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Q A patient of mine with CFS says she was told by her consultant that graded exercise for her condition is no longer recommended. Why would that be so?

A I am at a loss to know why the consultant has said that graded exercise is no longer recommended for chronic fatigue syndrome. This is simply untrue.

Only two treatments have been shown in appropriate randomised controlled trials to benefit CFS and those are cognitive behaviour therapy and graded exercise. These remain an essential element of any rehabilitation programme, as recommended in both the Canadian and Australian guidelines and in the York report on CFS in the UK.

The problem with graded exercise is the delivery of an appropriate programme. Physiotherapists, nurses and doctors who are not dealing regularly with CFS patients may set unrealistic exercise goals, which disillusions patients and makes them drop out of programmes. It does not mean that graded exercise does not work when delivered appropriately.

The term 'pacing' is used to reflect the need of CFS patients to balance exercise and rest and to work to the limits that their symptoms permit.

None of these therapies will deliver instant results, but with perseverance considerable functional improvement can be achieved.

The Department of Health has put additional ring-fenced funding into developing services for CFS patients in England, and by next spring these should be operational in almost all areas. NICE is now undertaking a review of therapies for CFS.

Dr Gavin Spickett,

consultant clinical immunologist, Royal Victoria Infirmary,


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