Graded exercise therapy: Difference between revisions

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(add quote, doctors as patients)
(→‎Criticism: MEA position paper, Forward ME Covid-19 letter, NICE survey)
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==Criticism==
==Criticism==
*2008, [https://meassociation.org.uk/2008/05/mea-position-on-graded-exercise-therapy-get/ ME Association position on graded exercise therapy (GET)]<ref name=MEA2007>https://meassociation.org.uk/2008/05/mea-position-on-graded-exercise-therapy-get/</ref> - [[ME Association]]
*2010, At the [[Invest in ME International ME Conference]] Doctor [[Paul Cheney]] said "The whole idea that you can take a disease like this and exercise your way to health is foolishness. It is insane".<ref>{{Cite news|url=https://paradigmchange.me/me/exercise-quotes/|title=Quotes About Exercise Intolerance from M.E. Experts|work=Myalgic Encephalomyelitis|access-date=2018-10-13|language=en-US}}</ref>
*2010, At the [[Invest in ME International ME Conference]] Doctor [[Paul Cheney]] said "The whole idea that you can take a disease like this and exercise your way to health is foolishness. It is insane".<ref>{{Cite news|url=https://paradigmchange.me/me/exercise-quotes/|title=Quotes About Exercise Intolerance from M.E. Experts|work=Myalgic Encephalomyelitis|access-date=2018-10-13|language=en-US}}</ref>
 
*2011, [http://iacfsme.org/PDFS/Reporting-of-Harms-Associated-with-GET-and-CBT-in.aspx Reporting of Harms Associated with Graded Exercise Therapy and Cognitive Behavioural Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome]<ref name=":2">{{Cite web|url=http://iacfsme.org/PDFS/Reporting-of-Harms-Associated-with-GET-and-CBT-in.aspx|title=Bulletin of the IACFS/ME 59 Reporting of Harms Associated with Graded Exercise Therapy and Cognitive Behavioural Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|last=Kindlon|first=Tom|author-link=Tom Kindlon|date=|website=iacfsme.org|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
*2011, [http://iacfsme.org/PDFS/Reporting-of-Harms-Associated-with-GET-and-CBT-in.aspx Reporting of Harms Associated with Graded Exercise Therapy and Cognitive Behavioural Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome]<ref name=":2">{{Cite web|url=http://iacfsme.org/PDFS/Reporting-of-Harms-Associated-with-GET-and-CBT-in.aspx|title=Bulletin of the IACFS/ME 59 Reporting of Harms Associated with Graded Exercise Therapy and Cognitive Behavioural Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|last=Kindlon|first=Tom|date=|website=iacfsme.org|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
*2011, Health-related quality of life in patients with chronic fatigue syndrome: group [[Cognitive behavioral therapy|cognitive behavioural therapy]] and graded exercise versus usual treatment. A randomised controlled trial with 1 year of follow-up<ref>{{Cite journal|last=Núñez|first=Montserrat|author-link=Montserrat Núñez|last2=Fernández-Solà|first2=Joaquim|author-link2=|last3=Nuñez|first3=Esther|author-link3=|last4=Fernández-Huerta|first4=José-Manuel|author-link4=|last5=Godás-Sieso|first5=Teresa|author-link5=|last6=Gomez-Gil|first6=Esther|author-link6=|date=Mar 2011|title=Health-related quality of life in patients with chronic fatigue syndrome: group cognitive behavioural therapy and graded exercise versus usual treatment. A randomised controlled trial with 1 year of follow-up|url=http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.467.4965&rep=rep1&type=pdf|journal=Clinical Rheumatology|volume=30|issue=3|pages=381–389|doi=10.1007/s10067-010-1677-y|issn=1434-9949|pmid=21234629|quote=|via=}}</ref> [http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.467.4965&rep=rep1&type=pdf (Full Text)]
 
