unstructured":"(2025, March 11). Hoge Gezondheidsraad Myalgische Encefalomyelitis\/Chronisch Vermoeidheidssyndroom HGR NR. 9508. Available online: https:\/\/www.health.belgium.be\/sites\/default\/files\/uploads\/fields\/fpshealth_theme_file\/20201020_hgr-9508_cvs_vweb.pdf."},{"key":"ref_5","unstructured":"(2025, January 23). IQWiG Abschlussbericht N21-01, Version 1.0, ME\/CFS: Aktueller Kenntnisstand, IQWiG-Berichte\u2014Nr. 1539. Available online: https:\/\/www.bundesgesundheitsministerium.de\/fileadmin\/Dateien\/5_Publikationen\/Gesundheit\/Berichte\/ME-CFS-aktueller-Kenntnisstand_Abschlussbericht_V1-0.pdf."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1136\/jnnp-2022-330463","article-title":"Anomalies in the review process and interpretation of the evidence in the NICE guideline for chronic fatigue syndrome and myalgic encephalomyelitis","volume":"94","author":"White","year":"2023","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2148","DOI":"10.1038\/s41591-024-03173-6","article-title":"Long COVID science, research and policy","volume":"30","author":"Davis","year":"2024","journal-title":"Nat. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"106297","DOI":"10.1016\/j.jinf.2024.106297","article-title":"The persistence of myalgic encephalomyelitis\/chronic fatigue syndrome (ME\/CFS) after SARS-CoV-2 infection: A systematic review and meta-analysis","volume":"89","author":"Dehlia","year":"2024","journal-title":"J. Infect."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1186\/s12967-020-02269-0","article-title":"Systematic review and meta-analysis of the prevalence of chronic fatigue syndrome\/myalgic encephalomyelitis (CFS\/ME)","volume":"18","author":"Lim","year":"2020","journal-title":"J. Transl. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"03019","DOI":"10.7189\/jogh.13.03019","article-title":"The economic burden of the post-COVID-19 condition: Underestimated long-term consequences of neuropsychological deficits","volume":"13","author":"Voruz","year":"2023","journal-title":"J. Glob. Health"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Rohrhofer, J., Hauser, L., Lettenmaier, L., Lutz, L., Koidl, L., Gentile, S.A., Ret, D., Stingl, M., and Untersmayr, E. (2024). Immunological Patient Stratification in Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome. J. Clin. Med., 13.","DOI":"10.3390\/jcm13010275"},{"key":"ref_12","first-page":"26","article-title":"Management of chronic (post-viral) fatigue syndrome","volume":"39","author":"Wessely","year":"1989","journal-title":"J. R. Coll. Gen. Pract."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/0005-7967(94)00077-W","article-title":"Chronic Fatigue Syndrome: A cognitive approach","volume":"33","author":"Surawy","year":"1995","journal-title":"Behav. Res. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/S0022-3999(98)00023-3","article-title":"The persistence of fatigue in chronic fatigue syndrome and multiple sclerosis: Development of a model","volume":"45","author":"Vercoulen","year":"1998","journal-title":"J. Psychosom. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1177\/1742395316644770","article-title":"Housebound versus nonhousebound patients with myalgic encephalomyelitis and chronic fatigue syndrome","volume":"12","author":"Pendergrast","year":"2016","journal-title":"Chronic Illn."},{"key":"ref_16","unstructured":"Edwards, E. (2025, January 23). Available online: https:\/\/www.s4me.info\/threads\/anomalies-in-the-review-process-and-interpretation-of-the-evidence-in-the-NICE-guideline-for-cfs-me-2023-white-et-al.34097\/page-18#post-483961."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/1476-5918-4-10","article-title":"Time course of exercise induced alterations in daily activity in chronic fatigue syndrome","volume":"4","author":"Black","year":"2005","journal-title":"Dyn. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e14138","DOI":"10.14814\/phy2.14138","article-title":"Abnormal blood lactate accumulation during repeated exercise testing in myalgic encephalomyelitis\/chronic fatigue syndrome","volume":"7","author":"Lien","year":"2019","journal-title":"Physiol. Rep."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Kujawski, S., Cossington, J., S\u0142omko, J., Zawadka-Kunikowska, M., Tafil-Klawe, M., Klawe, J.J., Buszko, K., Jakovljevic, D.G., Kozakiewicz, M., and Morten, K.J. (2021). On Behalf Of The European Network On Me\/Cfs Euromene. Relationship between Cardiopulmonary, Mitochondrial and Autonomic Nervous System Function Improvement after an Individualised Activity Programme upon Chronic Fatigue Syndrome Patients. J. Clin. Med., 10.","DOI":"10.3390\/jcm10071542"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1046\/j.1468-1331.1999.610063.x","article-title":"Demonstration of delayed recovery from fatiguing exercise in chronic fatigue syndrome","volume":"6","author":"Paul","year":"1999","journal-title":"Eur. J. Neurol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1111\/j.1365-2796.2011.02405.x","article-title":"Gene expression alterations at baseline and following moderate exercise in patients with Chronic Fatigue Syndrome and Fibromyalgia Syndrome","volume":"271","author":"Light","year":"2012","journal-title":"J. Intern. Med."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Stevens, S., Snell, C., Stevens, J., Keller, B., and VanNess, J.M. (2018). Cardiopulmonary Exercise Test Methodology for Assessing Exertion Intolerance in Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome. Front. Pediatr., 6.","DOI":"10.3389\/fped.2018.00242"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1089\/jwh.2009.1507","article-title":"Postexertional malaise in women with chronic fatigue syndrome","volume":"19","author":"VanNess","year":"2010","journal-title":"J. Womens Health"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1016\/j.jpain.2009.06.003","article-title":"Moderate Exercise Increases Expression for Sensory, Adrenergic, and Immune Genes in Chronic Fatigue Syndrome Patients but Not in Normal Subjects","volume":"10","author":"Light","year":"2009","journal-title":"J. Pain"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"14841492","DOI":"10.2522\/ptj.20110368","article-title":"Discriminative validity of metabolic and workload measurements for identifying people with chronic fatigue syndrome","volume":"93","author":"Snell","year":"2013","journal-title":"Phys. Ther."