It noted that a focus on exercise programs had discouraged patient participation in other types of physical activity due to concerns of  increased symptoms. An addendum stated, if studies based on the Oxford criteria were excluded, there would be insufficient evidence of the effectiveness of GET.A 2019 updated Cochrane review stated that, exercise therapy probably has a positive effect on fatigue in adults, and slightly improves sleep, but the long-term effects are unknown and has limited relevance to current definitions of ME/CFS. Cochrane started re-evaluating the effects of exercise therapies in chronic fatigue syndrome in 2020.Patient organisations have long criticised the use of exercise therapy, most notably GET, as a treatment for CFS. Based on an opinion survey of patients who had received GET, in 2015 the ME Association concluded, GET in its current delivered form should not be recommended as a primary intervention for persons with CFS. Adaptive pacing therapy
APT, not to be confused with pacing, is a therapy rather than a management strategy. APT is based on the idea that CFS involves a person only having a limited amount of available energy, and using this energy wisely will mean the "limited energy will increase gradually". : 5  A large clinical trial known as the PACE trial found APT was no more effective than usual care or specialized medical care.
While many patients prefer "myalgic encephalomyelitis", which they believe better reflects the medical nature of the illness, there is resistance amongst some clinicians toward the use of myalgic encephalomyelitis on the grounds that the inflammation of the central nervous system (myelitis) implied by the term has not been demonstrated.A 2015 report from the Institute of Medicine recommended the illness be renamed "systemic exertion intolerance disease", (SEID), and suggested new diagnostic criteria, proposing post-exertional malaise, (PEM), impaired function, and sleep problems are core symptoms of ME/CFS. Additionally, they described cognitive impairment and orthostatic intolerance as distinguishing symptoms from other fatiguing illnesses. Economic impact
Reynolds et al. (2004) estimated that the illness caused about $20,000 per person with CFS in lost productivity, which totals to $9.1 billion per year in the United States. : 29  This is comparable to other chronic illnesses that extract some of the biggest medical and socioeconomic costs. Direct healthcare costs are estimated at between $9 and $14 billion annually in the US alone. A 2008 study calculated that the total annual cost burden of ME/CFS to society in the US was extensive, and could approach $24.0 billion. A 2017 estimate for the annual economic burden in the United Kingdom from ME/CFS was 3.3 billion pounds sterling. Awareness day
12 May is designated as ME/CFS International Awareness Day.