*2011, Health-related quality of life in patients with chronic fatigue syndrome: group [[Cognitive behavioral therapy|cognitive behavioural therapy]] and graded exercise versus usual treatment. A randomised controlled trial with 1 year of follow-up<ref>{{Cite journal|last=Núñez|first=Montserrat|author-link=Montserrat Núñez|last2=Fernández-Solà|first2=Joaquim|author-link2=Joaquim Fernández-Solà|last3=Nuñez|first3=Esther|author-link3=Esther Nuñez|last4=Fernández-Huerta|first4=José-Manuel|author-link4=José-Manuel Fernández-Huerta|last5=Godás-Sieso|first5=Teresa|author-link5=Teresa Godás-Sieso|last6=Gomez-Gil|first6=Esther|author-link6=Esther Gomez-Gil|date=Mar 2011|title=Health-related quality of life in patients with chronic fatigue syndrome: group cognitive behavioural therapy and graded exercise versus usual treatment. A randomised controlled trial with 1 year of follow-up|url=http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.467.4965&rep=rep1&type=pdf|journal=Clinical Rheumatology|volume=30|issue=3|pages=381–389|doi=10.1007/s10067-010-1677-y|issn=1434-9949|pmid=21234629|quote=|via=}}</ref> [http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.467.4965&rep=rep1&type=pdf (Full Text)]
*2015, [http://www.meassociation.org.uk/wp-content/uploads/2015-ME-Association-Illness-Management-Report-No-decisions-about-me-without-me-30.05.15.pdf ME/CFS Illness Management Survey Results “No decisions about me without me”]<ref name=":3">{{Cite web|url=http://www.meassociation.org.uk/wp-content/uploads/2015-ME-Association-Illness-Management-Report-No-decisions-about-me-without-me-30.05.15.pdf|title=ME/CFS Illness Management Survey Results - “No decisions about me without me” Part 1|last=|first=|date=May 2015|website=meassociation.org|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
*2015, [http://www.meassociation.org.uk/wp-content/uploads/2015-ME-Association-Illness-Management-Report-No-decisions-about-me-without-me-30.05.15.pdf ME/CFS Illness Management Survey Results “No decisions about me without me”]<ref name=":3">{{Cite web|url=http://www.meassociation.org.uk/wp-content/uploads/2015-ME-Association-Illness-Management-Report-No-decisions-about-me-without-me-30.05.15.pdf|title=ME/CFS Illness Management Survey Results - “No decisions about me without me” Part 1|last=|first=|date=May 2015|website=meassociation.org|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
 
*2016, Do graded activity therapies cause harm in chronic fatigue syndrome?<ref>{{Cite journal|last=Kindlon|first=Tom|date=2017-03-20|title=Do graded activity therapies cause harm in chronic fatigue syndrome?|url=http://journals.sagepub.com/doi/full/10.1177/1359105317697323|journal=Journal of Health Psychology|language=en|volume=22|issue=9|pages=1146–1154|doi=10.1177/1359105317697323|issn=1359-1053|quote=|author-link=Tom Kindlon|author-link2=|author-link3=|author-link4=|author-link5=|via=}}</ref> [https://journals.sagepub.com/doi/full/10.1177/1359105317697323 (Full Text)] - Tom Kindlon
*2016, Do graded activity therapies cause harm in chronic fatigue syndrome?<ref>{{Cite journal|last=Kindlon|first=Tom|date=2017-03-20|title=Do graded activity therapies cause harm in chronic fatigue syndrome?|url=http://journals.sagepub.com/doi/full/10.1177/1359105317697323|journal=Journal of Health Psychology|language=en|volume=22|issue=9|pages=1146–1154|doi=10.1177/1359105317697323|issn=1359-1053|quote=|author-link=Tom Kindlon|author-link2=|author-link3=|author-link4=|author-link5=|via=}}</ref> [https://journals.sagepub.com/doi/full/10.1177/1359105317697323 (Full Text)]  
 