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/1479-5876-12-20","article-title":"Decreased oxygen extraction during cardiopulmonary exercise test in patients with chronic fatigue syndrome","volume":"12","author":"Vermeulen","year":"2014","journal-title":"J. Transl. Med."},{"key":"ref_27","first-page":"615","article-title":"Severity of symptom flare after moderate exercise is linked to cytokine activity in chronic fatigue syndrome","volume":"47","author":"White","year":"2010","journal-title":"Psychophysiology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1768","DOI":"10.3109\/09638288.2010.546936","article-title":"Diagnostic accuracy of symptoms characterising chronic fatigue syndrome","volume":"33","author":"Davenport","year":"2011","journal-title":"Disabil. Rehabil."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1186\/s12967-024-05410-5","article-title":"Cardiopulmonary and metabolic responses during a 2-day CPET in myalgic encephalomyelitis\/chronic fatigue syndrome: Translating reduced oxygen consumption to impairment status to treatment considerations","volume":"22","author":"Keller","year":"2024","journal-title":"J. Transl. Med."},{"key":"ref_30","unstructured":"Ramsay, M.A. (1988). Myalgic Encephalomyelitis and Post Viral Fatigue States: The Saga of Royal Free Disease, Gower Medical Publishing. [2nd ed.]."},{"key":"ref_31","unstructured":"Stephens, C. (2025, January 23). MEA Summary Review: Assessing PEM\u2014The Characteristic Symptom of ME\/CFS. Available online: https:\/\/meassociation.org.uk\/wp-content\/uploads\/MEA-Research-Review-Assessing-PEM-in-MECFS-25.03.19.pdf."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1177\/014107689108400224","article-title":"A report\u2014Chronic fatigue syndrome: Guidelines for research","volume":"84","author":"Sharpe","year":"1991","journal-title":"J. R. Soc. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"953","DOI":"10.7326\/0003-4819-121-12-199412150-00009","article-title":"The chronic fatigue syndrome: A comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group","volume":"121","author":"Fukuda","year":"1994","journal-title":"Ann. Intern. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1111\/j.1365-2753.2010.01512.x","article-title":"A review of the definitional criteria for chronic fatigue syndrome","volume":"18","author":"Christley","year":"2012","journal-title":"J. Eval. Clin. Pract."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1177\/1359105319847261","article-title":"Assessment of the scientific rigour of randomized controlled trials on the effectiveness of cognitive behavioural therapy and graded exercise therapy for patients with myalgic encephalomyelitis\/chronic fatigue syndrome: A systematic review","volume":"25","author":"Ahmed","year":"2020","journal-title":"J. Health Psychol."},{"key":"ref_36","unstructured":"Hooper, M., and Williams, M. (2025, January 23). MAGICAL MEDICINE: How to Make a Disease Disappear. Available online: https:\/\/www.margaretwilliams.me\/2010\/magical-medicine-press-release_12feb2010.pdf."},{"key":"ref_37","unstructured":"Smith, M.E.B., Nelson, H.D., Haney, E., Pappas, M., Daeges, M., Wasson, N., and McDonagh, M. (2025, January 26). Diagnosis and Treatment of Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome. Evidence Report\/Technology Assessment No. 219, Available online: https:\/\/effectivehealthcare.ahrq.gov\/products\/chronic-fatigue\/research."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"427","DOI":"10.7861\/clinmedicine.2-5-427","article-title":"The report of the Chief Medical Officer\u2019s CFS\/ME working group: What does it say and will it help?","volume":"2","author":"Sharpe","year":"2002","journal-title":"Clin. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1007\/s11606-021-07188-4","article-title":"Evidence-Based Care for People with Chronic Fatigue Syndrome and Myalgic Encephalomyelitis","volume":"37","author":"Sharpe","year":"2022","journal-title":"J. Gen. Intern. Med."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Vink, M., and Vink-Niese, A. (2022). The Updated NICE Guidance Exposed the Serious Flaws in CBT and Graded Exercise Therapy Trials for ME\/CFS. Healthcare, 10.","DOI":"10.3390\/healthcare10050898"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Wilshire, C.E., Kindlon, T., Courtney, R., Matthees, A., Tuller, D., Geraghty, K., and Levin, B. (2018). Rethinking the treatment of chronic fatigue syndrome-a reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT. BMC Psychol., 6.","DOI":"10.1186\/s40359-018-0218-3"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Vink, M., and Vink-Niese, F. (2019). Work Rehabilitation and Medical Retirement for Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome Patients. A Review and Appraisal of Diagnostic Strategies. Diagnostics, 9.","DOI":"10.3390\/diagnostics9040124"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Vink, M., and Vink-Niese, F. (2022). Is It Useful to Question the Recovery Behaviour of Patients with ME\/CFS or Long COVID?. Healthcare, 10.","DOI":"10.3390\/healthcare10020392"},{"key":"ref_44","first-page":"1","article-title":"An analysis of Dutch hallmark studies confirms the outcome of the PACE trial: Cognitive behaviour therapy with a graded activity protocol is not effective for chronic fatigue syndrome and Myalgic Encephalomyelitis","volume":"1","author":"Twisk","year":"2017","journal-title":"Gen. Med. Open"},{"key":"ref_45","first-page":"284","article-title":"A review on cognitive behavorial therapy (CBT) and graded exercise therapy (GET) in myalgic encephalomyelitis (ME)\/chronic fatigue syndrome (CFS): CBT\/GET is not only ineffective and not evidence-based, but also potentially harmful for many patients with ME\/CFS","volume":"30","author":"Twisk","year":"2009","journal-title":"Neuro Endocrinol. Lett."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1177\/1359105321990810","article-title":"The draft updated NICE guidance for ME\/CFS highlights the unreliability of subjective outcome measures in non-blinded trials","volume":"27","author":"Vink","year":"2022","journal-title":"J. Health Psychol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.52768\/2996-3788\/1022","article-title":"Confirmed: The Conclusion by NICE that CBT is not an Effective Treatment for ME\/CFS; Re-Analysis of a Systematic Review","volume":"2","author":"Vink","year":"2024","journal-title":"SciBase Neurol."