108:
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206:, so the effects on current patient cohorts may be different. An independent analysis of the same studies reached the opposite conclusion based on the unreliability of subjective outcomes in unblinded trials, lack of objective improvements in physical fitness and employment, and insufficient tracking of adverse events.
194:
A 2022 review commissioned by the CDC concluded that weak evidence suggests that GET has "small to moderate" benefits, including reduced fatigue, decreased depression and anxiety, and better sleep. It said these results are of uncertain relevance to people with severe ME/CFS, a diagnosis according to
190:
without a clear rationale. When the data were reanalyzed utilising the original protocol, the rate of improvement was only 21%, and recovery was just 4%. While trial participants reported subjective improvement, there was no clinically significant improvement in fitness according to the 6-minute walk
86:
A graded exercise programme starts with a physiotherapist or exercise physiologist assessing the patient's current abilities and negotiating goals. The patient then begins exercising at a level within their capabilities. The patient and therapist increase the duration of sessions, typically by 10-20%
174:
The available research into GET is of poor or very poor quality. These studies generally have limited tracking of adverse effects, employ outdated definitions of ME/CFS that do not require post-exertional malaise, and rely on subjective self-reported outcome measures within unblinded trials, making
115:
GET is based on the discredited model that people with ME/CFS avoid exerting themselves due to fear of triggering symptoms such as pain and fatigue, which causes deconditioning and further worsening of symptoms. Excessive focus on symptoms and attributing illness to biological factors are also said
132:
Major public health bodies recommend against GET. The CDC stopped recommending GET in 2017, and says that people with ME/CFS do not tolerate vigorous exercise. NICE's 2021 guidance for ME/CFS removed graded exercise, which was recommended in the previous 2007 version, and cautions against "any
90:
The exercise can be any activity that can be titrated, such as walking, jogging, swimming, using exercise machines, and these may be mixed to add variety. Increasing the intensity can be more challenging than increasing duration, and a heart rate monitor may be employed to track intensity. If
98:
Patients are told that if exercise provokes symptoms, it is a typical response to becoming more active rather than a pathological process that causes permanent damage. Adverse effects may be increased if the practitioner is unfamiliar with CFS or exercise is not ramped up appropriately.
128:
Graded exercise therapy is generally considered to be an ineffective, outdated standard of care that can worsen the condition. GET does not enable patients to increase their activity levels (as objectively measured by actigraphy) or return to work.
95:, they may be encouraged to pause the increases until symptoms become manageable again. In other cases, the patient is expected to continue fixed increases in activity regardless of the degree of post-exertional malaise they experience.
373:
119:
This model lacks evidence, contradicts patient experience, and fails to account for the biological evidence that ME/CFS is a serious medical condition. Further, mental health problems or deconditioning do not cause ME/CFS.
213:
asserts that GET causes a significant fraction of patients to get worse: 30% to 50% in self-reported patient questionnaires. According to the Mayo Clinic
Proceedings recommendations, 54% to 74% reported harm.
133:
programme that...uses fixed incremental increases in physical activity or exercise, for example, graded exercise therapy." According to NICE, studies of GET have been of poor or very poor quality.
151:
ME/CFS patient organizations strongly oppose GET because they disagree that mental health problems are a cause of their illness and because many patients anecdotally report harms due to GET.
202:
review of 8 studies concluded that GET "probably" reduces fatigue but that evidence on long-term effectiveness and potential harms are very limited. The studies analyzed employed older
369:
571:"PACE trial claims for recovery in myalgic encephalomyelitis/chronic fatigue syndrome - true or false? It's time for an independent review of the methodology and results"
1148:
195:
modern criteria, or post-exertional malaise. According to the review, limited evidence suggests that GET is not harmful, but that reporting of harms was "suboptimal."
866:
186:
were safe and resulted in recovery for 22% of participants and improvement for 60%. There has since been considerable debate over the validity of the results.
67:
203:
155:
75:
952:"Rethinking the treatment of chronic fatigue syndrome-a reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT"
78:, consider it ineffective, and its safety is disputed. However, GET still enjoys support among a minority of clinicians and organizations.
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Nevertheless, a large number of studies demonstrated that deconditioning does not perpetuate or explain the symptoms in these patients.
71:
650:
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every 1-2 weeks, until they can perform 30 minutes of light exercise five times a week. Then the intensity is raised if desired.
