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Trial By Error: Letter to British Journal of Sports Medicine from CPET Experts

medfeb

Senior Member
Messages
491
David Tuller has published a new blog on Virology Blog that includes a response that Workwell Foundation to an article promoting GET in the British Journal of Sports Medicine. David wrote:
In response to the BJSM article, the experts on post-exertional malaise from University of the Pacific and the Workwell Foundation wrote a letter to the journal that has not yet been published. These investigators have documented this symptom through use of the two-day CPET test, which measures the impact of exercise. They wanted to register their evidence-based opposition to the recommendation for GET. Since the letter makes valuable points and will be useful for those seeking to rebut the BJSM paper’s fallacious claims about exercise, I am happy to post it below.

The Workweek letter to the BJSM stated:
We are opposed to graded exercise therapy as a treatment for ME/CFS as recommended in this article. Our experiences working with ME/CFS patients are that graded exercise – particularly aerobic exercise–not only fails to improve function, it is detrimental to the health of patients.

The rationale behind using GET as treatment for ME/CFS is that it can reverse a cycle of inactivity and deconditioning, and subsequently reduce the fatigue and disability associated with this disease [2,3]. However, it seems counterintuitive at best to employ exercise as treatment when the hallmark of ME/CFS is a distinctive post-exertional malaise or PEM, whereby even trivial mental or physical exertion can cause a worsening of symptoms and reduced function [4].
 

Countrygirl

Senior Member
Messages
5,388
Location
UK
http://www.virology.ws/2018/02/05/t...journal-of-sports-medicine-from-cpet-experts/
Trial By Error: Letter to British Journal of Sports Medicine from CPET Experts
5 FEBRUARY 2018
By David Tuller, DrPH

Last October, the British Journal of Sports Medicine published a short paper that was essentially a summary of Cochrane’s systematic review of graded exercise for chronic fatigue syndrome (as Cochrane calls the illness). This systematic review is problematic for a number of reasons—not least of which is that it includes the debunked PACE trial and other Oxford criteria studies.

The Oxford case definition does not require any symptoms besides fatigue for diagnosis—including the cardinal symptom of post-exertional malaise. Studies that rely on Oxford criteria samples do not represent the experiences of patients with more narrowly defined disease. Systematic reviews of flawed trials produce flawed results.

In response to the BJSM article, the experts on post-exertional malaise from University of the Pacific and the Workwell Foundation wrote a letter to the journal that has not yet been published. These investigators have documented this symptom through use of the two-day CPET test, which measures the impact of exercise. They wanted to register their evidence-based opposition to the recommendation for GET. Since the letter makes valuable points and will be useful for those seeking to rebut the BJSM paper’s fallacious claims about exercise, I am happy to post it below.