Worse Than The Disease



A case study of Graded Exercise Therapy from UNDARK.


After living in Oklahoma for 40 years, Nita and Doug Thatcher retired in 2009 to the Rust Belt city of Lorain, Ohio, a Cleveland suburb that hugs Lake Erie. When Nita needed to find a new primary care doctor, a friend recommended someone from the Cleveland Clinic. Nita knew the institution’s reputation for cutting-edge research and superior medical services. But as a longtime patient grappling with chronic fatigue syndrome, a debilitating disorder that scientists still don’t fully understand, she was wary when she learned that the clinic was promoting a common but potentially dangerous treatment for the illness: a steady increase in activity known as graded exercise therapy.

The notion that people with chronic fatigue syndrome should be able to exercise their way back to health has enjoyed longstanding and widespread support, and “graded exercise” has become the de facto standard of clinical care. This approach has obvious intuitive appeal. Exercise helps all kinds of illnesses, and it’s a great tool for boosting energy. How could it possibly hurt?

British psychiatrists and psychologists developed the graded exercise strategy for treating chronic fatigue syndrome during the 1990s. They offered a straightforward rationale: These patients were not medically sick but severely out of shape (“deconditioned”) from prolonged avoidance of activity. And they avoided activity because they wrongly believed they had a biological disease that would get worse if they overexerted themselves. During treatment, patients were encouraged to question this “dysfunctional cognition,” view any resurgent symptoms as transient, and push through the exhaustion and pain to rebuild their strength.


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