Graded exercise therapy

Cognitive-behavioral model of ME-CFS

PACE trial subjective outcomes

Graded Exercise Therapy (GET) is a physical therapy approach designed to help individuals, particularly those suffering from chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME), gradually increase their level of physical activity. The primary goal of GET is to improve the patient's physical capacity and reduce the symptoms associated with these conditions. This therapy is based on the principle that a careful and gradual increase in physical activity can help overcome the exercise intolerance seen in patients with CFS/ME.

Overview

Graded Exercise Therapy begins with an assessment of the patient's current physical capabilities and their symptoms. A tailored exercise plan is then developed, starting with very low-intensity activities. The intensity and duration of these activities are gradually increased over time, based on the patient's tolerance. Activities may include walking, swimming, or specific exercises designed to improve strength and endurance without exacerbating symptoms.

Rationale

The rationale behind GET is the deconditioning theory, which suggests that the symptoms of CFS/ME may be perpetuated by a cycle of physical inactivity and resulting deconditioning. By gradually increasing activity, GET aims to break this cycle, improving physical fitness and energy levels. However, it is important to note that the effectiveness and safety of GET for CFS/ME patients have been subjects of debate within the medical community and among patient advocacy groups.

Controversy

Critics of GET argue that the therapy can lead to worsening symptoms for some patients, citing the potential for post-exertional malaise (PEM), a hallmark symptom of CFS/ME that is characterized by a significant exacerbation of symptoms following physical or mental exertion. Some studies and patient surveys have reported that a subset of patients experience an increase in symptoms after participating in GET. This has led to calls for more research into the therapy's safety and efficacy, as well as for the development of guidelines that more accurately reflect the experiences and needs of CFS/ME patients.

Current Guidelines

As of the last update, some health organizations have revised their recommendations regarding GET for CFS/ME. These revisions reflect the ongoing debate and emerging research on the subject. Patients are advised to approach GET with caution and to work closely with healthcare providers who are knowledgeable about CFS/ME to tailor the therapy to their individual needs and limitations.

Conclusion

Graded Exercise Therapy represents a complex and controversial approach to managing CFS/ME. While it may offer benefits for some patients, others may find it unsuitable or even harmful. Ongoing research and a personalized approach to treatment are essential to ensure the best outcomes for those affected by these conditions.