Psychological Medicine

  • Psychological Medicine / Volume 42 / Issue 10 / October 2012, pp 2217-2224
  • Copyright © Cambridge University Press 2012 The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution-NonCommercial-ShareAlike licence <>. The written permission of Cambridge University Press must be obtained for commercial re-use.
  • DOI: (About DOI), Published online: 28 February 2012

Original Articles

The effect of counselling, graded exercise and usual care for people with chronic fatigue in primary care: a randomized trial

L. Ridsdalea1 c1, M. Hurleya1, M. Kinga2, P. McCronea1 and N. Donaldsona3

a1 Department of Clinical Neuroscience, King's College London, Institute of Psychiatry, Academic Neuroscience Centre, London, UK

a2 Royal Free and University College Hospital, London, UK

a3 King's College London Dental Institute, London, UK


Background To evaluate the effectiveness of graded exercise therapy (GET), counselling (COUNS) and usual care plus a cognitive behaviour therapy (CBT) booklet (BUC) for people presenting with chronic fatigue in primary care.

Method A randomized controlled trial in general practice. The main outcome measure was the change in the Chalder fatigue score between baseline and 6 months. Secondary outcomes included a measure of global outcome, including anxiety and depression, functional impairment and satisfaction.

Results The reduction in mean Chalder fatigue score at 6 months was 8.1 [95% confidence interval (CI) 6.6–10.4] for BUC, 10.1 (95% CI 7.5–12.6) for GET and 8.6 (95% CI 6.5–10.8) for COUNS. There were no significant differences in change scores between the three groups at the 6- or 12-month assessment. Dissatisfaction with care was high. In relation to the BUC group, the odds of dissatisfaction at the 12-month assessment were less for the GET [odds ratio (OR) 0.11, 95% CI 0.02–0.54, p=0.01] and COUNS groups (OR 0.13, 95% CI 0.03–0.53, p=0.004).

Conclusions Our evidence suggests that fatigue presented to general practitioners (GPs) tends to remit over 6 months to a greater extent than found previously. Compared to BUC, those treated with graded exercise or counselling therapies were not significantly better with respect to the primary fatigue outcome, although they were less dissatisfied at 1 year. This evidence is generalizable nationally and internationally. We suggest that GPs ask patients to return at 6 months if their fatigue does not remit, when therapy options can be discussed further.

(Received May 10 2011)

(Revised January 25 2012)

(Accepted January 25 2012)

(Online publication February 28 2012)


c1 Address for correspondence: Dr L. Ridsdale, Department of Clinical Neuroscience, King's College London, Institute of Psychiatry, Academic Neuroscience Centre, PO41, De Crespigny Park, Denmark Hill Campus, London SE5 8AF, UK. (Email: