Graded Exercise Therapy? Van Cauwenbergh et al 2012

Comments on "Graded Exercise Therapy for CFS ME and FMS Friend or Foe"

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  • TAG : RACGP - Graded exercise therapy: chronic fatigue syndrome
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  • White PD, et al. (2011). Comparison of adaptive pacing therapy, cognitive behaviourtherapy, graded exercise therapy, and specialist medical carefor chronic fatigue syndrome (PACE): A randomised trial. Lancet, 377(9768): 823–826.

    “Few patients receiving cognitive behavior therapy or graded exercise therapy in the PACE trial had serious adverse reactions, and no more than those receiving adaptive pacing therapy or standard medical care,” they write. “This finding is important and should be communicated to patients to dispel unnecessary concerns about the possible detrimental effects of cognitive behavior therapy and graded exercise therapy, which will hopefully be a useful reminder of the potential positive effects of both interventions.”

  • In an accompanying editorial, Gijs Bleijenberg and Hans Knoop of the Expert Centre for Chronic Fatigue of Radboud University Nijmegen Medical Center in Nijmegen, Netherlands point out that many CFS advocacy groups have expressed concerns about the risks associated with CBT and graded exercise therapy, including further muscle .

    Another author, Professor Peter White from Barts and the London school of medicine and dentistry, said: "While there is still room for improvement, this is a real step forward in informing patients with CFS/ME which treatments can help to improve their health and ability to lead a more normal life."The Association of Young People with ME welcomed the findings and said it hoped it would begin to lay to rest fears about graded exercise therapy and CBT being harmful. It called for the study to be replicated in children. Mary-Jane Willows, AYME's chief executive, said: "These treatments should be made available to all patients by those who are trained and experienced in dealing with CFS/ME." She added that there was "an urgent need" to find a way to include house-bound patients in a trial. Participants in the study had to be able to get to hospital.

    Side effect Patients
    Fatigue 1
    Muscle fatigue 1

  • Study Type: Interventional
    Study Design: Allocation: Randomized
    Endpoint Classification: Efficacy Study
    Intervention Model: Parallel Assignment
    Masking: Double Blind (Subject, Investigator)
    Primary Purpose: Treatment
    Official Title: Dosage-dependence of Graded Exercise Therapy in Patients With Patellofemoral Pain Syndrome. A Randomized Controlled Clinical Trial.

    Another author, Professor Peter White from Barts and the London school of medicine and dentistry, said: "While there is still room for improvement, this is a real step forward in informing patients with CFS/ME which treatments can help to improve their health and ability to lead a more normal life."The Association of Young People with ME welcomed the findings and said it hoped it would begin to lay to rest fears about graded exercise therapy and CBT being harmful. It called for the study to be replicated in children. Mary-Jane Willows, AYME's chief executive, said: "These treatments should be made available to all patients by those who are trained and experienced in dealing with CFS/ME." She added that there was "an urgent need" to find a way to include house-bound patients in a trial. Participants in the study had to be able to get to hospital.

Graded Exercise Therapy (GET) - AYME

As one can see, Graded Exercise Therapy had a terrible safety profile in this data – 50% of 1214 people reported being made worse – that’s the equivalent of 607 reports of adverse reactions! CBT had the second worst safety profile with 26% reporting being made worse by it. But this was for a smaller number of patients (285) than GET, so is equivalent to 74 reports of adverse reactions.