Exercise and CME
They promote CBT and graded exercise which is what the psychiatrists would do. They may not intend to support the psychiatric view of ME/CFS, they may not realise what they are doing (which I think is the most likely explanation) but they have adopting some of the philosophy of the psychiatric school. Some of the psychiatrists don't push very aggressive programmes now (in their own practices) because patients can't do them, so lack of an aggressive exercise approach doesn't necessarily serve as proof of something being totally at odds with the psychiatric view.
This whole emphasis on exercise programmes comes from the psychiatric school of thought, because they think we are exercise/activity phobic and need to be pushed to do more.
The stuff about activity avoidance is also coming from the psychiatric school of thought (and that is where they got it here, as I showed in my piece quite a few pages back on their reference for that comment).
There is no evidence that patients pathalogically avoid activity. This is a psychiatric myth. There is no evidence that exercise programmes diminish most symptoms or lead to overal functional improvement. There is evidence that exercise can be harmful.
The CME could just advocate Pacing as most of the British groups do (this would mean that if patients feel better they do more, but there is no pressure to increase activity, or pretence of exercise as treatment, as is palpable in this document)
Lets look at some of the sources for the CAA material:
For this sentence:
There is no evidence for the above statement. Their sources for this comment are both from the psychiatric school of thought (the first study was really a paced exercise programme, not GET, but they called it GET and that what it gets referred to as, so a bit of spin going on there):
This quote from the CME:
Effective is a gross over-statement. The source for this comment is
No evidence that it improves activity levels. And one of the sources for this comment:
If they are going to mention CBT (or GET) they should point out the serious flaws in the research, that it doesn't lead to increased activity levels, and that there have been many surveys showing adverse or no useful effect (and they should quote these).
Orla
Cort
What I've been trying to say is that this is not that Psych program
They promote CBT and graded exercise which is what the psychiatrists would do. They may not intend to support the psychiatric view of ME/CFS, they may not realise what they are doing (which I think is the most likely explanation) but they have adopting some of the philosophy of the psychiatric school. Some of the psychiatrists don't push very aggressive programmes now (in their own practices) because patients can't do them, so lack of an aggressive exercise approach doesn't necessarily serve as proof of something being totally at odds with the psychiatric view.
This whole emphasis on exercise programmes comes from the psychiatric school of thought, because they think we are exercise/activity phobic and need to be pushed to do more.
The stuff about activity avoidance is also coming from the psychiatric school of thought (and that is where they got it here, as I showed in my piece quite a few pages back on their reference for that comment).
There is no evidence that patients pathalogically avoid activity. This is a psychiatric myth. There is no evidence that exercise programmes diminish most symptoms or lead to overal functional improvement. There is evidence that exercise can be harmful.
The CME could just advocate Pacing as most of the British groups do (this would mean that if patients feel better they do more, but there is no pressure to increase activity, or pretence of exercise as treatment, as is palpable in this document)
Lets look at some of the sources for the CAA material:
For this sentence:
Graded exercise may include both anaerobic and aerobic activities and can be effective in improving function and decreasing fatigue
There is no evidence for the above statement. Their sources for this comment are both from the psychiatric school of thought (the first study was really a paced exercise programme, not GET, but they called it GET and that what it gets referred to as, so a bit of spin going on there):
Wallman, KE, Morton AR, Goodman C, Grove R, Guilfoyle AM. Randomized controlled trial of graded exercise in chronic fatigue syndrome. Med J Aust. 2004;180:444-448.
Fulcher KY, White PD. Randomised controlled trial of graded exercise in patients with the chronic fatigue syndrome. BMJ. 1997;314:1647-1652.
This quote from the CME:
CME
CBT has been shown to be effective in managing CFS in small, short-term trials
Effective is a gross over-statement. The source for this comment is
Deale A, Husain K, Chalder T, Wessely S. Long-term outcome of cognitive behavior therapy versus relaxation therapy for chronic fatigue syndrome: a 5-year follow-up study. Am J Psychiatry. 2001;158:2038-2042.
CME
CBT may help CFS patients develop constructive coping strategies, better manage symptoms, improve their level of function, and enhance their ability to perform activities of daily life
No evidence that it improves activity levels. And one of the sources for this comment:
Reid S, Chalder T, Cleare A, Hotopf M, Wessely S. Extracts from clinical evidence: chronic fatigue syndrome. BMJ. 2000;320:292-296.
If they are going to mention CBT (or GET) they should point out the serious flaws in the research, that it doesn't lead to increased activity levels, and that there have been many surveys showing adverse or no useful effect (and they should quote these).
Orla