*2016, Can patients with chronic fatigue syndrome really recover after graded exercise or cognitive behavioural therapy? A critical commentary and preliminary re-analysis of the PACE trial<ref name=":4">{{Cite journal|last=Wilshire|first=Carolyn|last2=Kindlon|first2=Tom|last3=Matthees|first3=Alem|last4=McGrath|first4=Simon|date=2016-12-14|title=Can patients with chronic fatigue syndrome really recover after graded exercise or cognitive behavioural therapy? A critical commentary and preliminary re-analysis of the PACE trial|url=http://www.tandfonline.com/doi/full/10.1080/21641846.2017.1259724|journal=Fatigue: Biomedicine, Health & Behavior|language=en|volume=5|issue=1|pages=43–56|doi=10.1080/21641846.2017.1259724|issn=2164-1846}}</ref> [http://www.tandfonline.com/doi/full/10.1080/21641846.2017.1259724 (Full Text)]
*2016, Can patients with chronic fatigue syndrome really recover after graded exercise or cognitive behavioural therapy? A critical commentary and preliminary re-analysis of the PACE trial<ref name=":4">{{Cite journal|last=Wilshire|first=Carolyn|last2=Kindlon|first2=Tom|last3=Matthees|first3=Alem|last4=McGrath|first4=Simon|date=2016-12-14|title=Can patients with chronic fatigue syndrome really recover after graded exercise or cognitive behavioural therapy? A critical commentary and preliminary re-analysis of the PACE trial|url=http://www.tandfonline.com/doi/full/10.1080/21641846.2017.1259724|journal=Fatigue: Biomedicine, Health & Behavior|language=en|volume=5|issue=1|pages=43–56|doi=10.1080/21641846.2017.1259724|issn=2164-1846}}</ref> [http://www.tandfonline.com/doi/full/10.1080/21641846.2017.1259724 (Full Text)]
*2016, [https://undark.org/article/chronic-fatigue-graded-exercise-pace/ Worse Than the Disease: A popular therapy for chronic fatigue syndrome made many patients worse. Adding insult to injury, research supporting it is now unraveling.]<ref name=":6">{{Cite news|url=https://undark.org/article/chronic-fatigue-graded-exercise-pace/|title=For Chronic Fatigue Syndrome Sufferers, a Dubious Treatment Unravels|last=Tuller|first=David|date=2016-10-27|work=Undark|access-date=2018-11-27|archive-url=|archive-date=|dead-url=|language=en-US|author-link=David Tuller}}</ref>  
*2016, [https://undark.org/article/chronic-fatigue-graded-exercise-pace/ Worse Than the Disease: A popular therapy for chronic fatigue syndrome made many patients worse. Adding insult to injury, research supporting it is now unraveling.]<ref name=":6">{{Cite news|url=https://undark.org/article/chronic-fatigue-graded-exercise-pace/|title=For Chronic Fatigue Syndrome Sufferers, a Dubious Treatment Unravels|last=Tuller|first=David|date=2016-10-27|work=Undark|access-date=2018-11-27|archive-url=|archive-date=|dead-url=|language=en-US|author-link=David Tuller}}</ref>  
Line 54: Line 51:
*2018, Rethinking the treatment of Chronic Fatigue Syndrome—a reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT<ref>{{Cite journal|last=Wilshire|first=Carolyn E.|author-link=Carolyn Wilshire|last2=Kindlon|first2=Tom|author-link2=Tom Kindlon|last3=Courtney|first3=Robert|author-link3=Robert Courtney|last4=Matthees|first4=Alem|author-link4=Alem Matthees|last5=Tuller|first5=David|author-link5=David Tuller|last6=Geraghty|first6=Keith|author-link6=Keith Geraghty|last7=Levin|first7=Bruce|author-link7=Bruce Levin|date=2018-03-22|title=Rethinking the treatment of chronic fatigue syndrome—a reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT|url=https://bmcpsychology.biomedcentral.com/articles/10.1186/s40359-018-0218-3|journal=BMC Psychology|language=En|volume=6|issue=1|pages=|doi=10.1186/s40359-018-0218-3|issn=2050-7283|pmc=5863477|pmid=29562932|quote=|via=}}</ref> [https://bmcpsychology.biomedcentral.com/articles/10.1186/s40359-018-0218-3 (Full Text)]  
*2018, Rethinking the treatment of Chronic Fatigue Syndrome—a reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT<ref>{{Cite journal|last=Wilshire|first=Carolyn E.|author-link=Carolyn Wilshire|last2=Kindlon|first2=Tom|author-link2=Tom Kindlon|last3=Courtney|first3=Robert|author-link3=Robert Courtney|last4=Matthees|first4=Alem|author-link4=Alem Matthees|last5=Tuller|first5=David|author-link5=David Tuller|last6=Geraghty|first6=Keith|author-link6=Keith Geraghty|last7=Levin|first7=Bruce|author-link7=Bruce Levin|date=2018-03-22|title=Rethinking the treatment of chronic fatigue syndrome—a reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT|url=https://bmcpsychology.biomedcentral.com/articles/10.1186/s40359-018-0218-3|journal=BMC Psychology|language=En|volume=6|issue=1|pages=|doi=10.1186/s40359-018-0218-3|issn=2050-7283|pmc=5863477|pmid=29562932|quote=|via=}}</ref> [https://bmcpsychology.biomedcentral.com/articles/10.1186/s40359-018-0218-3 (Full Text)]  
