Until recently, most approaches to patients with chronic pain or other persistent disabling conditions have involved several weeks of multimodal care. The best studied of these approaches involve combined cognitive-behavioural therapy (CBT) and physical reactivation. CBT used in this context aims to help patients test and appropriately adjust harmful beliefs that they may have regarding the cause of their symptoms and the ways of treating their symptoms.

Exercise is known to have important physical and psychological impacts upon health and well-being.

In a randomized study, researchers examined the impact of a gradually increasing program of supervised aerobic exercise for patients with Chronic Fatigue Syndrome (CFS), comparing this approach to stretching and relaxation. After 12 weekly sessions, 51 percent of those assigned to exercise rated themselves globally as “much better” or “very much better,” whereas 27 percent of the stretching and relaxation group gave such a rating, a statistically significant difference, and improvements were stable over the subsequent several months. Fatigue, physical functioning, and fitness were also significantly better in the exercise group. Similar findings after exercise programs have been noted for other chronic or symptom-based disorders such as chronic low back pain, depressive disorders, and fibromyalgia. BMJ 1997;314(7095):1647–52