Research News

Tackling fears about exercise is important for ME treatment, analysis indicates

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h227 (Published 14 January 2015) Cite this as: BMJ 2015;350:h227

Re: Tackling fears about exercise is important for ME treatment, analysis indicates

The recent study in the Lancet Psychiatry [1] reported that fear of exercise was a mediating factor for fatigue and physical function in the case of both CBT and GET.

However the very presence of this fear on patients' willingness to engage in physical activity is inadvertently called into question by one of the authors (Trudie Chalder) during a press interview [2], in which she states that: 'On a day when they [patients] feel less symptomatic and very energetic they may do more than they are probably able to do and then of course suffer as a consequence'. It seems strange to me that a fear powerful enough to hinder the success of CBT and GET but which then abates on days when the patient is feeling less ill can actually exist, or indeed be a factor in the successful treatment of this condition.

What is perhaps particularly important to bear in mind is that the proposed 'success' of fear reduction is predicated on an increase in walking distance that is woefully small- after a year of therapy the patients receiving GET were able to increase the distance they walked on the six minute walking test (6mwt) by only 67m, (to 379m, 35m more than the SMC-only group) [3] but still far short of the 644m [4] average for a healthy adult. Even if such a fear were to exist, given these results, it seems unlikely that a change in beliefs will be enough to increase the walking distance by a further 265m.

Unfortunately we do not know what the mean 6mwt scores were for those who have low fear of exercise nor, despite a freedom of information request [5], for the 22% of patients receiving GET who have been labelled (controversially [6]) as 'recovered' [7]. I suggest that in order to avoid wasting any more tax payers' money, these data should be made available as soon as possible, so that the true effect of overcoming fear of exercise may be properly evaluated.

What is clear is that treatments of this kind are only tinkering around the edges of an illness that is in urgent need of more rigorous indepth biomedical investigation.

1. Chalder T, Goldsmith KA, White PD, Sharpe M, Pickles AR. Rehabilitative therapies for chronic fatigue syndrome: a secondary mediation analysis of the PACE trial. Lancet Psychiatry 14 Jan 2015, doi:10.1016/S2215-0366(14)00069-8.

2. Torjesen I. Tackling fears about exercise is important for ME treatment, analysis indicates. BMJ 2015;350:h227 http://www.bmj.com/content/350/bmj.h227

3. White, P. D., et al. "Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial." The Lancet 377.9768 (2011): 823-836.

4. Kindlon T. Reporting of Harms Associated with Graded Exercise Therapy and Cognitive Behavioural Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Bulletin of the IACFS/ME. 2011;19(2):59-111http://iacfsme.org/BULLETINFALL2011/Fall2011KindlonHarmsPaperABSTRACT/ta...

5. What do they know website: https://www.whatdotheyknow.com/request/6min_walking_test_data_recovered

6. Six Letters in Letter to the Editor: Comments on ‘Recovery from chronic fatigue syndrome after treatments given in the PACE trial’. Psychological Medicine, 43, pp 1787-1792 (2013). doi:10.1017/S003329171300113X.

7.White PD, Goldsmith K, Johnson AL, Chalder T, Sharpe M; PACE Trial Management Group. Recovery from chronic fatigue syndrome after treatments given in the PACE trial. Psychol Med. 2013 Jan 31:1-9.

Competing interests: No competing interests

20 January 2015
Anna K Sheridan
Patient/ex-scientist
Glasgow