Opinion Is the RACGP HANDI recommendation of incremental physical activity for CFS/ME harming patients?, 2026, Stallard/Praet/Gupta/Smith

[Dolphin]

AJGP > March > Is the RACGP HANDI recommendation of incremental physical activity for chronic fatigue syndrome

Viewpoint​

Volume 55, Issue 3, March 2026

Is the RACGP HANDI recommendation of incremental physical activity for chronic fatigue syndrome/myalgic encephalomyelitis harming patients?​

Jacqueline Stallard Stephan Praet Sandeep Gupta Angela Smith

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doi: 10.31128/AJGP-03-25-7614 | Download article

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In April 2024, The Royal Australian College of General Practitioners (RACGP) Handbook of Non-Drug Interventions (HANDI)committee published a guideline: Incremental physical activity for chronic fatigue syndrome/myalgic encephalomyelitis.1 The HANDI committee claims to recommend interventions that are based on ‘solid evidence’.2 But is this always the case?

Continues at:

Is the RACGP HANDI recommendation of incremental physical activity for chronic fatigue syndrome

The Handbook of Non-Drug interventions (HANDI) is an online formulary of non-drug interventions, enabling GPs to offer to a greater choice of interventions to their patients.

www1.racgp.org.au

 

[Nightsong]

A response from the "Chair, Editorial Committee for RACGP Handbook of Non-Drug Interventions" in favour of GET:

Invited response to viewpoint article ‘Is the RACGP HANDI recommendation of incremental physical activity for chronic fatigue syndrome/myalgic encephalomyelitis harming patients?’

 

[Utsikt]

A response from the "Chair, Editorial Committee for RACGP Handbook of Non-Drug Interventions" in favour of GET:

Invited response to viewpoint article ‘Is the RACGP HANDI recommendation of incremental physical activity for chronic fatigue syndrome/myalgic encephalomyelitis harming patients?’

Thinks PACE and Larun’s exercise review were good, but says that surveys about harm are at a high risk of bias so we don’t care about those.

The 2023 NICE guideline retraction was highly controversial and not aligned with research evidence, resulting in members of its writing group resigning. Details of the aberrant interpretation of evidence are outlined elsewhere.5,6

The attention to detail is worrying. It was 2021, and it wasn’t a retraction - it was an update.

 

[Liie]

Are there published data that show that GET is harmful?

I know that there are patient surveys that show this clearly. Are those the best evidence?

Is there any better evidence to point to?

(There probably is a specific thread about this somewhere.)

 

[Holinger]

The attention to detail is worrying. It was 2021, and it wasn’t a retraction - it was an update.

So basically they don’t give a stuff. They just make it up.

 

[dave30th]

It was 2021, and it wasn’t a retraction - it was an update.

yeah, I noticed that. very sloppy.

 

[MrMagoo]

Are there published data that show that GET is harmful?

I know that there are patient surveys that show this clearly. Are those the best evidence?

Is there any better evidence to point to?

(There probably is a specific thread about this somewhere.)

The PACE trial data? NICE ng206 wrote about it.

 

[Liie]

The PACE trial data? NICE ng206 wrote about it.

I think I read somewhere that there was a slight but not very significant improvement in the GET and GET+CBT groups.

But there were also patient reports afterwards that therapists didn't take them seriously when they said that they worsened.

 

[Jonathan Edwards]

a slight but not very significant improvement in the GET and GET+CBT groups.

actually it was 'significant' but very slight

 

[Kitty]

Are there published data that show that GET is harmful?

Maybe the important thing is that there is no evidence showing it's helpful.

Any treatment not supported by evidence might be described as harmful, and is certainly unethical. Even if it didn't make people more ill, it's still a waste of taxpayers' money and patients' and clinicians' time.

 

[DMissa]

Yes, “some patient groups” raise methodological critiques about GET trials and not the rest of the field that a clique have siloed themselves away from by intentionally using alternative nomenclature. Definitely not.

Top kek.

 

[Dolphin]

Does anyone know anything about any of the authors? The names don't ring a bell for me but I don't follow things closely in Australia.

The article gives this information:
Jacqueline Stallard
BSc Hons, GDPSY, Macgregor, ACT

Stephan Praet
MD, PhD, FEBSM, FACSEP, Sports and Exercise Physician, Ochre Health, Bruce, ACT; Adjunct Associate Professor, UCRISE, The University of Canberra, Bruce, ACT

Sandeep Gupta
MBBS, MA, FACNEM, FRACGP, Specialist General Practitioner, Lotus Holistic Medicine, Sunshine Coast, Qld

Angela Smith
BPhty (UQ), GDNR (UWA), APAM, Physiotherapist, Your Place Physio, Charnwood, ACT

 

[Hutan]

Are there published data that show that GET is harmful?

I think the MAGENTA study is pretty compelling. One young person attempted suicide, and even the paper, which was doing its best to put a positive spin on the treatments, acknowledged that it may have been attributable to GET. I'd have to read the study thread again, but I think there were documented deteriorations and no evidence of overall benefits.

Edit:
Magenta Study thread

The abstract says:

There was weak evidence of a greater risk of deterioration with GET (27%) than with AM (17%; p = 0.069).
..
There was no evidence that GET was more effective or cost-effective than AM in this setting, with very limited improvement in either study group evident by the 6-month or 12-month assessment points.

Lots of information was not collected/loss to followup.