},{"key":"ref_48","first-page":"RISM.000748","article-title":"Using Exercise Therapy for Long COVID Without Screening for Post-Exertional Symptom Exacerbation Potentially Increases the Risks for Patients Who Suffer from it: A Reanalysis of Three Systematic Reviews","volume":"10","author":"Vink","year":"2024","journal-title":"Res. Investig. Sports Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1186\/s12967-020-02455-0","article-title":"Review of case definitions for myalgic encephalomyelitis\/chronic fatigue syndrome (ME\/CFS)","volume":"18","author":"Lim","year":"2020","journal-title":"J. Transl. Med."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Nacul, L.C., Mudie, K., Kingdon, C.C., Clark, T.G., and Lacerda, E.M. (2018). Hand grip strength as a clinical biomarker for ME\/CFS and disease severity. Front. Neurol., 9.","DOI":"10.3389\/fneur.2018.00992"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1186\/s12967-021-02774-w","article-title":"Hand grip strength and fatigability: Correlation with clinical parameters and diagnostic suitability in ME\/CFS","volume":"19","author":"Kedor","year":"2021","journal-title":"J. Transl. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.clinbiomech.2020.01.003","article-title":"Maximal handgrip strength can predict maximal physical performance in patients with chronic fatigue","volume":"73","author":"Jammes","year":"2020","journal-title":"Clin. Biomech."},{"key":"ref_53","unstructured":"(2025, March 25). NICE 2007 Chronic Fatigue Syndrome\/Myalgic Encephalomyelitis (or Encephalopathy): Diagnosis and Management Clinical Guideline cg53 Published: 22 August 2007. Available online: https:\/\/huisartsvink.wordpress.com\/wp-content\/uploads\/2022\/02\/nice-2007-me-cfs-guideline.pdf."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1016\/S0140-6736(11)60096-2","article-title":"Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): A randomised trial","volume":"377","author":"White","year":"2011","journal-title":"Lancet"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1186\/1745-6215-14-386","article-title":"A randomised trial of adaptive pacing therapy, cognitive behaviour therapy, graded exercise, and specialist medical care for chronic fatigue syndrome (PACE): Statistical analysis plan","volume":"14","author":"Walwyn","year":"2013","journal-title":"Trials"},{"key":"ref_56","unstructured":"(2025, January 23). PACETrial Protocol: Final Protocol Version 5.0. Available online: https:\/\/huisartsvink.files.wordpress.com\/2022\/11\/pace-finalprotocolversion5.0-01february2006.pdf."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/S0140-6736(16)32589-2","article-title":"Guided graded exercise self-help plus specialist medical care versus specialist medical care alone for chronic fatigue syndrome (GETSET): A pragmatic randomised controlled trial","volume":"390","author":"Clark","year":"2017","journal-title":"Lancet"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1093\/occmed\/kqu168","article-title":"The Chalder Fatigue Scale (CFQ 11)","volume":"65","author":"Jackson","year":"2014","journal-title":"Occup. Med."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"2205","DOI":"10.1017\/S0033291712000232","article-title":"Implementing a minimal intervention for chronic fatigue syndrome in a mental health centre: A randomized controlled trial","volume":"42","author":"Tummers","year":"2012","journal-title":"Psychol. Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1016\/S2215-0366(15)00317-X","article-title":"Rehabilitative treatments for chronic fatigue syndrome: Long-term follow-up from the PACE trial","volume":"2","author":"Sharpe","year":"2015","journal-title":"Lancet Psychiatry"},{"key":"ref_61","unstructured":"(2025, January 23). Stakeholder Position Statement on the NICE Guideline for Depression in Adults. Available online: https:\/\/www.bacp.co.uk\/media\/13407\/stakeholder-position-statement-on-the-nice-guideline-for-depression-in-adults.pdf."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1001\/jama.286.11.1360","article-title":"Interventions for the treatment and management of chronic fatigue syndrome: A systematic review","volume":"286","author":"Whiting","year":"2001","journal-title":"JAMA"},{"key":"ref_63","unstructured":"White, P. (2025, January 23). If My Team\u2019s Research on ME Is Rejected, the Patients Will Suffer. Available online: https:\/\/www.theguardian.com\/commentisfree\/2016\/sep\/30\/me-chronic-fatigue-syndrome-patients-suffer-put-off-treatments-our-research."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"h5771","DOI":"10.1136\/bmj.h5771","article-title":"Tackling fear about exercise produces long term benefit in chronic fatigue syndrome","volume":"351","author":"Torjesen","year":"2015","journal-title":"BMJ"},{"key":"ref_65","unstructured":"Moss-Morris, R. (2025, January 23). Expert Reaction to Long-Term Follow-Up Study from the PACE Trial on Rehabilitative Treatments for CFS\/ME, and Accompanying Comment Piece. Available online: https:\/\/www.sciencemediacentre.org\/expert-reaction-to-long-term-follow-up-study-from-the-pace-trial-on-rehabilitative-treatments-for-cfsme-and-accompanying-comment-piece\/."},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Sharpe, M., Goldsmith, K., and Chalder, T. (2019). The PACE trial of treatments for chronic fatigue syndrome: A response to WILSHIRE et al. BMC Psychol., 7.","DOI":"10.1186\/s40359-019-0288-x"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1177\/1359105316688953","article-title":"Response to the editorial by Dr Geraghty","volume":"22","author":"White","year":"2017","journal-title":"J. Health Psychol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1177\/1359105316675213","article-title":"\u2018PACE-Gate\u2019: When clinical trial evidence meets open data access","volume":"22","author":"Geraghty","year":"2017","journal-title":"J. Health Psychol."},{"key":"ref_69","unstructured":"White, P.D. (2025, January 23). Why Deny Patients with Chronic Fatigue Syndrome Treatments That Can Help?. Available online: https:\/\/www.healthsense-uk.org\/images\/Newsletters\/Newsletter_118.pdf."},{"key":"ref_70","unstructured":"(2025, January 23). NICE Chronic Pain (Primary and Secondary) in over 16s: Assessment of All Chronic Pain and Management of Chronic Primary Pain [NG193]. Available online: https:\/\/www.nice.org.uk\/guidance\/ng193."