Peter White on Graded Exercise Therapy (possibly not of general interest)

Dolphin

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[Not that exciting]

I just read a copy of:

White Peter. How exercise can help chronic fatigue syndrome.
Pulse: 86-87, June 20, 1998
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"If there has been no increase in symptoms, the patient can be given the next fortnight's prescription, with the duration increased by one or two minutes, aiming at a total of half an hour of exercise, five days a week.
If there has been an increase in symptoms, or any other adverse effects, they should stay at their current level of exercise for a further week or two, until the symptoms are back to their previous levels."
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Contrast that with this paper:
KY Fulcher and PD White, 'Chronic fatigue syndrome: A description of graded exercise treatment', Physiotherapy 84 (1998), pp. 223-226. (this is a May edition)

"If they complain of fatigue in response to a new level of exercise, they should be advised to remain at the same level for an extra week, rather than progressing the duration, and to increase the exercise when the symptoms regress."
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So in two articles published a month apart, a slightly different description is given: "stay at their current level of exercise for a further week or two" vs "they should be advised to remain at the same level for an extra week".

Suggesting patients stay at it for 2 weeks is a bit easier to criticise.

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He also says in the article:
"Graded Exercise Programme:
This should be supervised by someone who knows what they are doing, such as a practice-attached physiotherapist. But many GPs and nurses have sufficient experience."
These days, he tends to bash surveys and say that the GET wasn't generally done by a properly trained expert and so wasn't GET and so the adverse effects aren't of much relevance. But he himself was encouraging such people to offer the treatment.
 
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So he trains these 'experts' to try different approaches, that's very reassuring. What a sensible fellow he is. Who knew he didn't have a treatment devised? Who knew he created a treatment without any scientific evidence? Come on, show of hands?