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ME campaigners dispute exercise study

Graded exercise can bring ‘moderate improvement’ in chronic fatigue, according to a new study, the PACE trial (White PD et al. Lancet 2011; 377: 823–36).

Media reports that ‘exercise cures chronic fatigue’ have aroused controversy among campaigners. But physio Jessica Bavinton, primary author of the graded exercise therapy (GET) section, blames a misunderstanding.

‘GET is a very clearly defined, patient-led, mutually negotiated programme,’ she says. ‘For someone who’s quite unwell it would start at a very low level, as little as three minutes walking.’

The trial compared 641 patients with chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME). All had fatigue as their main symptom. They were divided into four groups, one of which just had specialist medical care. The others also received either GET or or cognitive behaviour therapy (CBT) or adaptive pacing therapy (APT), which aimed to match their activity with their current levels of energy.

The GET and CBT groups showed some improvement; APT was not found to help.

The GET group gradually increased activity, in 15 50-minute sessions over nine months led by specially trained and supervised therapists.

Ms Bavinton said problems might arise if staff were not specially trained or were under pressure to achieve results in a shorter time.

But campaigners say the criteria excluded people with the most severe ME, who have neurological symptoms and are too ill to travel.

‘We are still in the dark about therapies for severely affected patients and those who experience, for example, pain as their primary symptom,’ says Sir Peter Spencer, chief executive officer of Action for ME.

The GET manual is at www.pacetrial.org

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