894:
Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy)—Diagnosis and management of CFS/ME in adults and children
496:"Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): diagnosis and management | Guidance | NICE"
66:) is a programme of physical activity that starts very slowly and gradually increases over time, intended as a treatment for
665:
A person with ME/CFS should never be coaxed to push past their limit as this can be dangerous and cause long-term relapse.
1024:
Larun L, Brurberg KG, Odgaard-Jensen J, Price JR, et al. (Cochrane Common Mental
Disorders Group) (October 2019).
441:
Larun L, Brurberg KG, Odgaard-Jensen J, Price JR, et al. (Cochrane Common Mental
Disorders Group) (October 2019).
1073:
1003:
Management of
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): An Updated Systematic Evidence Review
183:
818:"Graded exercise therapy does not restore the ability to work in ME/CFS - Rethinking of a Cochrane review"
760:"The Updated NICE Guidance Exposed the Serious Flaws in CBT and Graded Exercise Therapy Trials for ME/CFS"
346:
254:
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1074:"ME Association position on graded exercise therapy (GET) | 11 May 2008 | The ME Association"
950:
Wilshire CE, Kindlon T, Courtney R, Matthees A, Tuller D, Geraghty K, Levin B (March 2018).
394:"Evidence-Based Care for People with Chronic Fatigue Syndrome and Myalgic Encephalomyelitis"
294:"Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Essentials of Diagnosis and Management"
292:
Bateman L, Bested AC, Bonilla HF, Chheda BV, Chu L, Curtin JM, et al. (November 2021).
217:
Graded exercise therapy has also been tested against fatigue and post-exertional malaise in
522:"The 'cognitive behavioural model' of chronic fatigue syndrome: Critique of a flawed model"
141:
8:
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Ghali A, Lacombe V, Ravaiau C, Delattre E, Ghali M, Urbanski G, Lavigne C (June 2023).
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Ghali A, Lacombe V, Ravaiau C, Delattre E, Ghali M, Urbanski G, Lavigne C (June 2023).
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Management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
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Geraghty K, Jason L, Sunnquist M, Tuller D, Blease C, Adeniji C (2019).
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The discredited cognitive-behvioral model that underlies graded exercise
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consensus recommendations for the treatment of ME/CFS also oppose GET.
867:"For People With Chronic Fatigue Syndrome, More Exercise Isn't Better"
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619:"Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | CDC"
144:, Australia, say GET is ineffective and potentially dangerous. The
372:. Royal Australian College of General Practitioners. March 2015.
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681:"Myalgic Encephalomyelitis ("Chronic Fatigue Syndrome")"
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370:"Graded exercise therapy: chronic fatigue syndrome"
351:. Agency for Healthcare Research and Quality. 2016.
70:(ME/CFS). Most public health bodies, including the
1149:Myalgic encephalomyelitis/chronic fatigue syndrome
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68:myalgic encephalomyelitis/chronic fatigue syndrome
156:Royal Australian College of General Practitioners
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1026:"Exercise therapy for chronic fatigue syndrome"
443:"Exercise therapy for chronic fatigue syndrome"
392:Sharpe M, Chalder T, White PD (February 2022).
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1030:The Cochrane Database of Systematic Reviews
649:Department of Health & Human Services.
634:(ME/CFS) is a serious, long-term illness...
447:The Cochrane Database of Systematic Reviews
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178:The largest study on GET, the 2011
170:Outcomes reported by the PACE trial
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904:. 2007. p. 53. Archived from
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1097:Journal of Translational Medicine
758:Vink M, Vink-Niese A (May 2022).
710:Journal of Translational Medicine
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1013:. 2022. pp. ii–iii, 23.
575:Journal of Health Psychology
311:10.1016/j.mayocp.2021.07.004
191:test, an objective outcome.
184:cognitive-behavioral therapy
7:
655:www.betterhealth.vic.gov.au
569:Shepherd CB (August 2017).
161:
10:
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410:10.1007/s11606-021-07188-4
969:10.1186/s40359-018-0218-3
865:Doucleff M (2017-10-02).
221:, but found ineffective.
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588:10.1177/1359105317703786
538:10.1177/2055102919838907
182:, reported that GET and
116:perpetuate the illness.
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532:(1): 2055102919838907.
298:Mayo Clinic Proceedings
60:Graded exercise therapy
22:Graded exercise therapy
526:Health Psychology Open
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923:"Treatment of ME/CFS"
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1078:meassociation.org.uk
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