Graded exercise therapy

Domain II · Behavioural & cognitive · 1990 · UK

What it is

Source note. Sources include the PACE GET therapist manual (version 7, pages 1–63), the GETSET therapist manual, Wilshire et al. 2018 (PACE reanalysis), the FINE trial abstract (Wearden et al. 2010), the Forward ME / Oxford Brookes 2019 survey summary, Action for ME's 2025 summary of NICE NG206 rec…

Format

• This describes a typical course in the PACE era, as a patient would have experienced it. Named variants are in 2.9. Where details come only from secondary accounts of the manuals, they are tagged.
• First assessment. An initial session of about 90 minutes covered activity history, current activity, sleep and the person's illness beliefs, plus an assessment of physical capacity. Trial measures included a step test, a six-minute walk and the Borg exertion rating.

Who practises it, and how they are trained or regulated

• Fulcher & White (1997). Supervised, heart-rate-targeted aerobic exercise (mostly walking or cycling) over about 12 weeks, compared with flexibility and relaxation training.
• FINE trial "pragmatic rehabilitation" (Wearden et al. 2010). A programme of gradually increasing activity designed jointly by patient and therapist. It was given at home in 10 sessions over 18 weeks by one of three nurses with four months' training, to 296 primary-care patients meeting the Oxford criteria in north-west England (2005–2007). It gave a small fatigue benefit at 20 weeks that was not sustained at 70…

Evidence status, as the guide reports it

• Benefits and insurance. Engagement with recommended treatment could be used as evidence in disability-benefit, insurance and employment decisions. Refusing GET risked being recorded as non-compliance with treatment.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Use standard structured risk assessment. ME/CFS carries an elevated suicide risk (see 3.2), and isolation, disbelief and severity raise it. Build a collaborative safety plan, with lethal-means…

Problems the guide addresses

• Current recommended alternatives
• Assessing a client who went through GET
• Treatment considerations
• Ethical, reporting and legal duties

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.