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Graded Exercise Therapy
1: Introduction
2: Subject recruitment etc
3: Randomisation etc
4: Outcome measures

Your Experiences

We welcome your contributions – tell us about your experiences with exercise and/or CBT. Has your doctor ever suggested CBT? If so, did you go ahead with the treatment and was it helpful for you?

Please try your hand at a paper critique or summarise (if more appropriate) a research article for an upcoming edition of Talking Point. You can visit the monthly Research Abstracts list to select a referenced paper for this purpose.

Medical articles

Basic information
ME/CFS: a basic overview (PDF, 57KB)
Overlap between CFS & other symptom-based syndromes (PDF, 19KB)
Multiple Chemical Sensitivity (PDF, 32KB)
MCS: Basic Overview (PDF, 18KB)
Fibromyalgia Syndrome (PDF, 34KB)

Information for ME/CFS physicians
Autonomic function in CFS (PDF, 32KB)
Cardiovascular Function & Exercise in CFS (PDF, 33KB)
ME/CFS Guidelines: Management Guidelines for General Practitioners (PDF, 460KB)
ME/CFS: Basic Facts for General Practitioners (PDF, 18KB)
Cognitive Function in CFS (PDF, 32KB)
Research Definition of CFS, known as the CDC or Fukuda (1994) [external link]

Miscellaneous articles
CFS-like states (Jan 6, 2005)
Grade Exercise Therapy for ME… or you? (Mar 2001)
Adelaide research into CFS, fibromyalgia, & brain fog (Sep 22, 2004)

Graded Exercise Therapy for ME... or You? (continued)


Even though patients were randomised into the three levels of intervention and control groups, as Chaudhuri (2001) comments, there is no data presented in the paper to provide evidence that patients in each intervention group were adequately matched for levels of physical fitness before entering the study. One would usually consider randomisation sufficient to eliminate the risk of directed bias BUT base-line data would have been useful to validate this assumption. Further, comparison of base-line measurements with post-intervention measurements could have provided an important indicator of improved exercise capacity or fitness. Of course, it must be noted that such measurements are expensive, require substantial technician skill, and hence may not have been practically possible, even if desired by the authors.

Treatment Conditions

Chaudhuri (2001) states: “Frequent early contacts with patients in the three intervention groups (and not in the control group) might have confounded the outcome measures by positively influencing the results. This view is certainly supported by the difference between the control and the three intervention groups (and lack of difference between the individual intervention groups) emerging at the end of three months, with little changes thereafter. By speaking to their patients, Powell et al might have provided them with a coping strategy that the control group could not access.” Therefore, improvement cannot be stated as unequivocally being a result of the exercise therapy or indeed educational intervention alone. The latter is unlikely as Clark (2001) adds: “Had education itself been the significant intervention at least some differences between the groups could have been expected.”

One also wonders why an “activity diary” was not mentioned in the methodology. If not completed, there is less evidence to support the assumption that activities were carried out as instructed – i.e. with reference to type, intensity and duration. This would seem particularly important since measurements of physical fitness were not alluded to, and therefore were presumably not carried out.

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