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1017\/S2045796015000864","article-title":"How to prove that your therapy is effective, even when it is not: A guideline","volume":"25","author":"Cuijpers","year":"2016","journal-title":"Epidemiol. Psychiatr. Sci."},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"White, P.D., Sharpe, M.C., Chalder, T., DeCesare, J.C., Walwyn, R., and PACE Trial Group (2007). Protocol for the PACE trial: A randomised controlled trial of adaptive pacing, cognitive behaviour therapy, and graded exercise, as supplements to standardised specialist medical care versus standardised specialist medical care alone for patients with the chronic fatigue syndrome\/myalgic encephalomyelitis or encephalopathy. BMC Neurol., 7.","DOI":"10.1186\/1471-2377-7-6"},{"key":"ref_73","unstructured":"Knoop, H. (2025, January 23). Vragenlijst voor Ervaringen Pati\u00ebnten t.b.v. de Nieuwe Richtlijn ME\/CVS. Available online: https:\/\/huisartsvink.wordpress.com\/wp-content\/uploads\/2025\/01\/knoop-e-mail-to-patients-august-2023.pdf."},{"key":"ref_74","unstructured":"(2025, January 23). CBO Richtlijn Diagnose, Behandeling, Begeleiding en Beoordeling van Pati\u00ebnten Met Het Chronisch Vermoeidheidssyndroom (CVS). Available online: https:\/\/huisartsvink.wordpress.com\/wp-content\/uploads\/2024\/11\/cbo-richtlijn-chronisch-vermoeidheidssyndroom-cvs.pdf."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1854","DOI":"10.1001\/jama.2017.5150","article-title":"Postmarket Safety Events Among Novel Therapeutics Approved by the US Food and Drug Administration Between 2001 and 2010","volume":"317","author":"Downing","year":"2017","journal-title":"JAMA"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"110533","DOI":"10.1016\/j.jpsychores.2021.110533","article-title":"Adverse outcomes in trials of graded exercise therapy for adult patients with chronic fatigue syndrome","volume":"147","author":"White","year":"2021","journal-title":"J. Psychosom. Res."},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Wearden, A.J., Riste, L., Dowrick, C., Chew-Graham, C., Bentall, R.P., Morriss, R.K., Peters, S., Dunn, G., Richardson, G., and Lovell, K. (2006). Fatigue Intervention by Nurses Evaluation\u2014The FINE Trial. A randomised controlled trial of nurse led self-help treatment for patients in primary care with chronic fatigue syndrome: Study protocol. [ISRCTN74156610]. BMC Med., 4.","DOI":"10.1186\/1741-7015-4-9"},{"key":"ref_78","first-page":"CD003200","article-title":"Exercise therapy for chronic fatigue syndrome","volume":"2021","author":"Larun","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_79","unstructured":"Larun, L., Brurberg, K.G., Kristoffersen, D.T., Flottorp, S.A., and Glasziou, P. (2025, January 23). Exercise Therapy for Chronic Fatigue Syndrome (Individual Patient Data). Available online: https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?ID=CRD42018107473."},{"key":"ref_80","unstructured":"Chou, R., McDonagh, M., Griffin, J.C., and Grusing, S. (2025, January 23). Management of Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome (ME\/CFS): An Updated Systematic Evidence Review A Systematic Evidence Review Prepared for: Centers for Disease Control and Prevention 11 April 2022. Available online: https:\/\/huisartsvink.wordpress.com\/wp-content\/uploads\/2025\/01\/chou-2022-a-systematic-evidence-review-prepared-for-cdc-file1-final-report-mecfs-systematic-review-508.pdf."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1136\/bjsports-2021-104281","article-title":"Benefits outweigh the risks: A consensus statement on the risks of physical activity for people living with long-term conditions","volume":"56","author":"Reid","year":"2022","journal-title":"Br. J. Sports Med."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"3788","DOI":"10.1080\/09638288.2022.2135776","article-title":"The effectiveness of activity pacing interventions for people with chronic fatigue syndrome: A systematic review and meta-analysis","volume":"45","author":"Casson","year":"2023","journal-title":"Disabil. Rehabil."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1177\/1745691614535216","article-title":"Why Ineffective Psychotherapies Appear to Work: A Taxonomy of Causes of Spurious Therapeutic Effectiveness","volume":"9","author":"Lilienfeld","year":"2014","journal-title":"Perspect. Psychol. Sci."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1097\/PRS.0b013e318219c171","article-title":"The levels of evidence and their role in evidence-based medicine","volume":"128","author":"Burns","year":"2011","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_85","first-page":"59","article-title":"Reporting of Harms Associated with Graded Exercise Therapy and Cognitive Behavioural Therapy in Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome","volume":"19","author":"Kindlon","year":"2011","journal-title":"Bull. IACFS\/ME"},{"key":"ref_86","unstructured":"Miller, A. (2025, March 11). Expert Reaction to Updated NICE Guideline on Diagnosis and Management of ME\/CFS. Available online: https:\/\/huisartsvink.wordpress.com\/wp-content\/uploads\/2025\/03\/science-media-centre-2021-expert-reaction-to-updated-nice-guideline-of-mecfs-miller-cv.pdf."},{"key":"ref_87","unstructured":"(2025, January 23). Action for M.E. GET, GAT and Exercise on Prescription Survey Results. Available online: https:\/\/huisartsvink.wordpress.com\/wp-content\/uploads\/2025\/01\/action-for-me-2011-get-gat-and-exercise-on-prescription-survey-results-2.pdf."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1177\/1359105317726152","article-title":"Myalgic encephalomyelitis\/chronic fatigue syndrome patients\u2019 reports of symptom changes following cognitive behavioural therapy, graded exercise therapy and pacing treatments: Analysis of a primary survey compared with secondary surveys","volume":"24","author":"Geraghty","year":"2019","journal-title":"J. Health Psychol."},{"key":"ref_89","unstructured":"Oxford Clinical Allied Technology and Trials Services Unit (OxCATTS), Oxford Brookes University (2025, January 23). Evaluation of a Survey Exploring the Experiences of Adults and Children with ME\/CFS Who Have Participated in CBT and GET Interventional Programmes FINAL REPORT. Available online: https:\/\/huisartsvink.files.wordpress.com\/2019\/11\/nice-patient-survey-outcomes-cbt-and-get-oxford-brookes-full-report-03.04.19.pdf."