Using evidence (and experience) to develop practice in graded exercise therapy Dr Lucy Clark

Plan for Workshop 1. I will summarise the literature to date regarding GET 2. In groups you will discuss your own experiences of delivering GET 3. Each group will feed back on the experiences of those in their groups The aim is to learn from each other how we each deliver acceptable and effective GET interventions within the constraints we may have.

Exercise therapy for chronic fatigue syndrome In 2017 Larun and her colleagues published a review of all the work undertaken up to 2016 looking at the effectiveness and safety of GET for individuals with CFS. Larun L, Brurberg KG, Odgaard-Jensen J, Price JR. Exercise therapy for chronic fatigue syndrome. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No.: CD003200.

What did their review tell us? That patients with CFS may generally benefit and feel less fatigued following exercise therapy No evidence suggested that exercise therapy may worsen outcomes. There was a positive effect with respect to: Sleep physical function and self-perceived general health However, no conclusions for the outcomes of pain, quality of life, anxiety, depression were possible The effectiveness of exercise therapy seems greater than that of pacing but similar to that of CBT.

The overall message from the literature Randomised trials with low risk of bias are needed to investigate the type, duration and intensity of the most beneficial exercise intervention. The list of research studies reviewed from this are at the end of the slides

Research published since the Larun review GET is a safe intervention that might reduce fatigue and to a lesser extent physical disability for patients with CFS.

Qualitative outcome Anna Cheshire and Damien Ridge Supportive and understanding health professionals are key to a positive patient experience There are clinical implications for the way GES is delivered: those who have had the condition longer or have comorbid health conditions are likely to need more support to undertake GES health professionals can assist patients to benefit from GES in a number of ways, such as supporting patients through the indeterminate phase

What do we do in practice? My experiences: with 2 services private vocational rehabilitation practice Supervising therapists

Your experiences What do you do in your practices? What do/would you say to a sceptical/concerned patient? What are your concerns (if any) about the treatment you are currently able to offer, and any solutions? What do you think that you offer as part of your GET is helping your patients and why? Are there any situations in which you would not or have not offered GET?

Summarise feedback lucy.v.clark@uea.ac.uk

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