What lifestyle modifications and self-management strategies can I recommend to patients with ME/CFS to improve their quality of life?

Lifestyle modifications and self-management strategies for patients with ME/CFS to improve quality of life include:

• Energy management: Patients should learn to balance their energy use by recognizing their individual and fluctuating energy limits, avoiding overexertion, and pacing all types of activities (cognitive, physical, emotional, social) to reduce the risk of post-exertional malaise. This is a long-term, flexible, and tailored approach that may take weeks to years to stabilize or improve tolerance to activity. Healthcare professionals, especially those in ME/CFS specialist teams, can support patients in developing and adjusting an energy management plan that includes cognitive activity, physical mobility, daily living tasks, psychological and social demands, rest, sleep quality, and environmental factors ².
• Referral to specialist therapists: Referral to specialist physiotherapists or occupational therapists can help patients with mobility issues or those ready to increase physical activity safely ¹,².
• Psychological support and cognitive behavioural therapy (CBT): CBT may be appropriate for some patients to help manage symptoms, improve functioning, reduce stress, and develop self-management plans tailored to their needs. CBT should include shared understanding of challenges, exploring symptom meaning, adapting self-management strategies, and regular review ².
• Diet and hydration: Maintaining a healthy diet and adequate fluid intake is recommended. Referral to a dietitian is advised if there is risk of malnutrition, weight loss, weight gain, or restrictive diets ¹.
• Managing flare-ups and relapses: Patients should be informed that flare-ups and relapses can occur even when symptoms are well managed. Adjusting activity and rest during these periods is important ².
• Regular review and support: Annual reviews in primary care should cover symptom changes, self-management plans, psychological wellbeing, and future challenges. Referral back to specialist teams should be considered if new or worsening symptoms occur ¹.