Letter – The Guardian – re Graded Exercise Therapy and long-COVID

Sue Waddle
Sue Waddle

The Guardian’s letter page (11th March 2021) carried a call from Dr Alastair Miller, Prof Paul Garner and Prof Peter White, advocating Graded Exercise Therapy under the heading that ‘those with post-Covid fatigue syndrome should not be discouraged from trying it’.  The writers stated that “…  we do not know that graded exercise therapy is detrimental to recovery from the post-Covid fatigue syndrome. There are no such studies. In contrast, we know that graded exercise therapy is an effective treatment for chronic fatigue syndrome (or ME), a clearly related condition. Moreover, no trials of graded exercise have shown harm to patients. We need trials of this treatment in post-Covid fatigue. “

ME Research UK’s Vice Chair, Mrs Sue Waddle, has written to The Guardian in response


The suggestion that Graded Exercise should be used as a treatment for those patients now suffering what has been termed “Long Covid” and which exhibit symptoms with a marked resemblance to ME/CFS (Myalgic Encephalomyelitis/Chronic Fatigue Syndrome) is strongly refuted. 

Many ME/CFS patients who already exhibited moderate symptoms of the illness reported that undertaking Graded Exercise Therapy (GET) caused a marked escalation of symptoms, leaving their symptoms permanently worse. Two highly influential peer-reviewed articles often used to support the use of GET namely, the Cochrane review and the PACE trial, are subject to international criticism and calls for retraction based on deficiencies in underlying scientific methods employed and in the interpretation of data gathered.  

On 22nd July 2020 NICE issued a statement on GET and its use in recovery from coronavirus and specifically cautioned against its automatic use for those with post-COVID-19 fatigue. And that was at a point when NICE still advocated the use of GET for those with ME/CFS. 

Since then, NICE has held a wide-ranging, evidenced-based review of the ME/CFS guideline and on the use of GET in particular. This took into account all trials and studies, including the PACE trial, but also the lived experiences of those who undertook GET. The latest draft guideline states that GET should no longer be offered for the treatment of ME/CFS. Instead, patients should be encouraged to remain within their “energy envelope” so as not to worsen their symptoms. Hardly a ringing endorsement for the statement of “graded exercise therapy [being] an effective treatment for chronic fatigue syndrome (or ME), a clearly related condition.”  

All health professionals should, surely, ensure that first they do no harm and they would be wise to learn the lessons from the harm already done by GET to those suffering from what could be a parallel illness.”

Quote from The Guardian – Courtesy of Guardian News & Media Ltd

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