Graded Exercise Therapy (GET)

Graded exercise therapy, a medical term defined by NICE (National Institute for Health and Care Excellence) as:

“An approach for managing CFS/ME that involves planned increases in activity or exercise, working towards goals that are important for the person with CFS/ME. The first step in GET is to help to stabilise the amount of activity a person can do, then a manageable level of exercise is added. This is gradually increased towards aerobic exercise if and when the person is able, aiming towards recovery.”

The NHS adds that “GET should only be carried out by a trained specialist with experience of treating CFS and, if possible, should be offered on a one-to-one basis.”

The idea sounds reasonably straightforward, although no doubt the execution is rather more troublesome! Find out what you’re capable of, then very slowly increase, possibly using goals as milestones and incentives. Although the word ‘exercise’ is used, it doesn’t mean going for half hour walks. (At least to begin with!) The activities need to be tailored to the individual and could be anything from stretches, to standing and sitting, to walking for ten minutes, to swimming, to going to the shops, and so on.

But there are very different opinions about the suitability and success of this as a treatment method.

NICE and the NHS currently support the use of GET as a key form of treatment for ME/CFS.

The ME Association leaflet titled ‘ME/CFS: your questions answered’ says that while NICE guidelines recommends that GET be offered to those with mild to moderate symptoms (along with other treatments) they do not agree with this “. . . on the grounds that existing research evidence is weak and not consistent.” They have also carried out their own survey which returned the result that ‘significant numbers’ found the treatment had no effect or actually made them worse. They allow that some people find GET beneficial, but since it’s not currently possible to determine who these are beforehand, and given the number finding otherwise, it should be discontinued as a blanket treatment. They state that if it were a licensed drug it would already have been up for review.

It also sounds as though the success of GET depends on many things, including:

  • The attitude of the specialist supervising. Do they believe ME/CFS is a real condition with physical symptoms? Do they make it clear that the patient has to take things steadily and may have to ease off if they have a bad day, and that if they have a bad relapse they may have to begin all over again?
  • How the individual implements the method. Do they keep pushing themselves to improve and so cause a relapse or do they stop when necessary. Do they try once and then give up? Do they lose hope when it turns out not to be a cure.
  • The condition. ME/CFS is a variable condition, you can have good days and bad days, be fine for ages then suffer a relapse. Different triggers may make GET unsuitable for some.

For me, given that I’m used to managing my own condition, I already push myself to do what I can when I’m able, I don’t fancy having to drive to the clinic every month, and I hate setting ‘goals’, I don’t see this as something that would work for me. If it’s even offered. Not that I’m refusing it out of hand, I just don’t see where the benefits would come in.


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