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===Graded exercise therapy (GET) === Peter White helped develop graded exercise therapy (GET) <ref name=":4">{{Cite journal | last = Fulcher | first = K. Y. | last2 = White | first2 = P. D. | date = 1997-06-07| title = Randomised controlled trial of graded exercise in patients with the chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/9180065|journal=BMJ (Clinical research ed.)|volume=314|issue=7095|pages=1647–1652|doi=10.1136/bmj.314.7095.1647|issn=0959-8138|pmc=2126868|pmid=9180065}}</ref><ref name=":5">{{Cite journal | last = Clark | first = Lucy V. | last2 = White | first2 = Peter D. | date = 2005-06-01| title = The role of deconditioning and therapeutic exercise in chronic fatigue syndrome (CFS)|url=https://doi.org/10.1080/09638230500136308|journal=Journal of Mental Health|volume=14|issue=3|pages=237–252|doi=10.1080/09638230500136308|issn=0963-8237}}</ref>, on the basis that "CFS maintained by both the avoidance of activity and deconditioning."<ref name=":11">{{Cite journal | last = Gallagher | first = A.M. | last2 = Coldrick | first2 = A.R. | last3 = Hedge | first3 = B. | last4 = Weir | first4 = W.R.C. | last5 = White | first5 = P. D. | date = Apr 2005| title = Is the chronic fatigue syndrome an exercise phobia? A case control study|url=https://www.ncbi.nlm.nih.gov/pubmed/15992572|journal=Journal of Psychosomatic Research|volume=58|issue=4|pages=367–373|doi=10.1016/j.jpsychores.2005.02.002|issn=0022-3999|pmid=15992572}}</ref> In of his studies CFS patients were compared to sedentary controls. While both were equally unfit, CFS patients had reduced exercise capacity and perceived greater effort during exercise than sedentary controls.<ref>{{Cite journal | last = Fulcher | first = K. Y. | last2 = White | first2 = P. D. | date = Sep 2000| title = Strength and physiological response to exercise in patients with chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/10945803|journal=Journal of Neurology, Neurosurgery, and Psychiatry|volume=69|issue=3|pages=302–307|doi=10.1136/jnnp.69.3.302|issn=0022-3050|pmc=1737090|pmid=10945803}}</ref> With GET patients are instructed to gradually increase their level of physical activity.<ref name=":4" /> Under the guidance of a trained physical therapist, patients are instructed to find a baseline of physical activity they can easily manage, even on bad days.<ref name=":5" /> From there, the amount of exercise is increased time-contingently with the goal of reaching 30 minutes five times a week. When patients reach their goals, the intensity of exercise can be increased for example by going from walking to running or swimming.<ref>Bavinton J, Darbishire L, White PD. PACE. [https://me-pedia.org/images/8/89/PACE-get-therapist-manual.pdf Manual For Therapists. Graded Exercise Therapy. MREC Version 2]. 16 November 2004. </ref> According to White, patients can improve and even recover from CFS by following GET.<ref>{{Cite journal | last = White | first = P. D. | last2 = Goldsmith | first2 = K. | last3 = Johnson | first3 = A.L. | last4 = Chalder | first4 = T. | last5 = Sharpe | first5 = M. | date = Oct 2013| title = Recovery from chronic fatigue syndrome after treatments given in the PACE trial|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3776285/|journal=Psychological Medicine|volume=43|issue=10|pages=2227–2235|doi=10.1017/S0033291713000020|issn=0033-2917|pmc=3776285|pmid=23363640}}</ref> He has argued that “patients can be released from their self-perpetuating cycle of inactivity if the impairments that occur due to inactivity and their physiological deconditioning can be reversed. This can occur if they are willing to gradually exceed their perceived energy limits, and recondition their bodies through GET.”<ref name=":5" /> White has conducted three randomized trials that assessed the effectiveness of GET.<ref name=":4" /><ref name=":19">{{Cite journal | last = Sharpe | first = M. | last2 = Chalder | first2 = T. | last3 = McCrone | first3 = P. | last4 = Wilks | first4 = D. | last5 = O'Dowd | first5 = H. | last6 = Murphy | first6 = M. | last7 = Murphy | first7 = G. | last8 = Angus | first8 = B.J. | last9 = Bavinton | first9 = J. | date = 2011-03-05| title = Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial|url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60096-2/abstract|journal=The Lancet|language=English|volume=377|issue=9768 | pages = 823–836|doi=10.1016/S0140-6736(11)60096-2|issn=0140-6736|pmid=21334061}}</ref><ref>{{Cite journal | last = White | first = Peter D. | last2 = Beynon | first2 = Michelle | last3 = Vergara-Williamson | first3 = Mario | last4 = Thomas | first4 = Janice M. | last5 = Pesola | first5 = Francesca | last6 = Clark | first6 = Lucy V. | date = 2017-07-22| title = Guided graded exercise self-help plus specialist medical care versus specialist medical care alone for chronic fatigue syndrome (GETSET): a pragmatic randomised controlled trial|url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32589-2/abstract|journal=The Lancet|language=English|volume=390|issue=10092|pages=363–373|doi=10.1016/S0140-6736(16)32589-2|issn=0140-6736|pmid=28648402}}</ref> All claimed that CFS patients significantly improved in the GET-group, although the results have been challenged by others.