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Living with M.E.

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GET and GAT

GET and GAT

Specialist M.E. services will often use elements of two approaches – graded activity therapy (GAT) and graded exercise therapy (GET).

Below we explain what these approaches involved, the evidence base for them, and self-reported results from people with M.E. shared in our survey.

Please note, there has been no research conducted into whether GET and GAT are helpful for people who are severely affected by M.E.


What is GET?

The National Institute for Health and Care 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 M.E. symptoms and functioning, aiming towards recovery.”

It also 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 M.E. clinic, where this expertise exists, if at all possible. Details of clinics are available in our online directory.

A 2011 research study (PACE trial) identified an improvement for those patients that undertook CBT and GET over and above any benefit of standard medical care alone (14-16% improvement), which included advice on self-management.

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.

In 2014, we surveyed more than 2,000 people with M.E. Our resulting M.E. Time to deliver report shows that:

  • 23% of respondents had tried GET 
  • of these, 35% said they found it helpful or very helpful, 18% said it resulted in no change, and 47% said it made them a bit or much worse.

There have been no published randomised controlled trials of GET in children or the more severely affected.


What is GAT?

GAT is a person-centred approach to managing a person’s symptoms by using activity.

Activities are selected, adapted and graded for therapeutic purposes to promote health and well-being. Therapy is goal-directed and uses activity analysis and graded activity to enable people to improve, evaluate, restore and/or maintain their function and well-being in self-care, work and leisure.

Activity management is described in detail on p 20 of the NICE guideline.

It is important that GAT, like GET, should be delivered by a suitably trained therapist with experience in CFS/ME, under appropriate clinical supervision. People with M.E. who wish to try GAT 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.

GAT was not one of the approaches tested in the PACE trial. There have been no published randomised controlled trials of GAT.

In 2014, we surveyed more than 2,000 people with M.E. Our resulting M.E. Time to deliver report shows that:

  • 15% of respondents had tried GAT
  • of these, 48% said they found it helpful or very helpful, 19% said it resulted in no change, and 34% said it made them a bit or much worse.