The Danger of Graded Exercise Therapy

The Danger of Graded Exercise Therapy

One of the major symptoms of Chronic Fatigue Syndrome and/or Fibromyalgia (CFS/FM) is the extreme fatigue that may follow the performance of simple tasks. Just having a shower can be enough to debilitate someone with CFS/FM for several days or more. Unlike other illnesses with an identifiable course, CFS/FM is erratic and unpredictable, and there seems to be no certainty about what is manageable at any particular time. An activity that may be manageable on one occasion, may be the trigger for relapse of fatigue and/or pain on a different occasion. In a similar vein, an activity that uses less energy than another more demanding activity that was previously performed without any detrimental effect, may well be the trigger for relapse, which makes it extremely difficult (and frustrating) to assess what is manageable.

Graded Exercise Therapy (GET) is often recommended by professionals for CFS/FM patients in order to rebuild energy levels and bodily strength. With GET, a treatment plan is devised where physical exercise is introduced as a daily activity, commencing at a minimal level and gradually increasing exercise levels over a period of time.

I am very wary of recommending GET to those who experience chronic fatigue or other burnout symptoms, and I do not fully accept the opinion of a regular and graduated exercise regime for the purposes of developing greater participation and energy levels. Whilst this advice is well intentioned and appears to make sense, my experience is that exercise needs to be very carefully assessed by individuals themselves, in terms of what they feel is manageable on any particular day. I believe that a ‘set’, even though graduated, exercise regime can be extremely dangerous, and that to exercise each day in order to maintain a program or to help maintain muscle tone, can precipitate a setback and a worsening of symptoms if energy levels are inadequate.

Most people who experience CFS/FM symptoms become enthusiastic about exercising and increasing their activity at various times of improved energy, and then suffer afterwards either as an immediate or delayed response! There appears to be no fixed formula for engaging in exercise, and each person must gauge how much energy is available each day.

It seems that in times of the body being run down, such as with chronic fatigue or burnout, it is important to keep a tally of how much energy has been used, keeping in mind also that energy is expended in all physical, emotional and psychological responses. It becomes impossible to know the balance of energywhen all the influences on our energy supply cannot be measured, and we don’t know the total amount of energy already used or remaining. When energy levels are unpredictable, it is easy to lose confidence in knowing what you can manage, resulting in further feelings of frustration, unreliability and helplessness.

The erratic nature of energy supply is a hallmark of CFS/FM, and persisting with an exercise program with the hope of sustained improvement can in fact have the opposite effect. On days where possible, I think it is sensible to do some form of exercise. It is also wise to err on the side of less rather than more, and to be mindful of the cumulative effect of energy output associated with all your other activities, including mental and emotional aspects. I have found milder forms of exercise, such as some routines of Chi Gung, Yoga and Tai Chi, or a gentle walk with the dog are better suited to people who experience CFS/FM or other forms of burnout.

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  1. Hi Margaret,
    Thank you for writing on this topic. Whilst reading it I couldn’t help but think about chronic back pain and its psychosomatic nature. Would you be able to share some thoughts or maybe even a blog post?
    Thank you.

    • Margaret Lambert says

      I think there is a psychological component of all pain in that the pain has been either caused or exacerbated by emotional and/or experiential aspects of its origin and its impact on a person’s life. I believe it is essential to address the psychological aspects of the pain as well as the physical aspects if there is to be sustained relief and healing. Thanks for the prompt on the next blog!

  2. Graded exercise therapy caused my ME to become very severe in the space of about 3 weeks. That was three months ago, and I am not recovered. I do believe it is important to do some exercise every day, but the hospital I was attending forced us to do walking as the only form of exercise and provided little to no guidelines as to how much. As a result people were doing far too much and getting ill. I set the level of walking way too high – at 4,200 steps/day outdoors, and that didn’t include what I was doing indoors. Within a week or so my lymph glands had swollen and my middle (seemed like spleen area or liver) had swollen as well and I was very fatigued. Exercise I was engaging in successfully before GET, like hydrotherapy pool and occasional gentle form dance classes, now made me feel like I’d run a marathon and I had to abandon, but they said only walking counts as exercise and dismissed other forms of exercise. I asked to go down to 3000 steps instead of 4,200, but they said no, do 4000, so I did, despite feeling more and more ill and having to sleep for hours to recover. Then about week 3, I had two nights without much sleep and could no longer move my body hardly. I spent weeks only able to walk about 1 minute because my heart couldn’t keep up with the pace. There is something wrong with my heart it would appear now as it is not beating correctly and can’t regulate if I try to walk at a normal pace, but unfortunately as GPs in the UK take little notice of ME and they won’t even examine me. I deeply regret that I ever joined a GET programme as what I was doing was working much better. ie gentler forms of exercise and listening to my body. The problem with GET is that they don’t tell you about the risks of doing too much exercise and trivialise the side-effects of that and they dismiss all forms of exercise except walking. The hospital I was seen by seemed to be in total denial about the fact that over-exertion can cause people with ME to get worse and even said that if your lymph swells up, to keep on going as ‘its just ME’ and doesn’t count as an infection when your lymph swells up due to ME (hello?). My blood IMg is raised, which indicates raised antibodies, and my lymph swollen and blood calcium low and I have Gilbert’s syndrome that a lot of ME sufferers have, (that the Liver Foundation says over-exertion triggers), but the hospital psychologist and physio say they don’t know about the liver. Seems very negligent to have psychologists (ie they are not virologists, or hepatologists, or endocrinologists) telling people with infections and other physical drivers of fatigue that it’s just ME infection and to keep on going, even when it causes your body to react like it has the flu. I was very ill some 10 years ago due to blood calcium/parathyroid issues and they just dismiss it when these symptoms have returned. The big problem is that there is no integrated approach to medicine in this country and western medicine generally, so you have people who only know about one area of health making decisions about people without regard to their medical history or other fields of health because they’re not trained in them.


  1. […] to get the advice and approval of a doctor or specialist before starting on an exercise program.Many doctors and specialists consider exercise as an important and effective treatment for chronic f…leads to a sedentary lifestyle which has several detrimental effects to the body. Decreased physical […]

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