*2018, Graded exercise therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective and unsafe. Re-analysis of a Cochrane review<ref name=":5">{{Cite journal|last=Vink|first=Mark|author-link=Mark Vink|last2=Vink-Niese|first2=Alexandra|author-link2=Alexandra Vink-Niese|author-link3=|author-link4=|author-link5=|date=2018-10-08|title=Graded exercise therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective and unsafe. Re-analysis of a Cochrane review|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6176540/|journal=Health Psychology Open|volume=5|issue=2|pages=|doi=10.1177/2055102918805187|issn=2055-1029|pmc=|pmid=30305916|quote=|via=}}</ref> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6176540/ (Full Text)]
*2018, Graded exercise therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective and unsafe. Re-analysis of a Cochrane review<ref name=":5">{{Cite journal|last=Vink|first=Mark|author-link=Mark Vink|last2=Vink-Niese|first2=Alexandra|author-link2=Alexandra Vink-Niese|author-link3=|author-link4=|author-link5=|date=2018-10-08|title=Graded exercise therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective and unsafe. Re-analysis of a Cochrane review|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6176540/|journal=Health Psychology Open|volume=5|issue=2|pages=|doi=10.1177/2055102918805187|issn=2055-1029|pmc=|pmid=30305916|quote=|via=}}</ref> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6176540/ (Full Text)]
*2018, [https://healthycontrolblog.wordpress.com/2018/11/29/my-complaint-to-the-cochrane-governing-board-about-the-cochrane-review-of-exercise-for-chronic-fatigue-syndrome/ My complaint to the Cochrane Governing Board about the Cochrane review of Exercise for chronic fatigue syndrome]<ref>{{Cite news|url=https://healthycontrolblog.wordpress.com/2018/11/29/my-complaint-to-the-cochrane-governing-board-about-the-cochrane-review-of-exercise-for-chronic-fatigue-syndrome/|title=My complaint to the Cochrane Governing Board about the Cochrane review of Exercise for chronic fatigue syndrome|last=Struthers|first=Caroline|date=2018-11-29|work=Healthy Control|access-date=2018-11-29|archive-url=|archive-date=|dead-url=|language=en-US|quote=|author-link=Caroline Struthers}}</ref>
*2018, [https://healthycontrolblog.wordpress.com/2018/11/29/my-complaint-to-the-cochrane-governing-board-about-the-cochrane-review-of-exercise-for-chronic-fatigue-syndrome/ My complaint to the Cochrane Governing Board about the Cochrane review of Exercise for chronic fatigue syndrome]<ref>{{Cite news|url=https://healthycontrolblog.wordpress.com/2018/11/29/my-complaint-to-the-cochrane-governing-board-about-the-cochrane-review-of-exercise-for-chronic-fatigue-syndrome/|title=My complaint to the Cochrane Governing Board about the Cochrane review of Exercise for chronic fatigue syndrome|last=Struthers|first=Caroline|date=2018-11-29|work=Healthy Control|access-date=2018-11-29|archive-url=|archive-date=|dead-url=|language=en-US|quote=|author-link=Caroline Struthers}}</ref> - Caroline Struthers
*2019, [https://www.meassociation.org.uk/2019/04/forward-me-and-oxford-brookes-university-announce-results-of-patient-survey-on-cbt-and-get-in-me-cfs-03-april-2019/ Forward-ME and Oxford Brookes University announce the results of patient survey on CBT and GET in ME/CFS]<ref >{{Cite web|url=https://www.meassociation.org.uk/2019/04/forward-me-and-oxford-brookes-university-announce-results-of-patient-survey-on-cbt-and-get-in-me-cfs-03-april-2019|date=2019-04-03|title=Forward-ME and Oxford Brookes University announce the results of patient survey on CBT and GET in ME/CFS|website=ME Association|last=Forward-ME|author-link=Forward-ME|last2=Oxfors Brookes University}}</ref >- Survey commissioned by NICE to help inform the review of the UK's ME/CFS treatment guidelines
*2020, [https://meassociation.org.uk/wp-content/uploads/ForwardME-Letter-re-Covid-19-Management-and-Exercise-Caution-27.08.20.pdf Letter re Covid-19 Management and Exercise Caution]<ref name=GETcovidForwardME>{{Cite web|url=https://meassociation.org.uk/wp-content/uploads/ForwardME-Letter-re-Covid-19-Management-and-Exercise-Caution-27.08.20.pdf|date=2020-08-27|last=Forward-ME|author-link=Forward-ME|title =Letter re Covid-19 Management and Exercise Caution}}</ref> - [[Forward-ME]]


