thought I'd put everything in context with all the links:
(i) The following article was published in April 2008:
Chronic fatigue syndrome: an approach combining self-management with graded
exercise to avoid exacerbations.
Nijs J, Paul L, Wallman K.
J Rehabil Med. 2008 Apr;40(4):241-7.PMID: 18382818 [PubMed - indexed for
Controversy regarding the aetiology and treatment of patients with chronic
fatigue syndrome continues among the medical professions. The Cochrane
Collaboration advises practitioners to implement graded exercise therapy for
patients with chronic fatigue syndrome using cognitive behavioural
principles. Conversely, there is evidence that exercise can exacerbate
symptoms in chronic fatigue syndrome, if too-vigorous exercise/activity
promotes immune dysfunction, which in turn increases symptoms. When
designing and implementing an exercise programme for chronic fatigue
syndrome it is important to be aware of both of these seemingly opposing
viewpoints in order to deliver a programme with no detrimental effects on
the pathophysiology of the condition. Using evidence from both the
biological and clinical sciences, this paper explains that graded exercise
therapy for people with chronic fatigue syndrome can be undertaken safely
with no detrimental effects on the immune system. Exercise programmes should
be designed to cater for individual physical capabilities and should take
into account the fluctuating nature of symptoms. In line with cognitive
behaviourally and graded exercise-based strategies, self-management for
people with chronic fatigue syndrome involves encouraging patients to pace
their activities and respect their physical and mental limitations, with the
ultimate aim of improving their everyday functioning.
Full text at:
(ii) Lucy Clark and Peter White co-wrote a reply to which the authors
Chronic fatigue syndrome.
Clark LV, White PD.
J Rehabil Med. 2008 Nov;40(10):882-3; author reply* 883-5. No abstract
PMID: 19242631 [PubMed - indexed for MEDLINE]
*Response by: Jo Nijs, Lorna Paul, Karen Wallman
Full free text at:
(iii) Ellen Goudsmit and I wrote a response to this correspondence, to which
the other two groups replied:
Graded exercise for Chronic Fatigue Syndrome: Too soon to dismiss reports of
Kindlon T, Goudsmit EM
J Rehabil Med. 2010 Feb;42(2):184-6
Full free text at: