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NICE Advises Against Using Graded Exercise Therapy For Patients Recovering From COVID-19

Friday 24 July 2020


From The BMJ:



NICE advises against using graded exercise therapy for patients recovering from covid-19

By Ingrid Torjesen
BMJ 2020; 370 doi: (Published 21 July 2020)
Cite this as: BMJ 2020;370:m2912
Copyright © 2020 BMJ Publishing Group Ltd.

Graded exercise therapy may not be appropriate for treating post-viral fatigue in patients recovering from covid-19, the National Institute for Health and Care Excellence (NICE) has advised doctors.

In a statement NICE said that it was aware of concerns related to the impact of graded exercise therapy (GET) for managing post-viral fatigue in patients recovering from covid-19. It noted that its current advice on managing chronic fatigue may not be appropriate for this group of patients and acknowledged that it could also be out of date for other groups.1

“NICE’s guideline on ME/CFS [chronic fatigue syndrome] (CG53) was published in 2007,2 many years before the current pandemic, and it should not be assumed that the recommendations apply to people with fatigue following covid-19,” the statement said.

It emphasised that the recommendations on GET in this guideline applied only to patients with a diagnosis of chronic fatigue syndrome as part of specialist care, where it should be part of an individualised, person centred programme of care, where GET is recommended only for people with mild to moderate symptoms.

NICE added, “As the guideline is currently being updated, it is possible that these recommendations may change. The evidence for and against graded exercise therapy is one of the important issues the guideline committee is considering.”

NICE plans to consult on its updated guidance in November 2020. In the interim it advises doctors to use recent guidance from NHS England on the aftercare needs of inpatients recovering from covid-19, which includes advice on managing fatigue.3 That guidance says that “it is important to ensure a gradual return to activities and exercise and to teach pacing methods.”

Much of the support for GET comes from a study published in the Lancet in 2011, which concluded that patients with chronic fatigue syndrome benefited more from cognitive behavioural therapy and GET than from pacing therapy.4 Many patients reported that GET made them feel worse and that pacing was more effective,5 and the study’s methodology was heavily criticised.6 A review conducted by the Health Research Authority concluded that the study was properly conducted,7 but the review focused on the research process, not the conclusions.


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