==CDC withdrawal of GET treatment ==
==CDC withdrawal of GET treatment ==

Revision as of 00:34, September 19, 2020

Increasingvalueschart-gradedexercise.png

Graded exercise therapy (GET) is a form of physical therapy for the treatment of chronic fatigue syndrome (CFS) where physical activity is gradually increased over time. It is a treatment offered to ME/CFS patients in the UK by the National Health Service (NHS) as specified in the NICE guidelines. The use of Graded Exercise Therapy as a treatment is based on the disputed deconditioning hypothesis, and the highly controversial biopsychosocial model (BPS) of ME/CFS.[1]

Evidence[edit | edit source]

Patient reports of harm[edit | edit source]

Clinical trials have resulted in mixed results.[1][2][3] Surveys of patients conducted by patient charities have universally found Graded Exercise Therapy to be harmful, although a minority of patients found it helped them or simply ineffective.[4][5] A number of severely ill patients have reported that starting Graded Exercise Therapy will moderate symptoms cause a severe escalation of symptoms, leaving them permanently worse. Two highly influential peer-reviewed articles often used to support the use of Graded Exercise Therapy, the Cochrane review and the PACE trial, have had widescale calls for retraction based on criticism of the scientific method and standards used.[3]

Robin Brown, a British doctor with ME/CFS has created petition that many thousands have signed calling for GET and related CBT to be removed from the UK treatment guidelines immediately.[6]

Physical fitness unchanged[edit | edit source]

A number of studies by proponents of GET have found that it did not improve fitness, when self-rated perception of fatigue did improve after GET, no improvements in exercise capacity were statistically significant.[1][7][8] The controversial PACE trial's 6 minute walk test results showed those successfully completing GET were unable to walk as far as older patients awaiting a lung transplant or those with heart failure; data that was omitted from the original trial report.[8]

Patient analysis of PACE results[edit | edit source]

Graham McPhee and others created videos investigating the PACE trial data in relation to GET.[9][10] Several re-analyses of the PACE trial results have been published since the detailed PACE trial data was released into the public domain.[8]

Fear of exercise[edit | edit source]

The PACE trial investigators have stated that they believe a significant maintaining factor in the persistence of ME/CFS is fear of exercise.[11] This claim has been criticized as unsupported by trial results.[12] A study by Nijs et al. in 2004 concluded:

Chronic Fatigue Syndrome: Lack of Association between Pain-Related Fear of Movement and Exercise Capacity and Disability

These results indicate a lack of correlation between kinesiophobia and exercise capacity, activity limitations, or participation restrictions, at least in patients with CFS who are experiencing widespread muscle or joint pain.

