Graded exercise therapy can cure chronic fatigue syndrome
| Graded exercise therapy can cure chronic fatigue syndrome | |
|---|---|
| OUTDATED | |
| "Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is maintained by deconditioning and unhelpful beliefs, and can be reversed with graded exercise therapy and cognitive behavioral therapy." | |
| Domain | Health & Medicine |
| Tactic | Statistical & Evidentiary Distortion |
| Era | Current |
| First seen | 2011 |
| Origin | The UK PACE trial published in The Lancet in 2011, and treatment guidelines that relied on it |
| Last reviewed | 2026-10-30 |
| Further reading: books on Health & Medicine | |
For years, patients with ME/CFS, a long-term illness marked by severe fatigue and worsening of symptoms after exertion, were told their condition was maintained by deconditioning and fear of activity. Graded exercise therapy (GET), in which patients steadily increase activity, was a standard recommendation. The 2011 PACE trial reported that GET and CBT were moderately effective.
Many patients reported that GET made them worse. Health authorities have since withdrawn the recommendation.
What the evidence shows
- Trial criticism. Researchers and patients criticized PACE for changing its outcome measures during the trial. After a 2016 tribunal ordered release of the data, reanalyses found that recovery rates under the original measures were much lower.
- US guidance. The US Centers for Disease Control and Prevention removed GET and CBT as recommended treatments from its website in 2017.
- UK guidance. The National Institute for Health and Care Excellence (NICE) published a new guideline in October 2021 stating that GET should not be offered and that CBT is not a cure for ME/CFS.
- Post-exertional malaise. Current understanding treats post-exertional malaise, a worsening after exertion, as a core feature of the illness, which makes pushing through activity potentially harmful.
Why it matters
Patients were told for years that their illness was largely in their beliefs and behavior. The change in official guidance acknowledged that the evidence did not support that view.
Gaslighting Patients who reported getting worse were told their illness was maintained by their own beliefs and inactivity, an example often described as medical gaslighting. The word comes from Patrick Hamilton's 1938 play Gas Light and the 1944 film Gaslight, in which a husband dims the gas lamps and insists his wife is imagining it. Where the word comes from · More gaslighting cases
Sources
- National Institute for Health and Care Excellence, Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management, NG206, October 29, 2021.
- Peter D. White et al., "Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE)," The Lancet, 2011.
- Carolyn E. Wilshire et al., "Rethinking the treatment of chronic fatigue syndrome—a reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT," BMC Psychology, 2018.