Graded activity therapy

Graded Activity Therapy or GAT is an alternative name for the controversial treatment Graded Exercise Therapy (GET). Graded Activity Management (GAM) is another term used interchangeably with Graded Activity Therapy and Graded Exercise Therapy.

Graded Activity Therapy is defined in several different ways:
 * As identical to graded exercise therapy, or
 * As the same approach as graded exercise therapy but including cognitive / mental activity as well as physical activity

Theory
Graded activity therapy uses a graded approach, meaning continual goals involving increases in physical or cognitive activities regardless of the degree of symptoms or illness caused. The aim it to continue increase until full health is achieved, with CFS/ME assumed to be "curable" medically unexplained symptoms despite the known abnormal findings in ME/CFS patients. Under this graded approach there is no consideration for patients with a deteriorating course of ME/CFS, or of patients who do not improve. Patients are told to "push through" and ignore their symptoms. In cognitive behavioral therapy (CBT) patients are told their symptoms are not a sign of illness and to avoid "symptom focusing" but not to avoid "exercise and activity". Patients assumed to have abnormal illness beliefs in both CBT and GAT/GET, despite significant evidence disputing this.

This approach is known as the biopsychosocial model for ME/CFS, and is the justification for the use of both cognitive behavioral therapy and graded activity/exercise therapy in ME/CFS, which assumes no disease process is present and that symptoms are the result of inactivity, patient behaviors such as resting too much, and other factors claimed to "perpetuate" the illness.

PACE trial
The controversial PACE trial was the largest ever trial of graded exercise therapy, after a Freedom of Information Act request was granted in 2016, the full but anonymised data from the PACE trial patients was published, showing that graded exercise therapy did not result in clinically significant improvements in ME/CFS patients. Graded Activity Therapy is considered identical or nearly identical to graded exercise therapy by PACE trial authors Peter White, Michael Sharpe, Lucy Clark, and other promoters of the Biopsychosocial model of ME/CFS, a model and treatment approaches now abandoned by the CDC in the United States, the Dutch Health Council in the Netherlands, and by NICE and the NHS in England and Wales.

NICE guidelines 2021
The NICE guidelines update in 2021 changed the advice about graded exercise therapy (which had been recommended since 2007) to state that it was no longer recommended due to harms.

Days after the NICE guidelines update in 2021, some chronic fatigue syndrome clinics in the United Kingdom had already renamed their GET service documentation without making any other changes, leaving erroneous claims such as that Graded Activity Management was a NICE recommended therapy. Some CFS/ME clinics renamed their services prior to the final publication of the NICE guidelines, or chose different names for their graded exercise/activity programs years before.

Criticisms
Criticisms of graded activity therapy are the same as those of graded exercise therapy, and research about the harms of graded exercise therapy also combined the alternative name of graded activity therapy.