Graded exercise therapy

Graded exercise therapy (GET) is a form of physical therapy for the management of chronic fatigue syndrome 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.

Patient Analysis of PACE Results
Graham McPhee and others created videos investigating the PACE trial data in relation to Graded Exercise Therapy.

Fear of exercise
The PACE trial investigators have stated that they believe a causal factor of the persistence of ME/CFS is fear of exercise. This claim as been criticized as unsupported by trial results.

Criticism

 * 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".


 * 2011, Reporting of Harms Associated with Graded Exercise Therapy and Cognitive Behavioural Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome by Tom Kindlon.


 * 2015, ME/CFS Illness Management Survey Results “No decisions about me without me” by the ME Association


 * 2016, Do graded activity therapies cause harm in chronic fatigue syndrome?


 * 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

Notable studies

 * 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 (Frank Twisk)
 * 2016, Exercise therapy for chronic fatigue syndrome (Lillebeth Larun, Kjetil G. Brurberg, Jan Odgaard-Jensen, Jonathan R Price)
 * 2016, Neurocognitive improvements after best-practice intervention for chronic fatigue syndrome: Preliminary evidence of divergence between objective indices and subjective perceptions. (Cvejic E, Lloyd AR, Vollmer-Conna U)

Centers for Disease Control and Prevention

 * July 3 2017, the CDC's Chronic Fatigue Syndrome page has been changed to Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and GET and CBT recomendations have been removed.

Learn more

 * Wikipedia - Graded Exercise Therapy"
 * NHS Graded Exercise Therapy Booklet - A self-help guide for those with chronic fatigue syndrome/myalgic encephalomyelitis (pdf)