<ref>{{Cite journal | last = Shepherd | first = C. | last2 = Macintyre | first2 = A. | date = 1997-10-11| title = Graded exercise in chronic fatigue syndrome. Patients should have initial period of rest before gradual increase in activity|url=https://www.ncbi.nlm.nih.gov/pubmed/9361549|journal=BMJ (Clinical research ed.)|volume=315|issue=7113 | pages = 947; author reply 948|issn=0959-8138|pmc=2127628|pmid=9361549}}</ref><ref>{{Cite journal | last = Franklin | first = A.J. | date = 1997-10-11| title = Graded exercise in chronic fatigue syndrome. Including patients who rated themselves as a little better would have altered results|url=https://www.ncbi.nlm.nih.gov/pubmed/9361550|journal=BMJ (Clinical research ed.)|volume=315|issue=7113 | pages = 947; author reply 948|issn=0959-8138|pmc=2127632|pmid=9361550}}</ref><ref>{{Cite journal | last = Wood | first = Anna | date = Mar 24, 2018| title = Graded exercise self-help for chronic fatigue syndrome in GETSET|url=https://www.ncbi.nlm.nih.gov/pubmed/29595493|journal=Lancet (London, England)|volume=391|issue=10126|pages=1161–1162|doi=10.1016/S0140-6736(18)30619-6|issn=1474-547X|pmid=29595493}}</ref><ref>{{Cite journal | last = Crawford | first = Joan S. | date = Mar 24, 2018| title = Graded exercise self-help for chronic fatigue syndrome in GETSET|url=https://www.ncbi.nlm.nih.gov/pubmed/29595492|journal=Lancet (London, England)|volume=391|issue=10126|pages=1160|doi=10.1016/S0140-6736(18)30621-4|issn=1474-547X|pmid=29595492}}</ref> A review by Vink & Vink-Niese indicated that patients rarely improve on objective outcomes following GET.<ref>{{Cite journal | last = Vink | first = Mark | last2 = Vink-Niese | first2 = Alexandra | date = Jul 2018| 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/pubmed/30305916|journal=Health Psychology Open|volume=5|issue=2|pages=2055102918805187|doi=10.1177/2055102918805187|issn=2055-1029|pmc=6176540|pmid=30305916}}</ref> White has acknowledged that “GET does not work by improving physical fitness”<ref name=":6">{{Cite journal | last = Cheshire | first = Anna | last2 = Ridge | first2 = Damien | last3 = Clark | first3 = Lucy | last4 = White | first4 = Peter | date = 2018-10-16| title = Guided graded Exercise Self-help for chronic fatigue syndrome: patient experiences and perceptions|url=https://www.ncbi.nlm.nih.gov/pubmed/30325677|journal=Disability and Rehabilitation|pages=1–10|doi=10.1080/09638288.2018.1499822|issn=1464-5165|pmid=30325677}}</ref> but argued that it may work by improving exercise tolerance or reducing fear avoidance.<ref name=":6" /> The use of GET has been controversial in the ME/CFS community. In several surveys, patients indicated to have been harmed by this treatment.<ref>Kindlon, T. [https://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.] ''Bulletin of the IACFS/ME''. 2011;19(2):59-111.</ref> White has said that reports of harm are merely examples of GET being wrongly applied, for example when patients are told to go to the gym to exercise without any guidance<ref>{{Cite journal | last = Clark | first = Lucy V. | last2 = White | first2 = Peter D. | date = Nov 2008| title = Chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/19242631|journal=Journal of Rehabilitation Medicine|volume=40|issue=10 | pages = 882–883; author reply 883–885|doi=10.2340/16501977-0261|issn=1651-2081|pmid=19242631}}</ref> - an explanation that has been contested.<ref>{{Cite journal | last = Kirke | first = Karen D. | date = Aug 2017| title = PACE investigators' response is misleading regarding patient survey results|url=https://www.ncbi.nlm.nih.gov/pubmed/28805528|journal=Journal of Health Psychology|volume=22|issue=9|pages=1168–1176|doi=10.1177/1359105317703787|issn=1461-7277|pmid=28805528}}</ref> White has acknowledged however that “It is an apparent paradox that graded exercise programmes are prescribed for patients with CFS/ME, when post-exertional malaise is a feature, which requires explanation.”<ref name=":6" />
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