Graded Exercise Therapy (GET): What You Need to Know

Pro Health recently published this article , summarizing a new study on Graded Exercise Therapy (GET). They warn that patients treated with GET, a widely used therapy for ME/CFS and FM patients, could be more harmful than helpful. While I am glad to see this research being done, and the acknowledgement that physical activity can and will make symptoms worse for many patients, I think this could potentially lead healthcare providers and patients astray.

For me, the question is not should we use GET, but when should we use GET. Implementing an exercise therapy to a patient acutely suffering from Chronic Fatigue Syndrome is kind of like starting physiotherapy for a patient with a broken femur bone before surgery- counterproductive. Once the major stressors and causes of the fatigue, pain, and discomfort have been indentified and removed recovery can begin. Starting a recovery plan before this time can and will be harmful to patients, and this may be why so many patients find themselves in relapse again and again.

Now, I know what you’re thinking: we don’t know what causes Chronic Fatigue or Chronic Pain, how can we remove those stressors or causes?  This is where careful observation and patient stories come in. I may be shunned for saying this, but I don’t think it is so important to know the cause of illness as it is to understand how we can heal. Here are some tips on discovering what some of your stressors and triggers may be:

  • Keep a daily Activity Diary which records pain and fatigue levels every 30-60 minutes throughout your day. Do this for two weeks and see if you notice any patterns. Do you always feel worse after a bad night of sleep? At certain times in the day? After physical or emotional strenuous activities? After a holiday dinner at your in-laws? Record your observations.
  • Keep a daily Food Diary and record your fatigue and pain levels immediately after eating, 30 minutes after eating, and 3 hours after eating. Do this for two weeks and see if you notice any patterns in the types of food you eat.
  • Keep a Sleep Diary. What time do you wake up and go to sleep each day? How many times in the night do you wake up? Do you feel rested when you wake up? Is there a change in your sleep patterns from day to day, and if so, how does this affect your pain and fatigue?
  • Do an Elimination Diet. Many CFS and FM patients find they have a wealth of food sensitivities and allergies. Gluten tends to be especially common and is hidden in many foods. Determine if there are any foods that upset your gut.
  • Meditate or Journal. Meditation can give you a ‘third party’ perspective on your thoughts and feelings-  can you identify any negative thought patterns or feelings that could be causing you stress and draining your energy levels?
  • Get tested for Deficiencies or Viruses. Many patients suffer from vitamin or nutrient deficiency, or have strands of harmful viruses lingering in their blood streams.
Photo Credit: Arya Ziai via Compfight cc

Photo Credit: Arya Ziai via Compfight cc

Gather your research and observations for two weeks. It may also be helpful to research findings from other patients after the initial two weeks and see if any of your patterns match up with any others. Once completing these tasks you should have a pretty good idea of which activities increase your fatigue and pain, which are neutral, and which increase your energy and reduce your pain. Put your regular activities and foods into these three categories, and try to eliminate as many in the bottom category as you can. For those in the harmful category which you cannot eliminate, make sure you take plenty of time for rest both before and after that activity.

Once you consistently eliminate harmful foods and activities, and treat any outstanding medical disorders that may be present in conjunction with CFS and FM, you can begin a recovery program. Of course, GET should not be the only therapy you are receiving, but it is important to gently rebuild your physical strength after your period of rest and healing. The length one needs to rest and heal before aiming to become more active again will vary widely from person to person, so you will need to listen to your body, and do some experimenting.

In conclusion, be wary if your healthcare team suggests GET  before you have been given the proper time and guidance to eliminate that which will make your illness worse, but do not discount GET and similar therapies simply because they have been mismanaged.



3 thoughts on “Graded Exercise Therapy (GET): What You Need to Know

  1. Reblogged this on my chronic life journey and commented:
    This is a lot to consider when you are already dealing with being unwell but it is definitely worth while. I keep an energy expenditure diary which records what level of activity I’m doing every half hour and I record my pain levels, nausea levels, fatigue levels and other symptoms three times a day at the moment.

  2. I’ll beg to differ here.

    GET has been pushed on us as a type of “cure”. The idea being if we can just increase slowly enough that we “will” get better using GET.

    Of course, as you rightly point out any programme of increase can only be useful once healing has happened – BUT no amount of logging will cause that healing in itself – nor will the simple checks you suggest remove the illness for more than a few lucky individuals..

    I’ll be honest, once I’m feeling better, I will NOT need GET to give me permission to do more. I will naturally do more! I will also listen to my body the whole way back upwards (soon please) rather than follow any GET rules of continuous gradual increase. Because that is what GET in it’s purest form suggests! It does not suggest you listen to your body and pace carefully…..

    A careful pacing approach to the road back up to activity would be much more helpful, in my view, than GET – which by it’s very nature encourages you to ignore warning signals and continue the increase anyway.

    As I understand it, we all have a sort of glass ceiling somewhere – and during recovery it may raise at first to only a slightly higher level. Finding it’s new level is very important. Trying to force through that level using GET style graded increases is NOT sensible – EVER!

    No matter how GET gets re-dressed and softened to really mean pacing, I fear the damage is done. Some physios will always use the “push on through” style of GET. The name has been permanently tarnished in my view and should no longer be used.

  3. ” Implementing an exercise therapy to a patient acutely suffering from Chronic Fatigue Syndrome is kind of like starting physiotherapy for a patient with a broken femur bone before surgery”

    This. So much this. It blows my mind that ANYONE in the medical profession would actually believe that GET is appropriate for someone who has just been diagnosed with M.E.

    To me, the logical progression would be “Ok, you’re now feeling a bit better and are able to do some small stuff, so lets do tiny measured bits of activity every day, see how that effects you, and hopefully progress over time”. Not “Sitting up for more than 30 seconds makes you violently ill, so you should definitely be doing some exercise”.

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