Graded exercise/activity is a bit like pacing but the focus is on gradual but progressive increases in aerobic exercise such as walking or swimming and everyday activities such as taking a bath.
Some doctors believe that the inactivity and resulting loss of fitness (deconditioning) that occurs with M.E. can make the illness last longer and that graded exercise/activity can help to reverse this. Also, by reintroducing activities that you may be avoiding, your confidence will improve.
Action for M.E. prefers to refer to the approach as graded activity, rather than exercise, because the best practitioners do not just focus on physical exercise, for example walking, but include targets for everyday activities like writing a letter, having a bath or speaking to a friend.
A good graded activity/exercise programme starts and then continues at a manageable and realistic pace. Walking is often chosen as an exercise and it could start at just a few paces. If someone is severely affected by M.E. simply rolling over in bed or moving from their bed to a nearby chair could be a starting point. Once the body has adapted to this activity, it is challenged slightly more to allow a further increase in strength and fitness. It is a very gradual process and takes into account any setbacks or relapses, making adjustments if necessary. Stability in activity is also encouraged to help reduce the ups and downs.
Graded exercise is seen by some as a controversial therapy. There have been cases where it has been badly or inflexibly applied. Graded exercise should be supervised by a properly trained therapist, such as a physiotherapist (Physio), or an occupational therapist (OT) and they must have a proper understanding of M.E. The treatment programme must be agreed by the patient and the therapist, be based on that individual's current physical capacity and flexibly applied.
There have been no clinical research trials into this approach in children but studies in adults have shown positive results in some people well enough to attend an out-patient clinic. We suggest that careful checks are made to ensure that programmes are led by practitioners with experience or training in M.E.
Information produced July 2003