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"2343","DOI":"10.1007\/s00431-024-05458-x","article-title":"Graded exercise therapy compared to activity management for paediatric chronic fatigue syndrome\/myalgic encephalomyelitis: Pragmatic randomized controlled trial","volume":"183","author":"Gaunt","year":"2024","journal-title":"Eur. J. Pediatr."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"l6802","DOI":"10.1136\/bmj.l6802","article-title":"Impact of blinding on estimated treatment effects in randomised clinical trials: Meta-epidemiological study","volume":"368","author":"Moustgaard","year":"2020","journal-title":"BMJ"},{"key":"ref_92","first-page":"1","article-title":"Influence of reported study design characteristics on intervention effect estimates from randomised controlled trials: Combined analysis of meta-epidemiological studies","volume":"16","author":"Jones","year":"2012","journal-title":"Health Technol. Assess."},{"key":"ref_93","first-page":"283","article-title":"Graded exercise therapy does not restore the ability to work in ME\/CFS\u2014Rethinking of a Cochrane review","volume":"66","author":"Vink","year":"2020","journal-title":"Work"},{"key":"ref_94","first-page":"485","article-title":"Nonpharmacologic interventions for CFS: A randomized trial","volume":"172","author":"Jason","year":"2007","journal-title":"J. Clin. Psychol. Med. Settings"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1177\/1359105305049774","article-title":"A randomized controlled graded exercise trial for chronic fatigue syndrome: Outcomes and mechanisms of change","volume":"10","author":"Sharon","year":"2005","journal-title":"J. Health Psychol."},{"key":"ref_96","unstructured":"(2025, January 25). FOIARequest to QMUL. Dataset File. FOIA Request 2014\/F73a. Available online: https:\/\/huisartsvink.files.wordpress.com\/2022\/03\/pace-ipd_foia-qmul-2014-f731.pdf."},{"key":"ref_97","unstructured":"(2025, January 25). FOIARequest to QMUL. A Selection of Individual Participant Data from the PACE Trial for Chronic Fatigue Syndrome. Readme File. FOIA Request 2014\/F73b. Available online: https:\/\/huisartsvink.files.wordpress.com\/2022\/03\/pace-ipd-readme.pdf."},{"key":"ref_98","doi-asserted-by":"crossref","unstructured":"Monaghan, T.F., Agudelo, C.W., Rahman, S.N., Wein, A.J., Lazar, J.M., Everaert, K., and Dmochowski, R.R. (2021). Blinding in Clinical Trials: Seeing the Big Picture. Medicina, 57.","DOI":"10.3390\/medicina57070647"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"e6701","DOI":"10.32872\/cpe.6701","article-title":"A Brief History of Aaron T. Beck, MD, and Cognitive Behavior Therapy","volume":"3","author":"Beck","year":"2021","journal-title":"Clin. Psychol. Eur."},{"key":"ref_100","first-page":"CD001027","article-title":"Cognitive behaviour therapy for chronic fatigue syndrome in adults","volume":"2008","author":"Price","year":"2008","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_101","unstructured":"Soares-Weiser, K. (2025, January 23). Publication of Cochrane Review: \u2018Exercise Therapy for Chronic Fatigue Syndrome\u2019 2 October 2019. Available online: https:\/\/www.cochrane.org\/news\/cfs."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"2055102918805187","DOI":"10.1177\/2055102918805187","article-title":"Graded exercise therapy for myalgic encephalomyelitis\/chronic fatigue syndrome is not effective and unsafe. Re-analysis of a Cochrane review","volume":"5","author":"Vink","year":"2018","journal-title":"Health Psychol. Open"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"2917","DOI":"10.1017\/S0033291722002471","article-title":"A systematic literature review of randomized controlled trials evaluating prognosis following treatment for adults with chronic fatigue syndrome","volume":"52","author":"Ingman","year":"2022","journal-title":"Psychol. Med."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"5878","DOI":"10.1080\/09638288.2021.1949049","article-title":"Graded exercise therapy for patients with chronic fatigue syndrome in secondary care\u2014A benchmarking study","volume":"44","author":"Smakowski","year":"2022","journal-title":"Disabil. Rehabil."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1093\/occmed\/kqab170","article-title":"Chronic fatigue syndrome and occupational status: A retrospective longitudinal study","volume":"72","author":"Stevelink","year":"2022","journal-title":"Occup. Med."},{"key":"ref_106","first-page":"1235","article-title":"Graded exercise therapy and cognitive behavior therapy do not improve employment outcomes in ME\/CFS","volume":"74","author":"Tuller","year":"2023","journal-title":"Work"},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1016\/S0140-6736(00)04198-2","article-title":"Cognitive behaviour therapy for chronic fatigue syndrome: A multicentre randomised controlled trial","volume":"357","author":"Prins","year":"2001","journal-title":"Lancet"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1136\/bmj.38301.587106.63","article-title":"Cognitive behaviour therapy for adolescents with chronic fatigue syndrome: Randomised controlled trial","volume":"330","author":"Stulemeijer","year":"2005","journal-title":"BMJ"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1017\/S0033291709992212","article-title":"How does cognitive behaviour therapy reduce fatigue in patients with chronic fatigue syndrome? The role of physical activity","volume":"40","author":"Wiborg","year":"2010","journal-title":"Psychol. Med."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1136\/jnnp.2006.100974","article-title":"The effect of cognitive behaviour therapy for chronic fatigue syndrome on self-reported cognitive impairments and neuropsychological test performance","volume":"78","author":"Knoop","year":"2007","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1192\/bjp.bp.108.051292","article-title":"Guided self-instructions for people with chronic fatigue syndrome: Randomised controlled trial","volume":"193","author":"Knoop","year":"2008","journal-title":"Br. J. Psychiatry"},{"key":"ref_112","unstructured":"Stordeur, S., Thiry, N., and Eyssen, M. (2025, January 23). Chronisch Vermoeidheidssyndroom: Diagnose, Behandeling en Zorgorganisatie [Fatigue Syndrome: Diagnosis, Treatment and Organisation of Care]. Available online: https:\/\/kce.fgov.be\/sites\/default\/files\/2021-11\/d20081027358.pdf."