When Rest May Be Best for Post-Viral Fatigue | ME / Chronic fatigue syndrome

rer Alastair Miller, Professor Paul Garner, and Professor Peter White are wrong when they state that Graduated Exercise Therapy (GET) is a safe and effective treatment for ME / chronic fatigue syndrome (Letters , March 11).

After reviewing all the published evidence from clinical trials, the new Nice guideline no longer recommends GET as an effective treatment for ME / CFS.

Patient evidence submitted to Nice and analyzed by Oxford Brookes University also concluded that GET caused symptoms to worsen in the vast majority of people who had tried it. The new Nice directive on ME / CFS therefore recommends that people stay within their energy limits and not be prescribed GET.

The way activity-induced fatigue is described in the long Covid is no different from that found in ME / CFS. This is hardly surprising as they are both debilitating post-viral conditions.

Many people with long-lasting Covid relapse when they increase their level of physical activity too quickly and fail to balance rest and activity. In the current state of our knowledge, therefore, there are very good reasons why people with both long-term Covid and ME / CFS should avoid any activity program that involves gradual increases in blood pressure. ‘exercise – like the GET.

What they need is a good old-fashioned recovery period at the onset of their illness. This should be followed by gradual, flexible, and cautious increases in physical and mental activity.
Dr Charles Shepherd
Honorary Medical Advisor, ME Association

While I am happy to see long discussions about Covid, I was disappointed to read such a one-sided view of Graduated Exercise Therapy, or GET.

GET as an effective treatment for ME is no longer recommended, and the similarities between long Covid and ME are not yet properly

demonstrated. There are peer-reviewed publications that have rightly questioned the validity of the GET recommendation as an effective treatment for ME. The lack of clinical studies on the harms of GET indicates a need for research, not that it is reasonable to assume that it is therefore safe.

Long-standing Covid patients struggle to access fast and effective treatment. It is better to improve patient health care in a more balanced and informed way without recommending what has long been controversial.
Rachel Harding
Nottingham