From the Guidelines

Cognitive-behavioral therapy is the recommended treatment for chronic fatigue.

Cognitive-behavioral therapy: This treatment has the greatest evidence, with multiple studies consistently finding significant improvement in health function, health-related quality of life, or physical function in patients with chronic fatigue syndrome 1.
Mindfulness-based therapies: There is also strong evidence supporting mindfulness-based therapies, such as mindfulness-based stress reduction and meditation awareness training, which have been shown to reduce functional impairment and improve quality of life in patients with chronic fatigue syndrome 1.

Stimulants: The use of stimulants for the treatment of fatigue in patients with chronic fatigue syndrome is not recommended due to insufficient evidence 1.
Duloxetine: There is insufficient evidence to recommend the use of duloxetine for patients with chronic fatigue syndrome 1.

Patient preferences and resource availability: When considering treatment options, it is essential to take into account patient preferences and resource availability, as adherence to treatments can vary 1.
Exercise: While exercise has been shown to be beneficial in some studies, the evidence is not as strong as it is for cognitive-behavioral therapy and mindfulness-based therapies 1.

From the Research

Exercise therapy is a recommended treatment for chronic fatigue syndrome, as it has been shown to reduce fatigue and improve physical functioning, sleep, and self-perceived general health 2.
Cognitive behavior therapy (CBT) is also an effective treatment for chronic fatigue syndrome, and its effectiveness is similar to that of exercise therapy 2, 3, 4.
Graded exercise therapy (GET) is a type of exercise therapy that involves gradually increasing the intensity and duration of exercise, and it has been shown to be effective in reducing fatigue and improving function in patients with chronic fatigue syndrome 3, 4.
Pacing is also an important aspect of treatment, as patients with chronic fatigue syndrome should be educated to pace their activity to avoid exceeding their limited energy capacity 5.
Treatment should prioritize comorbidities and symptoms based on severity, and a comprehensive treatment plan should be tailored to the individual patient's needs 5, 4, 6.

Exercise can be harmful to patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) if it triggers postexertional malaise, and patients should be cautious when starting an exercise program 5.
There is no proven treatment or cure for ME/CFS, and treatment should focus on managing symptoms and improving quality of life 5, 3.
A thorough clinical assessment is necessary before starting treatment, and treatment should be delivered by appropriately trained therapists working in close collaboration with the patient 3.

Acupuncture may be a useful adjunctive therapy for chronic fatigue syndrome, although more research is needed to confirm its effectiveness 5.
Pharmacologic therapies have not been proven effective for chronic fatigue syndrome, and treatment should focus on non-pharmacologic interventions such as CBT, exercise therapy, and pacing 2, 4.