Review The effect of graded exercise therapy on fatigue in people with serious respiratory illness: a systematic review, 2024, Angela T. Burge et al

Abstract
Background In adults with serious respiratory illness, fatigue is prevalent and under-recognised, with few treatment options. The aim of this review was to assess the impact of graded exercise therapy (GET) on fatigue in adults with serious respiratory illness.

Methods Electronic databases were searched to identify randomised controlled trials (RCTs) testing GET (involving incremental increases in exercise from an established baseline) in adults with serious respiratory illness. The primary outcome was fatigue and secondary outcomes were health-related quality of life (HRQoL) and adverse events. Two authors independently screened for inclusion, evaluated risk of bias and extracted data.

Results 76 RCTs were included with 3309 participants, most with a diagnosis of COPD or asthma. Reductions in fatigue measured by the Chronic Respiratory Disease Questionnaire fatigue domain score were demonstrated following GET consisting of aerobic with/without resistance training (mean difference (MD) 0.53 points, 95% CI 0.41–0.65, 11 RCTs, 624 participants) and GET using resistance training alone (MD 0.58 points, 95% CI 0.21–0.96, two RCTs, 82 participants) compared with usual care. Although the mean effect exceeded the minimal important difference, the lower end of the confidence intervals did not always exceed this threshold so the clinical significance could not be confirmed. GET consistently improved HRQoL in people with a range of chronic respiratory diseases on multiple HRQoL measures. No serious adverse events related to GET were reported.

Conclusion GET may improve fatigue alongside consistent improvements in HRQoL in people with serious respiratory illness. These findings support the use of GET in the care of people with serious respiratory illness.
LINK

 

Also by the same author, the title of which hints at the authors attitude to sick people.

Get a move on: physical (in)activity in people with obstructive airway disease

https://openres.ersjournals.com/content/10/4/00305-2024.article-info

 

As is usually the case, where they argue that there is a significant effect, it's the least significant possible using minimally important differences that are very low. I'm not sure what a sensitivity analysis involves, but for the primary outcome of fatigue, the minimal important difference is set at 0.5, and the result is 0.53, but with a sensitivity analysis it drops below the MID to 0.46. Any other fatigue evaluation was, by their own admission, uninterpretable:

Only 3 studies had any "long-term" (12 months isn't long term but whatever) assessments and the minimal improvements were not sustained, but they have so little follow-up data that it barely matters:

So basically this would be like a course where a student passes with the minimal grade possible but could not pass the same assessment, despite an expectation of continuing to practice those skills, a year later. And still this class would get recommended for broad adoption. No other industry works with such low standards and expectations.

Most of the studies are small. Comparisons are difficult and haphazard given the huge heterogeneity and you have to squint very hard to find anything actually useful in the secondary outcomes here. Especially considering the costs involved. So as usual the conclusion is not supported by the data.

I mean just consider the fact that for the primary outcome of fatigue, the effect is a hair above the minimal significance they decided and which they admit suffers from a high level of bias, which itself is very low, that it doesn't hold at 1 year (but they have so little data on this that it's impossible to say) and drops below when using a sensitivity analysis, that's the best they can demonstrate, and still they conclude:

This is ridiculous. This is aspirational-based medicine: if it worked, it would be amazing, but since it doesn't, just argue that it shows promise, or whatever. The standards are obviously way too low. Uber drivers have to maintain a 4-star rating or they're out. This barely edges a 1-star rating and it gets full recommendations.

Notable:

It is actually quite clear, but whatever. Doubtful that they understand what PEM given, you know, how exertion causes deterioration and this is all about exertion.

This entire paradigm is worthless. The whole thing belongs in the trash.