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"c1777","DOI":"10.1136\/bmj.c1777","article-title":"Nurse led, home based self help treatment for patients in primary care with chronic fatigue syndrome: Randomised controlled trial","volume":"340","author":"Wearden","year":"2010","journal-title":"BMJ"},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1037\/a0033561","article-title":"Mediators of the effects on fatigue of pragmatic rehabilitation for chronic fatigue syndrome","volume":"81","author":"Wearden","year":"2013","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_115","doi-asserted-by":"crossref","unstructured":"McCrone, P., Sharpe, M., Chalder, T., Knapp, M., Johnson, A.L., Goldsmith, K.A., and White, P.D. (2012). Adaptive pacing, cognitive behaviour therapy, graded exercise, and specialist medical care for chronic fatigue syndrome: A cost-effectiveness analysis. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0040808"},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/S2215-0366(14)00069-8","article-title":"Rehabilitative Therapies For Chronic Fatigue Syndrome: A secondary mediation analysis of the PACE trial","volume":"2","author":"Chalder","year":"2015","journal-title":"Lancet Psychiatry"},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.1016\/S0140-6736(12)60025-7","article-title":"Effectiveness of internet-based cognitive behavioural treatment for adolescents with chronic fatigue syndrome (FITNET): A randomised controlled trial","volume":"379","author":"Nijhof","year":"2012","journal-title":"Lancet"},{"key":"ref_118","unstructured":"Nijhof, S.L., Bleijenberg, G., Uiterwaal, C.S.P.M., Kimpen, J.L.L., and van de Putte, E.M. (2025, January 23). Authors\u2019 Reply. Available online: https:\/\/huisartsvink.wordpress.com\/wp-content\/uploads\/2022\/03\/nijhof-fitnet-2012-actometer-correspondence-2012_internet-based-cbt-for-adolescents-piis0140673612613269.pdf."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1111\/joim.12402","article-title":"Multidisciplinary rehabilitation treatment versus cognitive behavioural therapy for patients with chronic fatigue syndrome: A randomized controlled trial","volume":"279","author":"Smeets","year":"2016","journal-title":"J. Intern. Med."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.clinph.2024.04.019","article-title":"A systematic review of quantitative EEG findings in Fibromyalgia, Chronic Fatigue Syndrome and Long COVID","volume":"163","author":"Tamasauskas","year":"2024","journal-title":"Clin. Neurophysiol."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/S0889-857X(05)70270-2","article-title":"Fibromyalgia and chronic fatigue syndrome: Similarities and differences","volume":"22","author":"Buchwald","year":"1996","journal-title":"Rheum. Dis. Clin. N. Am."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1016\/j.mpmed.2012.09.018","article-title":"Chronic Fatigue Syndrome","volume":"40","author":"Perry","year":"2012","journal-title":"Medicine"},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1016\/S0140-6736(98)08320-2","article-title":"Functional somatic syndromes: One or many?","volume":"354","author":"Wessely","year":"1999","journal-title":"Lancet"},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1097\/PHM.0000000000000485","article-title":"Determining the Minimal Clinically Important Difference for 6-Minute Walk Distance in Fibromyalgia","volume":"95","author":"Kaleth","year":"2016","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"2055102919840614","DOI":"10.1177\/2055102919840614","article-title":"Cognitive behavioural therapy for myalgic encephalomyelitis\/chronic fatigue syndrome is not effective. Re-analysis of a Cochrane review","volume":"6","author":"Vink","year":"2019","journal-title":"Health Psychol. Open"},{"key":"ref_126","unstructured":"(2025, March 25). FINE Trial Released Individual Participant Data. Available online: https:\/\/huisartsvink.wordpress.com\/wp-content\/uploads\/2019\/11\/fine-trial-released-individual-participant-data.xls."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"5291","DOI":"10.3390\/curroncol31090390","article-title":"Internal Consistency and Floor\/Ceiling Effects of the Gross Motor Function Measure for Use with Children Affected by Cancer: A Cross-Sectional Study","volume":"31","author":"Rossi","year":"2024","journal-title":"Curr. Oncol."},{"key":"ref_128","doi-asserted-by":"crossref","unstructured":"Bernstein, D.N., Houck, J.R., and Hammert, W.C. (2019). A Comparison of PROMIS UE Versus PF: Correlation to PROMIS PI and Depression, Ceiling and Floor Effects, and Time to Completion. J. Hand Surg., 44.","DOI":"10.1016\/j.jhsa.2018.12.006"},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1093\/rheumatology\/keg289","article-title":"Fatigue in systemic lupus erythematosus: A randomized controlled trial of exercise","volume":"42","author":"Tench","year":"2003","journal-title":"Rheumatology"},{"key":"ref_130","first-page":"m4774","article-title":"Updated NICE guidance on chronic fatigue syndrome","volume":"371","author":"Wade","year":"2021","journal-title":"BMJ"},{"key":"ref_131","unstructured":"Sch\u00fcnemann, H., Bro\u017cek, J., Guyatt, G., and Oxman, A. (2013). GRADE Handbook for Grading Quality of Evidence and Strength of Recommendations, GradePro. Available online: https:\/\/gdt.gradepro.org\/app\/handbook\/handbook.html."},{"key":"ref_132","unstructured":"Wade, D. (2025, January 23). Expert Reaction to Lancet Study Looking at Treatments for Chronic Fatigue Syndrome\/ME. Available online: https:\/\/www.sciencemediacentre.org\/expert-reaction-to-lancet-study-looking-at-treatments-for-chronic-fatigue-syndromeme-2-2\/."},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1177\/1359105317722370","article-title":"Special issue on the PACE Trial","volume":"22","author":"Marks","year":"2017","journal-title":"J. Health Psychol."},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1177\/1359105317700886","article-title":"PACE team response shows a disregard for the principles of science","volume":"22","author":"Edwards","year":"2017","journal-title":"J. Health Psychol."},{"key":"ref_135","doi-asserted-by":"crossref","unstructured":"GRADE Working Group (2004). Grading quality of evidence and strength of recommendations. BMJ, 328, 1490\u20131494.","DOI":"10.1136\/bmj.328.7454.1490"},{"key":"ref_136","unstructured":"Royal College of Physicians, Royal College of Physicians of Edinburgh, Royal College of General Practitioners, Royal College of Psychiatrists, Academy of Medical Royal Colleges, Faculty of Sport and Exercise Medicine, and Faculty of Occupational Medicine (2025, March 25). Medical Leaders Sign Joint Statement in Response to NICE Guidance on ME\/CFS. Available online: https:\/\/huisartsvink.files.wordpress.com\/2022\/03\/medical-leaders-sign-joint-statement-in-response-to-nice-guidance-on-mecfs-rcp-london.pdf."