The National Institute for Health and Clinical Excellence (NICE) defines Graded Exercise Therapy (GET) as:
“An evidence-based approach to CFS/M.E. that involves physical assessment, mutually negotiated goal-setting and education.”
It says: “The first step is to set a sustainable baseline of physical activity, then the duration of the activity is gradually increased in a planned way that is tailored to the person.
“This is followed by an increase in intensity, when the person is able, taking into account their preferences and objectives, current activity and sleep patterns, setbacks/relapses and emotional factors.
“The objective is to improve the person’s CFS/M.E. symptoms and functioning, aiming towards recovery.”
GET seeks to reverse this deconditioning effect.
Does it help?
The PACE trial found that adults with CFS/M.E. who were well enough to participate in its study (ie. not housebound or bedbound) showed moderate improvements in fatigue and physical function following 52 weeks of GET.
The proportion of participants rating themselves as “much” or “very much” better was 41% (62 out of 152 participants).
The PACE trial concluded that GET is safe with few adverse effects. However, surveys carried out by Action for M.E. and other patient groups suggest that graded activity/ exercise may sometimes be harmful, perhaps if they are delivered inappropriately.
Of those who responded to our 2008 survey and who had received GET, 45% of people with M.E. said it helped them, 21% said it made no difference to them and 34% said it made them worse.
In our 2010 survey, reported in InterAction magazine, only 22.2% reported any degree of improvement after GET and 60.2% reported that it had made their condition worse. Of these, 44.1% said it had made them much or very much worse.
GAT emerged as doing more good than harm, with 26.3% reporting that they were worse following therapy, while 39.4% reported an improvement.
We are analysing the patient narratives in our 2010 study to identify the main factors associated with harmful outcomes and will publish our findings
There have been no published randomised controlled trials of GET in children or the more severely affected.
What does NICE advise?
The National Institute for Health and Clinical Excellence (NICE) says:
“GET should be delivered: by a suitably trained GET therapist with experience in CFS/ME, under appropriate clinical supervision; one-to-one if possible.”
People with M.E. who wish to try GET should ask to be referred to a specialist CFS/M.E. clinic, where this expertise exists, if at all possible. Details of clinics are available in our online directory.
Read past articles about GET in our InterAction archive.