Jo Nij, Katrien Vanherberghen, William Duquet & Kenny De Meirleir (2004)


Doctors who are patients with ME/CFS[edit | edit source]

Graded exercise therapy and CBT. "As a physician bedridden with myalgic encephalomyelitis (ME) for more than a decade who is totally dependent on others, all thanks to a major relapse caused by GET, I am in a unique position to answer how harmful GET and cognitive behavioral therapy (CBT) really are. The basis of these therapies is false illness beliefs, meaning that it is all in the mind. These beliefs ignore all of the evidence that ME is a physical disease, such as intracellular immune dysfunctions, which not only restrict exercise capacity but also worsen with exercise (2)." - Maik Speedy (2015). Annals of Internal Medicine.
Graded exercise therapy caused a permanent relapse that left Dr Maik Speedy bedridden.


A number of doctors diagnosed with ME/CFS have shared their personal experiences of graded exercise therapy or have spoken out against GET to both other doctors and patients. These include:

Articles explaining GET not appropriate for ME/CFS[edit | edit source]

Describing graded exercise in comparison with symptom-contingent graded exercise therapy or pacing

Criticism[edit | edit source]

CDC withdrawal of GET treatment[edit | edit source]

July 3, 2017, The Centers for Disease Control and Prevention's (CDC) website Chronic Fatigue Syndrome page has been changed to "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)" and GET and CBT recommendations have been removed.[29][30]

StopGET petitions[edit | edit source]

A number of different patients and patient charities have created #stopGET petitions to campaign for an end to graded exercise therapy treatment in ME/CFS:

  • Stop GET trials - MEAction[31]
  • Stop harming ME/CFS patients - take CBT/GET out of NICE guidelines NOW. - Dr. Hng's UK petition to stop GET and CBT
  • The NICE guideline for CFS/ME is not fit for purpose and needs a complete revision - a petition the ME Association delivered to Andrew Dillon at NICE
  • Suspend all trials of graded exercise therapy in children and adults with ME/CFS - UK parliament petition (archived)[32]

Notable studies[edit | edit source]

  • 2004, Chronic Fatigue Syndrome: Lack of Association between Pain-Related Fear of Movement and Exercise Capacity and Disability [33] (Full Text)
  • 2009, A review on cognitive behavorial therapy (CBT) and graded exercise therapy (GET) in myalgic encephalomyelitis (ME) / chronic fatigue syndrome (CFS): CBT/GET is not only ineffective and not evidence-based, but also potentially harmful for many patients with ME/CFS[1] (Abstract)
  • 2016, Exercise therapy for chronic fatigue syndrome[2] (Full Text)
  • 2016, Neurocognitive improvements after best-practice intervention for chronic fatigue syndrome: Preliminary evidence of divergence between objective indices and subjective perceptions.[34] (Abstract)
  • 2017, PACE investigators' response is misleading regarding patient survey results[35] (Full Text)
  • 2018, Rethinking the treatment of chronic fatigue syndrome—a reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT [36] (Full Text)
  • 2019, Evaluation of a survey exploring the experiences of adults and children with ME/CFS who have participated in CBT and GET interventional programmes. FINAL REPORT[37] (Full text)

Learn more[edit | edit source]

See also[edit | edit source]

