Chronic fatigue syndrome (CFS) involves severe disabling fatigue that affects physical and mental functioning.¹ Reported prevalence varies between 0.05% and 2% depending on definitions and methodologies.^2,3 There are significant short and long term effects on young people and their families, including long term school non-attendance.^4,5 Most reported studies are not randomised, are from a variety of different clinical settings, and show variable outcomes: 5–20% being seriously incapacitated in the longer term, with larger numbers having residual symptoms.^2,6–9

There is lack of consensus about the effectiveness of the main treatment approaches. These range from approaches that involve high levels of rest, through “pacing” to more active rehabilitation. More active rehabilitation has developed as a treatment focusing on graded rehabilitation, and more recently cognitive behavioural techniques. They are now more likely to integrate a range of approaches to address physiological, psychological, social, and systemic aspects of the syndrome.

Strong feelings about treatment can be expressed by proponents at either end of the spectrum, sometimes with criticism of alternative approaches. Some advocating active rehabilitation quote research saying that prolonged excessive inactivity has adverse consequences.¹⁰ Conversely advocates of prolonged rest who find support from internet sites,¹¹ some specialist clinics,⁴ and some general practitioners¹² believe active rehabilitation can be damaging. Criticism of overzealous rehabilitation can tend to undermine all rehabilitation, and criticism of rest can tend to undermine all energy management programmes. This polarisation of views conspires against healthy discussion on middle ground treatments. This makes open minded randomised controlled trials essential to provide evidence to guide treatment and restore confidence in treatment centres, particularly as new initiatives to establish centres of excellence unfold.

This study assesses the feasibility of a larger treatment trial comparing the effectiveness of the two current most common …