},{"key":"ref_137","unstructured":"Hughes, B. (2025, January 23). Eight (or More) Logical Fallacies in That Paper Bemoaning the New NICE Guideline for ME\/CFS. Available online: https:\/\/thesciencebit.net\/2023\/01\/10\/eight-or-more-logical-fallacies-in-that-paper-bemoaning-the-new-NICE-guideline-for-me-cfs\/."},{"key":"ref_138","unstructured":"NICE (2025, January 23). The Guidelines Manual (PMG6), Process and Methods Published: 30 November 2012. Available online: https:\/\/www.nice.org.uk\/process\/pmg6\/resources\/the-guidelines-manual-pdf-2007970804933."},{"key":"ref_139","unstructured":"(2025, January 23). A Report of the CFS\/ME Working Group Report to the Chief Medical Officer of an Independent Working Group. Available online: https:\/\/www.meresearch.org.uk\/wp-content\/uploads\/2013\/05\/WorkingGroupReport.pdf."},{"key":"ref_140","unstructured":"Bavinton, J., Darbishire, L., White, P.D., and On behalf of the PACE Trial Management Group (2025, January 26). PACE Manual for Therapists. GRADED EXERCISE THERAPY FOR CFS\/ME. Available online: https:\/\/huisartsvink.wordpress.com\/wp-content\/uploads\/2025\/01\/pace-get-therapist-manual.pdf."},{"key":"ref_141","unstructured":"Burgess, M., and Chalder, T. (2025, March 11). PACE Manual for Participants COGNITIVE BEHAVIOUR THERAPY for CFS\/ME. MREC Version 2\u2014November 2004. Available online: https:\/\/www.qmul.ac.uk\/wiph\/media\/the-wolfson-institute-of-population-health-wiph\/documents\/4.cbt-participant-manual.pdf."},{"key":"ref_142","unstructured":"Burgess, M., and Chalder, T. (2025, January 26). PACE Manual for Therapists, COGNITIVE BEHAVIOUR THERAPY for CFS\/ME MREC Version 2 ISRCTN54285094. Available online: https:\/\/huisartsvink.wordpress.com\/wp-content\/uploads\/2018\/11\/burgess-cbt-therapist-manual.pdf."},{"key":"ref_143","unstructured":"(2025, January 26). NICE Multiple Sclerosis in Adults: Management NICE Guideline Published: 22 June 2022. Available online: https:\/\/www.nice.org.uk\/guidance\/ng220\/resources\/multiple-sclerosis-in-adults-management-pdf-66143828948677."},{"key":"ref_144","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1186\/s12967-023-04587-5","article-title":"A scoping review of \u2018Pacing\u2019 for management of Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome (ME\/CFS): Lessons learned for the long COVID pandemic","volume":"21","author":"Mclaughlin","year":"2023","journal-title":"J. Transl. Med."},{"key":"ref_145","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.3109\/09638288.2011.635746","article-title":"Pacing as a strategy to improve energy management in myalgic encephalomyelitis\/chronic fatigue syndrome: A consensus document","volume":"34","author":"Goudsmit","year":"2012","journal-title":"Disabil. Rehabil."},{"key":"ref_146","first-page":"37","article-title":"Patient management of post-viral fatigue syndrome","volume":"40","year":"1990","journal-title":"Br. J. Gen. Pract."},{"key":"ref_147","first-page":"i2016","article-title":"GRADE evidence to decision (Etd) Frameworks: A systematic and transparent approach to making well informed Healthcare choices. 1: Introduction","volume":"353","author":"Moberg","year":"2016","journal-title":"BMJ"},{"key":"ref_148","unstructured":"(2025, January 26). NKCV: Over NKCV en Team. Available online: https:\/\/huisartsvink.wordpress.com\/wp-content\/uploads\/2024\/07\/nkcv-over-nkcv-en-team.pdf."},{"key":"ref_149","unstructured":"Williams, M. (2025, January 26). Michael Sharpe Quotes. Available online: https:\/\/www.margaretwilliams.me\/2019\/michael-sharpe-quotes-2019.pdf."},{"key":"ref_150","unstructured":"Kindlon, T. (2025, March 25). If I Review a Peter Denton White Paper, I\u2019ll Push for Him to Declare He\u2019s a CMO for a Disability Insurer. Available online: https:\/\/x.com\/TomKindlon\/status\/1263101177886990337."},{"key":"ref_151","unstructured":"Williams, M. (2025, January 26). PROOF POSITIVE?. Available online: https:\/\/www.margaretwilliams.me\/2016\/proof-positive-revisited.pdf."},{"key":"ref_152","unstructured":"Swiss Re (2025, January 26). Managing Claims for Chronic Fatigue the Active Way. Available online: https:\/\/huisartsvink.wordpress.com\/wp-content\/uploads\/2025\/01\/swiss-re-managing-claims-for-chronic-fatigue-the-active-way-swiss-re-leading-global-reinsurer.pdf."},{"key":"ref_153","unstructured":"King\u2019s College London (2025, January 26). CBT for Chronic Fatigue Syndrome. Available online: https:\/\/huisartsvink.wordpress.com\/wp-content\/uploads\/2025\/01\/chalder-kings-college-london-cbt-for-chronic-fatigue-syndrome.pdf."},{"key":"ref_154","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1177\/1359105317697324","article-title":"Investigator bias and the PACE trial","volume":"22","author":"Lubet","year":"2017","journal-title":"J. Health Psychol."},{"key":"ref_155","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1001\/jama.290.2.252","article-title":"A social science perspective on gifts to physicians from industry","volume":"290","author":"Dana","year":"2003","journal-title":"JAMA"},{"key":"ref_156","unstructured":"Korn, D., and Ehringhaus, S. (2007). The Scientific Basis of Influence and Reciprocity: A Symposium, Association of American Medical Colleges."},{"key":"ref_157","unstructured":"Groopman, J. (2007). How Doctors Think, Houghton Mifflin Company."},{"key":"ref_158","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1017\/S0033291723003148","article-title":"Does the effect of cognitive behavior therapy for chronic fatigue syndrome (ME\/CFS) vary by patient characteristics? A systematic review and individual patient data meta-analysis","volume":"54","author":"Kuut","year":"2024","journal-title":"Psychol. Med."},{"key":"ref_159","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1037\/hea0001346","article-title":"Effectiveness of an Online Multicomponent Program (FATIGUEWALK) for Chronic Fatigue Syndrome: A Randomized Controlled Trial","volume":"43","author":"Serrat","year":"2024","journal-title":"Health Psychol."},{"key":"ref_160","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1017\/S0033291720005292","article-title":"The evidence for cognitive behavioural therapy in any condition, population or context: A meta-review of systematic reviews and panoramic meta-analysis","volume":"51","author":"Fordham","year":"2021","journal-title":"Psychol. Med."