The ME Association writes to GP Notebook about their information for GPs on exercise for people with ME/CFS – last reviewed November 2021
Dear GP Notebook
Re: Exercise in ME
This information on exercise, which was reviewed in 11/2021, is based on the recommendations in the old (2007) NICE guideline on ME/CFS (reference 5).
The 2007 NICE guideline was withdrawn in October 2021 – as was the recommendation on the use of graded exercise therapy (GET).
Having reviewed all the evidence on safety and efficacy for GET, the guideline committee concluded that the clinical trials involving GET were all of low or very low quality and there was substantial and consistent evidence of people being harmed by GET.
Consequently, NICE is now recommending that GET should not be offered to people with ME/CFS in the new (October 2021) guideline:
1.11.14: Do not offer people with ME/CFS:
- any therapy based on physical activity or exercise as a cure for ME/CFS
- generalised physical activity or exercise programmes – this includes programmes developed for healthy people or people with other illnesses
- any programme that does not follow the approach in recommendation 1.11.13 or that uses fixed incremental increases in physical activity or exercise, for example, graded exercise therapy (see box 4)
- physical activity or exercise programmes that are based on deconditioning and exercise avoidance theories as perpetuating ME/CFS.
This out-of-date and potentially harmful guidance on the use of exercise in ME/CFS, therefore, needs to be withdrawn and replaced with guidance that is consistent with recommendations on activity and energy management in ME/CFS in the new (2021) NICE guideline (whole of section 1.11)
The MEA would be very happy to help here if required
Dr Charles Shepherd
Hon Medical Adviser, ME Association
Member of NICE guideline on ME/CFS committee – 2019 – 2021
Dr Charles Shepherd,
Trustee and Hon. Medical Adviser to the ME Association.