I thought it might be useful to get an overview of medical guidelines on ME/CFS that have been influenced by the Cochrane review on graded exercise therapy (GET). I’m mostly interested in official government positions or influential medical authorities that have referred to the Cochrane review to (1) recommend the use of graded exercise therapy for patients with ME/CFS, (2) ignore surveys where ME/CFS patients report having been harmed by GET or (3) deflect criticism of other GET-trials such as PACE. I’ve already given a short overview and I’ll try to update it with the information that others add to this thread. I hope that people from countries such as France, Italy, Spain, Norway Sweden, Austria etc. could have a quick look to what official government or medical guidelines in their country say and whether the Cochrane review is cited. You can search the Cochrane reference by looking for : Larun L, Brurberg KG, Odgaard-Jensen J, Price JR. Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev. 2015;2:CD003200. The review was published in 2015 but has been amended several times since, so the year in the citation may be different. Many thanks in advance, Germany In response to a parliamentary question, the German federal government referred to the Cochrane review to defend the use of graded exercise therapy for patients with CFS against criticism from patient surveys that indicate harms caused by GET. http://dip21.bundestag.de/dip21/btd/19/126/1912632.pdf The German College of General Practitioners and Family Physicians has published a 2018 guideline on fatigue (Müdigkeit). In the chapter on CFS, the Cochrane review is mentioned as evidence for exercise therapy. https://www.awmf.org/uploads/tx_szleitlinien/053-002l_S3_Muedigkeit_2018-06.pdf A 2018 guideline of the Association of the Scientific Medical Societies in Germany on Functional Disorders mentions the Cochrane review as evidence that exercise therapy is beneficial in patients with CFS. https://www.awmf.org/uploads/tx_szleitlinien/051-001l_S3_Funktionelle_Koerperbeschwerden_2018-11.pdf Denmark The Danish Health Authority cited the Cochrane review to recommended graded exercise therapy for patients with CFS. https://www.sst.dk/da/udgivelser/2018/~/media/1CE89F3206874263888BA4719419B844.ashx Researcher Per Fink has cited the Cochrane review to argue that GET is an effective treatment for (severe) ME/CFS patients and to oppose changes to the classification of ME/CFS as a functional disorder. https://translate.google.com/translate?sl=da&tl=en&u=https://propatienter.dk/sygdomme/muskler/1977-29-arig-kvinde-har-ligget-to-ar-i-morkt-rum-debat-i-folketinget-i-dag.html Australia The Cochrane review has been used by the Royal Australian College of General Practitioners to recommend graded exercise therapy for patients with CFS. https://www.racgp.org.au/clinical-r...ded-exercise-therapy-chronic-fatigue-syndrome The HANDI working group headed by Paul Glasziou has used the Cochrane review to promote the use of graded exercise therapy as a safe and effective treatment for patients with CFS. https://journals.sagepub.com/doi/abs/10.1177/1755738019852393?journalCode=inoa An ongoing Australian randomized controlled trial is testing how to educate healthcare professionals about the “level 1 evidence” for graded exercise therapy for patients with CFS, citing the 2017 Cochrane review. The intervention consists of an educational program for healthcare professionals on the use of GET For CFS. The protocol (Li et al. 2017) explains: “The intervention has been designed based on a manual developed by the research group that drew on Cochrane reviews of cognitive behaviour therapy (CBT) and graded exercise therapy (GET) interventions for CFS.” https://bmjopen.bmj.com/content/7/5/e014133 New Zeeland A medical educational document in ‘New Zealand doctor’ cites the Cochrane review to claim that exercise is beneficial for chronic fatigue syndrome. The document is part of PEARLS (Practical Evidence About Real Life Situations) and was developed by the Cochrane Primary Care Field, New Zealand Branch of the Australasian Cochrane Centre at the Department of General Practice and Primary Health Care, University of Auckland and funded by the Ministry of Health. https://www.nzdoctor.co.nz/vault/pearls/exercise-beneficial-chronic-fatigue-syndrome The UK The NICE 2017 Surveillance report on the CG53 guideline on ME/CFS noted that “Cochrane reviews appear to support the guideline recommendations on CBT and GET.” The surveillance report concluded that a review of the guideline was not necessary, a decision that was later overruled when the majority of stakeholders argued that update was indicated. https://www.nice.org.uk/guidance/cg...Surveillance-decision#reason-for-the-decision When the PACE trial was criticized during a 2018 Westminster Hall debate, The Minister for Care, Caroline Dinenage, referred to the Cochrane review to defend PACE. She said: "Since 2011, PACE trial data has been shared with many independent scientists as part of normal research collaboration, including the internationally respected research organisation Cochrane, which independently validated the findings." https://hansard.parliament.uk/commo...