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Campaigners dispute benefits of exercise for fatigue syndrome

25 February 2011 - 12:37pm

Graded exercise can bring 'moderate improvement' for patients with chronic fatigue, according to a study published in The Lancet.

The PACE Trial, by P. D. White and colleagues, has aroused controversy among health campaigners, who dispute its validity.


But specialist physiotherapist Jessica Bavinton, primary author of the graded exercise therapy (GET) section, says critics have misunderstood the method as it was not what people usually meant by exercise.


Clearly defined programme


‘It’s 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, something they could do comfortably. It might be as little as three minutes walking, timed very carefully.’


The PACE Trial compared treatments received by 641 patients with chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME).


They all had fatigue as their main symptom, but were well enough to attend clinics for treatment. All of them received specialist medical care, including advice and medicines where required.


CBT also helpful


They were divided into four groups, one of which just had the medical care. The other groups additionally received either GET or adaptive pacing therapy (APT), in which patients match their activity to their current levels of energy, or cognitive behaviour therapy (CBT).


Those in the GET and CBT groups showed some improvement; APT was not found to help.


The GET group gradually increased the amount of exercise they could do, under the guidance of specially trained and supervised physios or exercise physiologists following a manual. They had 15 fifty-minute sessions over nine months.


Ms Bavinton said problems might arise where staff were under pressure to achieve results in a shorter time, such as six half-hour sessions. Patients had reported setbacks when pushed to progress too quickly.


‘Training is also an issue, as this is a relatively new therapy and only now found to be effective,’ she said.


Severe cases excluded


But campaigners say the criteria excluded people with the most severe forms of ME - who have neurological and other symptoms - as all those who took part were well enough to travel.


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

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