Intended for healthcare professionals


Graded exercise in chronic fatigue syndrome

BMJ 1997; 315 doi: (Published 11 October 1997) Cite this as: BMJ 1997;315:947

Patients should have initial period of rest before gradual increase in activity

  1. Charles Shepherd, Medical directora,
  2. Anne Macintyre, Medical advisera
  1. a ME Association, High Street, Stanford le Hope, Essex SS17 0HA
  2. b Springfield Medical adviser, Action for ME/CFS
  3. c Portsmouth and South East Hampshire Health Authority, Portsmouth PO3 6DP
  4. d 23 Melbourne Road, Teddington, Middlesex TW11 9Q
  5. e Department of Psychological Medicine, St Bartholomew's and the Royal London Medical and Dental School, London EC1A 7BE
  6. f National Sports Medicine Institute, London EC1M 6BQ

    Editor–We remain firmly opposed to exercise programmes that encourage patients with the chronic fatigue syndrome to increase their levels of physical activity progressively without making allowance for fluctuating levels of disablement. Nevertheless, we welcome Kathy Y Fulcher and Peter D White's finding that an individually tailored programme can produce benefits in a carefully selected subset.1 We have concerns, however, about the way in which these results have been oversimplified in the media and may now be put into practice by health professionals with no experience of this approach to management.

    Our first concern is whether the results are as impressive as they seem. We find it surprising that patients in the exercise group who rated themselves as better showed no significantly greater improvement in either peak oxygen consumption or muscle strength than did the other patients. In addition, it would have been useful to know what percentage of both groups had stopped claiming long term sickness benefits—perhaps the most objective assessment of improvement.

    Secondly, we are concerned that all the patients had been ill for a considerable period (median 2.7 years). Definitions of the chronic fatigue syndrome state that symptoms must have been present for at least six months before a diagnosis can be made. As a result no similar research study has been done into the most appropriate advice regarding rest and activity during the first few months of this illness. Until this has been done, our guidelines will continue to advise an initial period of rest followed by a gradual increase in activity.

    Thirdly, severely affected patients were excluded from the study. A small but important minority are either wheelchair-bound or even bedbound, and for this group any type of activity programme must inevitably be structured at an entirely different level.

    Fourthly, the authors seem to …

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