},{"key":"ref_161","unstructured":"Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences, Routledge."},{"key":"ref_162","doi-asserted-by":"crossref","first-page":"18","DOI":"10.3991\/ijim.v15i02.18853","article-title":"The Effectiveness of Dynamic Geometry Software Applications in Learning Mathematics: A Meta-Analysis Study","volume":"15","author":"Juandi","year":"2021","journal-title":"Int. J. Interact. Mob. Technol."},{"key":"ref_163","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s12991-015-0063-1","article-title":"A systematic appraisal of allegiance effect in randomized controlled trials of psychotherapy","volume":"14","author":"Dragioti","year":"2015","journal-title":"Ann. Gen. Psychiatry"},{"key":"ref_164","unstructured":"Clark, L.V., Tims, E., White, P.D., and On behalf of the GETSET Trial Management Group (2025, January 26). GETSET Study GUIDED GRADED EXERCISE SELF-HELP (GES) FOR CFS\/ME Therapist Manual. Available online: https:\/\/huisartsvink.files.wordpress.com\/2022\/11\/getset-therapists-manual-with-appendices.pdf."},{"key":"ref_165","doi-asserted-by":"crossref","first-page":"102e9","DOI":"10.1016\/j.jclinepi.2007.03.012","article-title":"Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes","volume":"61","author":"Revicki","year":"2008","journal-title":"J. Clin. Epidemiol."},{"key":"ref_166","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1186\/s12967-025-06281-0","article-title":"Letter: Time to correct the record on the global burden of myalgic encephalomyelitis\/chronic fatigue syndrome (ME\/CFS)","volume":"23","author":"Vardaman","year":"2025","journal-title":"J. Transl. Med."},{"key":"ref_167","doi-asserted-by":"crossref","first-page":"105","DOI":"10.2147\/CLEP.S39876","article-title":"The prevalence of chronic fatigue syndrome\/myalgic encephalomyelitis: A meta-analysis","volume":"5","author":"Johnston","year":"2013","journal-title":"Clin Epidemiol."},{"key":"ref_168","doi-asserted-by":"crossref","unstructured":"Komaroff, A.L., and Lipkin, W.I. (2023). ME\/CFS and Long COVID share similar symptoms and biological abnormalities: Road map to the literature. Front. Med., 10.","DOI":"10.3389\/fmed.2023.1187163"},{"key":"ref_169","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/j.molmed.2024.02.003","article-title":"Unravelling shared mechanisms: Insights from recent ME\/CFS research to illuminate long COVID pathologies","volume":"30","author":"Annesley","year":"2024","journal-title":"Trends Mol. Med."},{"key":"ref_170","doi-asserted-by":"crossref","unstructured":"O\u2019Dowd, H., Gladwell, P., Rogers, C.A., Hollinghurst, S., and Gregory, A. (2006). Cognitive behavioural therapy in chronic fatigue syndrome: A randomised controlled trial of an outpatient group programme. Health Technol. Assess., 10.","DOI":"10.3310\/hta10370"},{"key":"ref_171","doi-asserted-by":"crossref","first-page":"44","DOI":"10.5617\/njhe.2413","article-title":"Health-related quality of life in Denmark on a relative scale: Mini Catalogue of mean EQ-5D-3L Index Scores for 17 Common chronic conditions","volume":"4","author":"Olesen","year":"2016","journal-title":"Nord. J. Health Econ."},{"key":"ref_172","doi-asserted-by":"crossref","unstructured":"Falk Hvidberg, M., Brinth, L.S., Olesen, A.V., Petersen, K.D., and Ehlers, L. (2015). The Health-Related Quality of Life for Patients with Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome (ME\/CFS). PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0132421"},{"key":"ref_173","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1136\/pgmj.54.637.711","article-title":"Early outbreaks of \u2018epidemic neuromyasthenia\u2019","volume":"54","author":"Parish","year":"1978","journal-title":"Postgrad. Med. J."},{"key":"ref_174","first-page":"82","article-title":"Management of the post-viral fatigue syndrome. Response to Ho-Yen","volume":"40","author":"Wessely","year":"1990","journal-title":"Br. J. Gen. Pract."},{"key":"ref_175","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1002\/mus.880060502","article-title":"Physical models of rehabilitation in neuromuscular disease","volume":"6","author":"Vignos","year":"1981","journal-title":"Muscle Nerve"},{"key":"ref_176","first-page":"14","article-title":"Muscle strengthening through high-resistance weight training in patients with neuromuscular disorders","volume":"69","author":"Miller","year":"1988","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_177","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1136\/bmj.323.7312.546","article-title":"Assessment of therapeutic safety in systematic reviews: Literature review","volume":"323","author":"Ernst","year":"2001","journal-title":"BMJ"},{"key":"ref_178","unstructured":"Bavinton, J., Dyer, N., and White, P.D. (2025, January 26). PACE Graded Exercise Therapy Information for Participants. Available online: https:\/\/huisartsvink.wordpress.com\/wp-content\/uploads\/2025\/01\/pace-get-participant-manual-graded-exercise-therapy.-2004.pdf."},{"key":"ref_179","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1136\/bjsports-2016-096581","article-title":"How much is too much? (Part 1) International Olympic Committee consensus statement on load in sport and risk of injury","volume":"50","author":"Soligard","year":"2016","journal-title":"Br. J. Sports Med."},{"key":"ref_180","unstructured":"Powell, P. (2025, January 26). FINE Trial Patient Booklet Version 9 29\/04\/05. Available online: https:\/\/huisartsvink.wordpress.com\/wp-content\/uploads\/2019\/11\/fine-trial-patient-pr-manual-ver9-apr05.pdf."},{"key":"ref_181","first-page":"6","article-title":"Reactivering van pati\u00ebnten met chronische vermoeidheid middels \u2018graded exercise therapy\u2019 met minimale directe begeleiding (2005\u20132010)","volume":"3","author":"Brandon","year":"2012","journal-title":"Sport Geneeskd."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/15\/4\/584\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:08:17Z","timestamp":1760029697000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/15\/4\/584"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,2]]},"references-count":181,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["life15040584"],"URL":"https:\/\/doi.org\/10.3390\/life15040584","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,2]]}}}