Given all the drama over the update of the NICE Guidelines, one might be forgiven for forgetting about another important update regarding exercise therapy for ME/CFS:
The Cochrane Review of Exercise Therapy for ME/CFS
As most of you know, this is a long, sad story.
It can also be a confusing story, as there were at one time two separate updates being conducted simultaneously by Cochrane.
Source: https://forums.phoenixrising.me/threads/dr-david-tuller-the-cochrane-controversy.61350/
A new version of the Cochrane Review of Exercise Treatments was published in 2017.
Source: https://forums.phoenixrising.me/thr...-fatigue-syndrome-is-not-effective-and.61850/
In 2018, Cochrane announced a temporary withdrawal.
Source: https://forums.phoenixrising.me/thr...idst-deluge-of-complaints.61911/#post-1006898
Source: https://forums.phoenixrising.me/thr...ane-review-of-exercise-therapy-for-cfs.62040/
In 2019 Cochrane slightly amended its exercise review, but the amended review wasn't much better.
Source: https://content.iospress.com/articles/work/wor203174
Also in 2019, Cochrane announced a full update of the exercise review.
Source: https://forums.phoenixrising.me/threads/cochrane-is-reviewing-us-again.79204/
So where are we now? To find out, read MEAction's recent recap:
Cochrane Redux (2021)
https://www.meaction.net/2021/06/16/cochrane-redux/
The Cochrane Review of Exercise Therapy for ME/CFS
As most of you know, this is a long, sad story.
It can also be a confusing story, as there were at one time two separate updates being conducted simultaneously by Cochrane.
David Tuller 2018 said:
Cochrane–formerly called the Cochrane Collaboration–is respected worldwide for its systematic reviews of medical treatments. These reviews are often cited as the definitive source of information about treatment efficacy and safety.
[...]
But like any organization, Cochrane can get things wrong—as it has in the case of chronic fatigue syndrome. (Cochrane generally uses the term CFS, so I will also when referring to these systematic reviews.)
[...]
The most recent review of exercise therapies for CFS, which mainly included studies of graded exercise, was published in 2014. These systematic reviews and previous versions, all of which reported benefits from the treatments, were conducted by Cochrane’s Common Mental Disorders group.
[...]
But like any organization, Cochrane can get things wrong—as it has in the case of chronic fatigue syndrome. (Cochrane generally uses the term CFS, so I will also when referring to these systematic reviews.)
[...]
The most recent review of exercise therapies for CFS, which mainly included studies of graded exercise, was published in 2014. These systematic reviews and previous versions, all of which reported benefits from the treatments, were conducted by Cochrane’s Common Mental Disorders group.
A new version of the Cochrane Review of Exercise Treatments was published in 2017.
Dr Mark Vink 2018 said:
The analysis of the 2017 Cochrane review reveals flaws, which means that contrary to its findings, there is no evidence that graded exercise therapy is effective. Because of the failure to report harms adequately in the trials covered by the review, it cannot be said that graded exercise therapy is safe. The analysis of the objective outcomes in the trials provides sufficient evidence to conclude that graded exercise therapy is an ineffective treatment for myalgic encephalomyelitis/chronic fatigue syndrome.
In 2018, Cochrane announced a temporary withdrawal.
A respected science journal is to withdraw a much-cited review of evidence on an illness known as chronic fatigue syndrome (CFS) amid fierce criticism and pressure from activists and patients.
Cochrane has temporarily removed a review from its database that claims exercise therapy is effective for chronic fatigue syndrome (CFS) and myalgic encephalomyelitis (ME).
In 2019 Cochrane slightly amended its exercise review, but the amended review wasn't much better.
Dr Mark Vink 2020 said:
The Cochrane review concluded that graded exercise therapy (GET) improves fatigue at the end of treatment compared to no-treatment. However, the review did not consider the unreliability of subjective outcomes in non-blinded trials, the objective outcomes which showed that GET is not effective, or the serious flaws of the studies included in the review. These flaws included badly matched control groups, relying on an unreliable fatigue instrument as primary outcome, outcome switching, p-hacking, ignoring evidence of harms, etc. The review did also not take into account that GET does not restore the ability to work.
Also in 2019, Cochrane announced a full update of the exercise review.
Cochrane said:
In October 2019, Cochrane announced its commitment to a full update the Cochrane Review Exercise therapy for chronic fatigue syndrome. The statement noted plans for: “a comprehensive review of the protocol, which will be developed in consultation with an independent advisory group that we intend to convene. This group will involve partners from patient-advocacy groups from different parts of the world who will help us to embed a patient-focused, contemporary perspective on the review question, methods and findings.”
So where are we now? To find out, read MEAction's recent recap:
Cochrane Redux (2021)
https://www.meaction.net/2021/06/16/cochrane-redux/