Trial By Error: Letter To British Journal Of Sports Medicine From CPET Experts

David Tuller


By David Tuller, DrPH.


Last October, the British Journal of Sports Medicine published a short paper that was essentially a summary of Cochrane’s systematic review of graded exercise for chronic fatigue syndrome (as Cochrane calls the illness). This systematic review is problematic for a number of reasons—not least of which is that it includes the debunked PACE trial and other Oxford criteria studies.

The Oxford case definition does not require any symptoms besides fatigue for diagnosis—including the cardinal symptom of post-exertional malaise. Studies that rely on Oxford criteria samples do not represent the experiences of patients with more narrowly defined disease. Systematic reviews of flawed trials produce flawed results.

In response to the BJSM article, the experts on post-exertional malaise from University of the Pacific and the Workwell Foundation wrote a letter to the journal that has not yet been published. These investigators have documented this symptom through use of the two-day CPET test, which measures the impact of exercise. They wanted to register their evidence-based opposition to the recommendation for GET. Since the letter makes valuable points and will be useful for those seeking to rebut the BJSM paper’s fallacious claims about exercise, I am happy to post it below.


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