Letter on Graded Exercise Therapy and ME | ‘Frontline’ journal | 19 June 2013

From the Letters Page, ‘Frontline’, journal of the Chartered Society of Physiotherapy, 19 June 2013.


With reference to your discussion on graded exercise therapy (GET), in response to the ‘Making the grade’ article (20 March), one of the most challenging features of myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS) is the symptom of ‘post-exertional malaise’.

This is characterised by a delayed and prolonged adverse physical reaction to minimal exertion, which is not relieved by rest.

There is a normal human urge to be active, and this is the same for ME/CFS patients who engage in activity as far as they can safely do so without exacerbating the illness.

However, some may not be able to increase their activity levels safely and shouldn’t be encouraged to do what isn’t safe for them.

It is important to avoid exaggerating the benefits of GET, and therapists must avoid being the cause of worsening symptoms as a result of an insensitive or misguided emphasis on increasing activity.

Instead of aiming to increase a patient’s activity levels, the immediate therapeutic focus should be on supporting patients to cope with limitations, and to live comfortably.

Robert Courtney (ME patient)


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