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Central role for physiotherapy in ME

New guidance gives exercise therapy a crucial role in the treatment of ME. Louise Hunt looks at what this will mean for physiotherapy

'This is a renewed opportunity for physiotherapists to be at the centre of chronic fatigue syndrome/ME care.' So says Jessica Bavinton, the physiotherapist who advised the National Institute for Health and Clinical Exellence on the guidance it has just published on the diagnosis and management of what can be a crippling condition.

The importance of the guidance, she says, is that is has graded exercise therapy as a key component of recommended treatment.

The fact it was chosen as one of the treatments that should be offered as part of individualised programmes, along with cognitive behavioural therapy and activity management, reflects the strong evidence base for its effectiveness, says Ms Bavinton. Until now there has only been a focus on psychological interventions.

This new emphasis on exercise has been welcomed by physiotherapists specialising in CFS/ME care, such as those at St Bartholomew's hospital CFS/ME centre, one of the CFS/ME coordination hubs for London.

'Graded exercise therapy is an important part of the physiotherapy management of people with CFS/ME, and the guidelines support its delivery by appropriately trained physios,' says senior physio Nicky Dyer.

Under the guidance, services are expected to be far more flexible than they may have been to date. For physiotherapists, this could mean providing home visits where patients cannot get to clinics, or longer and more spaced out treatment sessions.

'It is about patient choice. Patients' goals should be at the centre (of care) and physios should not push the patient to do more than they can do. Some patients may not choose to do exercise at all,' says Ms Bavinton.

The guidance is aimed at all physios who come into contact with CFS/ME patients, and Ms Bavinton suggests that they may need to adjust their mindsets to cater for the highly variable pace of recovery in these patients.

'Physios will need to be patient with outcomes as it can take months if not years for progress to be made,' she says.

In the UK, an estimated 193,000 people, including children, have CFS/ME. The guidelines cover all age groups. Esther Crawley, a consultant paediatrician at Bath Royal National Hospital for Rheumatic Diseases, hopes they will influence service developments for children.

Dr Crawley, who also advised on the guidelines, says: 'Most children in the UK are not accessing anything for CFS/ME, let alone exercise therapy.' She believes the therapy could make a big difference to some children, but says there has been a lack of support and training for physios to provide this help.

Dr Crawley says physios have all the right skills to deliver the treatment and that they can make a big difference. 'Commissioners are going to have to invest in training people to provide high quality exercise therapy, especially in paediatrics,' she adds.

Both NICE advisers also stress the importance of physios receiving training and advice from specialists in CFS/ME, principally from one of the 13 English clinical network coordination centres.


Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy) is available at


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