By David Tuller, DrPH.
Last week I admonished the US Centers for Disease Control for including fuzzy language about exercise in its new package of “information for healthcare providers.” The way the Mayo Clinic deals with the illness it calls chronic fatigue syndrome is an excellent illustration of why it is so important for the CDC to stop fudging and get this right.
Mayo has long advocated graded exercise and cognitive behavior therapy, or what it calls on its website “cognitive training,” as key elements of its treatment plan. Here’s how Mayo’s website explains the mechanism of graded exercise: “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 hypothesis that patients are experiencing a form of hypersensitivity to exercise akin to an allergy is just that—a hypothesis. It is unclear why Mayo appears to be presenting it here as fact.
Of course, this hypothesis appears to have become a preferred explanation for the purported positive effects of GET and CBT. Now that the “deconditioning” theory championed in the PACE trial has essentially been discarded, members of the CBT/GET ideological brigades have adopted other justifications for continued adherence to their favored treatments.
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