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When rest may be best for post-viral fatigue | Letters


Dr Alastair Miller, Professor Paul Garner and Professor Peter White are not correct when they state that graded exercise therapy (GET) is a safe and effective treatment for ME/chronic fatigue syndrome (Letters, 11 March).

Having reviewed all the published evidence from clinical trials, the new Nice guideline no longer recommends GET as an effective treatment for ME/CFS.

Patient evidence submitted to Nice, and analysed by Oxford Brookes University, also concluded that GET caused symptoms to worsen in the vast majority of people who had tried it. The new Nice guideline on ME/CFS therefore recommends that people should remain within their energy limitations and not be prescribed GET.

The way in which activity-induced fatigue is described in long Covid is no different from that found in ME/CFS. This is hardly surprising as they are both debilitating post-viral conditions.

Many people with long Covid are relapsing when they increase physical activity levels too quickly and fail to balance rest with activity. In our current state of knowledge there are therefore very good reasons why people with both long Covid and ME/CFS should avoid any activity programme that involves incremental increases in exercise – such as GET.

What they require is a period of good old-fashioned convalescence at the start of their illness. This should be followed by gradual, flexible and cautious increases in physical and mental activity.
Dr Charles Shepherd
Honorary medical adviser, ME Association

While I’m glad to see long Covid discussed, I was disappointed to read such a one-sided view of graded exercise therapy, or GET.

GET as an effective treatment for ME is no longer recommended, and similarities between long Covid and ME are yet to be properly

demonstrated. There are peer-reviewed publications which have rightly questioned the validity of recommending GET as an effective treatment for ME. The lack of clinical studies about the harm of GET indicates a need for research, and not that it is reasonable to assume it is therefore safe.

Patients with long Covid do struggle to access timely and effective treatments. Improving healthcare for patients is best done in a more balanced and informed way without recommending what has long been controversial.
Rachel Harding
Nottingham



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