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 Twisk, Frank N. M.; Maes, Michael (2009). "A review on cognitive behavorial therapy (CBT) and graded exercise therapy (GET) in myalgic encephalomyelitis (ME) / chronic fatigue syndrome (CFS): CBT/GET is not only ineffective and not evidence-based, but also potentially harmful for many patients with ME/CFS". Neuro Endocrinology Letters. 30 (3): 284–299. ISSN 0172-780X. PMID 19855350.
  2. 2.0 2.1 Larun, Lillebeth; Brurberg, Kjetil G.; Odgaard‐Jensen, Jan; Price, Jonathan R. (2016). "Exercise therapy for chronic fatigue syndrome". Cochrane Database of Systematic Reviews (6). doi:10.1002/14651858.CD003200.pub5. ISSN 1465-1858.
  3. 3.0 3.1 3.2 Vink, Mark; Vink-Niese, Alexandra (October 8, 2018). "Graded exercise therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective and unsafe. Re-analysis of a Cochrane review". Health Psychology Open. 5 (2). doi:10.1177/2055102918805187. ISSN 2055-1029. PMID 30305916.
  4. 4.0 4.1 Kindlon, Tom. "Bulletin of the IACFS/ME 59 Reporting of Harms Associated with Graded Exercise Therapy and Cognitive Behavioural Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome". iacfsme.org. Cite has empty unknown parameter: |dead-url= (help)
  5. 5.0 5.1 "ME/CFS Illness Management Survey Results - "No decisions about me without me" Part 1" (PDF). meassociation.org. May 2015. Cite has empty unknown parameter: |dead-url= (help)
  6. Brown, Robin. "NICE stop harming ME/CFS patients - Take CBT and GET out of the CFS guidelines NOW! | Sign the Petition". Change.org. Retrieved November 13, 2018. Cite has empty unknown parameter: |dead-url= (help)
  7. Moss-Morris, Rona; Sharon, Cynthia; Tobin, Roseanne; Baldi, James C. (March 2005). "A Randomized Controlled Graded Exercise Trial for Chronic Fatigue Syndrome: Outcomes and Mechanisms of Change". Journal of Health Psychology. 10 (2): 245–259. doi:10.1177/1359105305049774. ISSN 1359-1053.
  8. 8.0 8.1 8.2 8.3 Wilshire, Carolyn; Kindlon, Tom; Matthees, Alem; McGrath, Simon (December 14, 2016). "Can patients with chronic fatigue syndrome really recover after graded exercise or cognitive behavioural therapy? A critical commentary and preliminary re-analysis of the PACE trial". Fatigue: Biomedicine, Health & Behavior. 5 (1): 43–56. doi:10.1080/21641846.2017.1259724. ISSN 2164-1846.
  9. "PACEindividuals". Vimeo. Retrieved October 13, 2018.
  10. "PACEgraph". Vimeo. Retrieved October 13, 2018.
  11. Torjesen, Ingrid (October 28, 2015). "Tackling fear about exercise produces long term benefit in chronic fatigue syndrome". BMJ. 351: h5771. doi:10.1136/bmj.h5771. ISSN 1756-1833. PMID 26511755.
  12. "Objective measures found a lack of improvement for CBT & GET in the PACE Trial: subjective improvements may simply represent response biases or placebo effects in this non-blinded trial". The BMJ. October 13, 2018.
  13. Crowhurst, Greg (September 3, 2005). "Issues relating to Severe ME And Graded Exercise" (PDF). Stonebird. Cite has empty unknown parameter: |dead-url= (help)
  14. 14.0 14.1 Tuller, David (October 27, 2016). "For Chronic Fatigue Syndrome Sufferers, a Dubious Treatment Unravels". Undark. Retrieved November 27, 2018. Cite has empty unknown parameter: |dead-url= (help)
  15. Maxted, Camilla (August 6, 2017). "This Is Why I Quit Exercise Therapy". BuzzFeed. Retrieved November 29, 2018. Cite has empty unknown parameter: |dead-url= (help)
  16. Kindlon, Tom (March 20, 2017). "Do graded activity therapies cause harm in chronic fatigue syndrome?". Journal of Health Psychology. 22 (9): 1146–1154. doi:10.1177/1359105317697323. ISSN 1359-1053.
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  29. Trial By Error: The CDC Drops CBT/GET - Virology Blog
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