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We respond to a letter promoting exercise for Long Covid

On 11 March 2021 a letter was published in the Guardian encouraging the use of graded exercise for Long Covid patients. This letter was strongly opposed by ME Charities, Long Covid advocates, and both ME and Long Covid patients alike, due to the inaccuracies and potentially damaging advice.


Physios for ME teamed up with Long COVID Physio to write a response to the Guardian. However, a response by Dr Charles Shepherd of the ME Association was published, and we are pleased that this important information has been made public.


We would like to share our own letter here:


"We write with concern at the letter published 11 March, as we believe it is inaccurate and may lead to patient harm.


We are Physios For ME and Long COVID Physio, Physiotherapists specialising in ME/CFS and Physiotherapists living with Long COVID, both globally advocating for safe and effective rehabilitation.


As Physiotherapists we are leading advocates for therapeutic exercise and are specialists in delivering exercise-based rehabilitation. Therefore when we caution against the use of exercise, it is pertinent to take note.


The letter encourages people with Long COVID to try graded exercise because “there are no studies to show [it] is detrimental”. While research in this area is relatively new, one study has reported 86% of 3,762 people with Long COVID relapsed due to exertional activities such as exercise. NICE have cautioned against the use of graded exercise therapy for people recovering from COVID-19.


The letter states “graded exercise therapy is an effective treatment for chronic fatigue syndrome.” This ignores the NICE review from November 2020 which describes evidence for graded exercise therapy as “low or very low quality”, with revised guidelines (to be published April 2021) advising against the use of graded exercise therapy for people with ME/CFS.


There is objective evidence of the adverse physiological effects of exercise on people with ME/CFS and qualitative research has demonstrated that over 80% of people with ME/CFS have cited graded exercise as a cause for the deterioration of their condition.


The aim is to prevent patient harm by identifying those who develop these abnormal physiological responses to exercise, and the best way to do this is for clinicians to expand their knowledge of “post exertional malaise” so that interventions are appropriate."

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