-4566-940D-249F5026FF73/PACETrialPeopleWithME The Health Research Authority (HRA) cited the Cochrane review to argue that the PACE trial was high quality. In a 2019 report the HRA wrote: “The robustness of the PACE trial has been considered in a Cochrane review that classified it as high quality. This was also challenged by critics, and the author of the review responded to those criticisms. It would be as inappropriate for the regulator to disregard these indications that the trial was of high quality as to ignore the criticisms that have been expressed.” https://www.parliament.uk/documents...Research-Authority-to-Chair-re-PACE-trial.pdf Fiona Watt, Executive Chair of the Medical Research Council, cited the Cochrane review as a reason to disagree with criticism of the PACE trial. She wrote: “While most of the criticism focuses on the PACE trial, there is a large amount of evidence from other studies that also shows CBT and graded exercise therapy (GET) can be helpful to some CFS/ME patients. Other research groups, using different study designs, have drawn similar conclusions about the benefit of these treatments. This evidence is summarised in three Cochrane reviews. Cochrane reviews are systematic reviews of primary research in human healthcare and health policy, and are internationally recognised as the gold standard in evidence-based healthcare.” https://mrc.ukri.org/news/browse/criticism-of-the-pace-trial/ Mayo Clinic US The influential Mayo Clinic in the US currently gives CFS patients the following advice: “Gradually increasing the intensity of your exercise over time may help reduce your hypersensitivity to exercise, just like allergy shots gradually reduce a person's hypersensitivity to a particular allergen.” The main article cited by Mayo to support the use of graded exercise is the Cochrane review. http://www.virology.ws/2018/08/06/trial-by-error-mayo-still-champions-get/ UpToDate cites the Cochrane review as evidence supporting the use of GET in CFS, but the article is cautious in its conclusions and also mentions criticism of GET trials. https://www.uptodate.com/contents/c...ic-encephalomyelitis-chronic-fatigue-syndrome Canada The 2016 Clinical Practice Guidelines for ME/CFS 2016, Alberta, Canada, mentions the Cochrane review, but the guideline also discusses the methodological weakness of GET-trials and is cautious in its conclusion. http://www.topalbertadoctors.org/download/1929/MECFS CPG.pdf?_20191017122609 A 2016 article in the Canadian Medical Association on exercise therapy for various chronic conditions, mentions the Cochrane review as evidence for exercise therapy in CFS. It writes that "there are no absolute contraindications to exercise for patients with chronic fatigue syndrome." https://www.cmaj.ca/content/cmaj/188/7/510.full.pdf Belgium Minerva, a Belgium website that offers evidence-based medicine guidelines for primary care physicians used the Cochrane review to advise graded exercise therapy for patients with CFS. http://www.minerva-ebm.be/NL/Article/2071 A government website in Belgium that that writes medical guidelines for doctors (ebpractice.net) used the Cochrane review to promote GET in ME/CFS. Recently, however, the GET review has been removed and is no longer cited. https://www.ebpnet.be/nl/Pages/default.aspx (I think the guideline is not visible for readers outside Belgium). The guideline was formulated by Duodecim, a company owned by the Finnish Medical Society that publishes information content for medical and healthcare professionals. The guideline on fatigue citing the Cochrane review might still be in use in other countries. The Netherlands The 2018 report of the Dutch Health Council cites the Cochrane review but argued there was insufficient reason to advise GET in the Netherlands. https://www.gezondheidsraad.nl/documenten/adviezen/2018/03/19/me-cvs The 2013 guideline formulated by several societies of Dutch physicians referred to the 2004 Cochrane review by Edmonds et al. to advise graded exercise therapy. https://www.nvvg.nl/files/41/04_Richtlijn_CVS_Definitief_8_feb_2013.pdf A controversial series of news articles by De Monitor which criticized ME/CFS patient organizations for objecting to GET/CBT cited the Cochrane review to respond to criticism of their articles. https://demonitor.kro-ncrv.nl/artikelen/de-monitor-reageert-op-kritiek-uitzending-mecvs Switzerland In its overview article on chronic fatigue, the Revue médicale suisse cites the Cochrane review to recommend graded exercise therapy. https://www.revmed.ch/RMS/2015/RMS-N-496/Syndrome-de-fatigue-chronique#anchor-B24 Sweden The ME/CFS guideline of Region Kronoberg, references Cochrane indirectly. It reads (translated into English): "Current compilations of the state of knowledge include NICE 2007, NAS/IOM 2015, Cochrane 2017 and Swedish recommendations from SLL/viss.nu and the national clinical knowledge support. [...]" The guideline recommends graded exercise therapy but also mentions that many patients object to the therapy. http://dokpub.regionkronoberg.se/OpenDoc.aspx?Id=146163 Norway Several Norwegian sources refer to the Cochrane review. The Norwegian Institute of Public Health, for example, has highlighted the conclusions of the Cochrane review in this 2015 article: https://www.fhi.no/publ/2015/bedre-...ing-for-personer-med-kronisk-utmattelsessynd/ The website Norsk Helseinformatikk, made by the same company that publishes the Electronic Guidelines for Doctors in Norway, recommends graded exercise for ME. https://nhi.no/sykdommer/hjernenerv...om-kronisk/utmattelsessyndrom-kronisk/?page=8 It refers to an article by Kjersti Uvaag and Elin Bolle Strandhe in the Journal of the Norwegian Physiotherapist Association where the Cochrane review is used as a source. https://oslo-universitetssykehus.no/seksjon/nasjonal-kompetansetjeneste-for-cfsme/Documents/Kronikk CFS-ME Fysioterapeuten 08-17.pdf A 2017 open-access journal sponsored by the Norwegian Society for Psychological Science said GET is effective for CFS patients referencing the Cochrane review. https://psykologisk.no/sp/2017/01/e1/ Professor Brun Wyller cites the Cochrane review in an overview article on ME/CFS for the Journal of the Norwegian Medical Association in 2015. The article writes: "We believe the evidence base for cognitive behavioural therapy is so solid that all patients with chronic fatigue syndrome/myalgic encephalomyelitis should be offered this treatment." This includes patients with severe ME/CFS. https://tidsskriftet.no/en/2015/12/...tis-pathophysiology-diagnosis-and-treatment-0 Italy A ME/CFS guideline by The Italian National Agency for Regional Healthcare Services does not mention the Cochrane review. It's possible that the guideline was written before 2015, when the update of the Cochrane review by Larun et al. was first published. https://www.s4me.info/threads/the-influence-of-the-cochrane-review-on-get.11768/#post-208734 France ? Spain ? Finland ? Other countries ?