TREATMENT DATABASE

Graded Exercise Therapy (GET) is a training program that increases exercise in small increments on a day-to-day basis. It is usually accompanied by CBT (cognitive behavioral therapy), a psychotherapeutic program designed to correct “ false illness beliefs.”

USES IN ME/CFS: GET was developed in Great Britain as a therapy for ME/CFS. It is based on the idea that ME/CFS is fundamentally a psychological condition that manifests itself as an avoidance of activity. The underlying concept of GET is that maintaining the habit of avoidance perpetuates ME/CFS symptoms.

The GET program has been met with a great deal of criticism. Both patient groups and researchers have pointed out that exercise intolerance is the hallmark symptom of ME/CFS and that a program of systematic exercise will inevitably cause relapse. Researchers who have investigated the mitochondrial defects and resultant cardiac insufficiencies that are common in ME/CFS patients have added that it is dangerous to force severely ill ME/CFS patients into any kind of exercise regime.

The supporters of GET answered this flood of criticism with an extensive randomized trial comparing GET, CBT, Pacing and specialist medical care in 641 ME/CFS patients. Predictably, the PACE trial, as it was called, concluded that GET and CBT could be added to specialized medical care to improve outcomes, but that Pacing (which limits physical activity and requires resting) is not effective.

The PACE trial was immediately hailed as a breakthrough. But since its publication numerous scientists, researchers, patients, and organizations have discredited the results of the trial. The primary complaint is that the bar for "recovery" was lowered after the trial began, which resulted in patients being classified as "recovered" even though they were just as sick or sicker than when they started, according to the trial's parameters. The trial's original claim that 22% of patients recovered has since been adjusted downward to roughly 7%, a figure that could easily have been attributed to a number of causes, including spontaneous remission and/or inclusion of participants who did not have ME/CFS. (The selection criteria were very broad.)

WARNING: Patients have almost universally reported that GET makes their disease worse, sometimes permanently. Knowledgeable specialists do not recommend GET for ME/CFS.

Treatment rating for Graded Exercise Therapy (GET)