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A graded exercise therapy circuit class for rheumatology pain patients (Warning - may raise blood pressure!)

Discussion in 'General ME/CFS news' started by MeSci, May 1, 2018.

  1. MeSci

    MeSci Senior Member (Voting Rights)

    Cornwall, UK
    Source: Rheumatology
    Vol 57, Suppl 3
    Date: April 25, 2018


    The G.E.T. Going Group: A graded exercise therapy circuit class for rheumatology pain patients: outcomes of those completing the group, and survey of reasons for non-completion
    James P Wright(1), William J Gregory(1,2)
    1 Rehabilitation, Salford Royal NHS Foundation Trust, Salford, UK
    2 Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK



    Since 2012 at Salford Royal we have been running a physiotherapy-led graded exercise circuit class for people with chronic fatigue syndrome (CFS); more recently this groups inclusion criteria has been expanded to treat patients with a diagnosis of fibromyalgia.


    Over a six month period (May 2017 to October 2017), data were collected for non-CFS patients attending the full six sessions of the graded exercise group. The session involves a five minute warm up and then an eight station circuit of graded exercises each undertaken for a two
    minute period. Patients are encouraged to gradually increase their exertion by recording exercise repetitions and with careful monitoring by a physiotherapist and a therapy assistant.

    Measure Your Medical Outcome Profile version 2 (MYMOP2) (Paterson 1999) was used as the
    primary outcome measure; the one-minute sit-to-stand test was chosen as the secondary outcome measure. Early in data collection it was noted that a number of patients failed to make all six sessions. An analysis was undertaken of those patients who failed to make the six sessions to see if there were any consistent reasons for non-attendance.


    Sixteen patients with a diagnosis of fibromyalgia completed the six sessions. Across this group there was an overall average total MYMOP2 improvement of 0.84 (averages of 0.33 and 0.82 increases in symptoms 1 and 2; average 0.93 increase in activity and 0.80 increase in well-being scores). One-minute sit-to-stand scores also improved for the group, with an average improvement of 1.33 repetitions. Eleven of the patients failing to fully complete the six sessions were successfully contacted by phone and consented to discuss their reasons for failing to complete the course (Table 1).


    For those patients able to commit to the full six sessions programme, a physiotherapy-led, graded exercise circuit class results in benefits seen to subjective and objective measures. However, with this cohort of fibromyalgia patients there were issues with exercise class adherence; non-compliance of fibromyalgia patients with rehabilitation programmes has previously been documented (Naylor et al. 2017). We have concluded a greater educational component needs to be added pre-group to better engage patients in their rehabilitation goals.

    (c) 2018 Oxford University Press
    (c) 2018 British Society for Rheumatology

    My suggestion - maybe you should educate yourselves a little about these conditions, rather than the patients.
  2. Sly Saint

    Sly Saint Senior Member (Voting Rights)

    so there weren't actually any people diagnosed with CFS in the group(?)
    I think gentle exercise is supposed to help some people with fibro only(?)

    Although the fact that this therapy is normally used for CFS patients is alarming.
  3. Trish

    Trish Moderator Staff Member

    This doesn't sound like graded exercise therapy to me. Where is the finding your base level and then adding x% per week, tailored to each individual? Not that GET is a good thing, it's a disaster for pwME, but this sounds even worse.
    Even at my mildest with my ME I couldn't have done 5 minutes warm up followed by 2 minutes each of 8 different exercises on top of the demands of my daily life at the time. I was sent to a 6 week group for fibromyalgia patients at my local hospital Rheumatology department back then, and it was much gentler and involved a lot less exercise than this, but it still made me crash.
  4. Daisybell

    Daisybell Moderator Staff Member

    New Zealand
    I’m sure the irony of writing that 11/16 fibro patients failed to attend all the sessions, and also that patients need help to engage in ‘their rehabilitation goals’ has completely passed them by.

    Non-compliance/non-adherence - or whatever damn thing you want to call it - is simply the ‘professional’ not listening to the patient and pushing them to adhere to the goal the professional wants the person to set. I’m all for removing practice registration for any professional who calls a patient ‘non-compliant’.
    MEMarge, ukxmrv, MeSci and 9 others like this.
  5. Amw66

    Amw66 Senior Member (Voting Rights)

    Who reviewed this paper? I am not in the least bit scientific ( my brain works in tangents) , but this is mince - and not even butcher' s mince.

    A number of points come to mind after a glance..

    Was there any recording of harms?

    Did the intervention force participants to modify activity outwith the programme?

    Were heart monitors used? If so, just for exercise or throughout?

    Using group stats may mask significant differences in response.

    How many patients failed to complete the full number of sessions ? ( 11 were contacted and gave details but this infers others did not). What % of participants did this group constitute? Could potentially be as much as 50%- in which case can this really be considered a suitable therapy?

    Did this group relate to symptom severity?

    I don' t know what the improvement scale is to know if it' s of any use to measure change, or if it' s like the CF scale and capable of alternative interpretation ....
  6. alktipping

    alktipping Senior Member (Voting Rights)

    seems like the people who made this study neglected to learn anything about f m . hello flare ups they are not always going to be fit enough to travel never mind complete an exercise class afterwards.
    MEMarge, ukxmrv, MeSci and 4 others like this.
  7. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

    London, UK
    This is an abstract for a presentation at a British Society for Rheumatology meeting, not paper. Nevertheless it will have been passed by independent reviewers. There was a time when drivel like this did not get through.
    MEMarge, ukxmrv, MeSci and 8 others like this.
  8. Woolie

    Woolie Senior Member

    Oh, isn't it so annoying when you develop a wonderful programme and those naughty patients just refuse to do what's good for them!
    alktipping, MEMarge, Trish and 6 others like this.
  9. James Morris-Lent

    James Morris-Lent Senior Member (Voting Rights)

    United States
    I'm sure GET has been properly flayed around these parts to the point where it resembles a long-deceased equid. But what I haven't heard said is that, frankly, GET is just the lamest thing ever. Lame as in you have to be an inveterate sap for the notion of it to stir your spirit after you've thought about it for a good two seconds. Transparently fatuous. I shudder at the thought of what kind of boob actually makes this his or her life's work willingly; the fact that this particular species of chump evidently does walk the earth in appreciable numbers fills me with great trepidation regarding the general fate of humankind.

    Let's look at this logically:

    If: the person's body is able to tolerate your regimen and make good progress:
    Well, you won't see any people like this because they would have already increased their activity on their own; having noticed in the course of existing that they were able to walk around and lift things without incident, they will chose to do engage in activities that aren't completely stupid, so not GET.​

    If: the person's body can tolerate the regimen initially but does not adapt robustly to increasing exertion:
    Maybe they should use their limited energy to function and enjoy life as much as possible rather than pointlessly moving weights up and down (or whatever cloddish routine you have concocted).
    If: the person's body can't tolerate the regimen:
    Uh, you're torturing them. But don't worry, you're the victim, you know, of something... because.​

    Some ideas can, despite failing to pan out, be reasonably deemed by the discerning and broad-minded to have been 'good' and worthwhile. GET is not one of these. It never had a chance; it's just so half-baked as to be intrinsically asinine.
    alktipping, MEMarge, Trish and 10 others like this.
  10. chrisb

    chrisb Senior Member (Voting Rights)

  11. James Morris-Lent

    James Morris-Lent Senior Member (Voting Rights)

    United States
    Is this Chalder the type specimen?
  12. chrisb

    chrisb Senior Member (Voting Rights)

    One could say that.

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