Graded Exercise Therapy: How to Make It Safe and Effective
exercise therapy (GET) is physical exercise program that increases
the duration and intensity of exercise slowly and gradually. This clinical
approach has been used for many decades for chronic fatigue syndrome (CFS),
heart failure, chronic back pain, diabetes and many other conditions.
A typical program of graded exercise therapy starts with 5
minute walking every other day for 1 or 2 weeks. If the person feels
improvement, he can add up to 5 more minutes to his exercise for the next 1 or 2 weeks.
Clinical trials of
graded exercise therapy
for chronic fatigue reported moderate improvement (Tench et al, 2005)
or inconclusive results (Ridsdale et al, 2004).
some reviews suggested that graded exercise therapy can
be harmful for chronic fatigue patients (Twisk & Maes,
2009). Why do we have this confusion?
Over 150 Russian doctors tested thousands of their patients and found that
physical exercise with mouth breathing is a great threat to health since it
usually causes exacerbations of symptoms and feeling worse after exercise. These
health professionals confirmed that exercise become safe and effective when the
person has nose only breathing during physical exercise.
Effects of graded exercise therapy
98% of modern people exercise with mouth breathing and believe that breathing
more is good, it is
clear that such a graded exercise therapy will produce poor effects on brain and
body oxygenation. Sick people
are generally unable to get benefits from graded exercise therapy with oral breathing.
In contrast, nose breathing allows the utilization of nitric oxide (produced in
sinuses) and increases alveolar CO2 that improves oxygen transport
profoundly improving biochemistry of the human body and decreasing one's heart rate.
If graded exercise therapy
is done with strictly nasal breathing (in and
out), patients can avoid the following negative after-effects of exercise
with mouth breathing: anaerobic cellular respiration, elevated blood lactate,
oxidative stress or the production of free radicals, chronic inflammatory response,
and the over-expression of hypoxia inducible factor-1. For more details, visit
the web page devoted to effects of exercise on the respiratory system (see the link below).
over 150 Russian MDs practicing the Buteyko breathing method in Russia, physical
activity with nose breathing is safe even for sick people with chronic fatigue
or fibromyalgia. It should be increased very gradually in order to be the
central factor of graded exercise therapy that helps people to develop light and easy
automatic breathing at rest (i.e., normal breathing) and
increase body-oxygen levels.
Another finding of Russian doctors is that sick people with less than 20
s for the body-oxygen test (with fibromyalgia or chronic
fatigue as well) cannot exercise rigorously with
nose breathing (e.g., during running). Therefore, they should exercise easier
and start with walking as an initial phase of their graded exercise therapy.
With more than 20 s of oxygen in the body, people can
start running with nose breathing in and out, as their final
part of graded exercise therapy.
Psychol Med. 2004 Jan;34(1):37-49.
Is graded exercise better than cognitive behavior therapy for fatigue? A
UK randomized trial in primary care.
Ridsdale L, Darbishire L, Seed PT.
Department of Neurology, Guy's, King's and St Thomas's School of Medicine,
BACKGROUND: Patients frequently present with unexplained fatigue in primary
care, but there have been few treatment trials in this context. We aimed to
test cognitive behavior therapy (CBT) and graded exercise therapy (GET) for
patients presenting to their family doctor with fatigue. Secondly, we
described the outcome for a cohort of patients who presented to the same
doctors with fatigue, who received standard care, plus a booklet...
CONCLUSIONS: Short courses of GET were not superior to CBT for patients
consulting with fatigue of over 3 months in primary care. CBT was easier 'to
sell'. Low recovery in the CFS subgroup suggests that brief treatment is too
Rheumatology (Oxford). 2003 Sep;42(9):1050-4. Epub 2003 Apr 16.
Fatigue in systemic lupus erythematosus: a randomized controlled trial of
Tench CM, McCarthy J, McCurdie I, White PD, D'Cruz DP.
National Sports Medicine Institute, The London NHS Trust, London, UK.
CONCLUSION: These findings support the use of appropriately prescribed
graded aerobic exercise in the management of patients with fatigue and
systemic lupus erythematosus.
Neuro Endocrinol Lett. 2009;30(3):284-99.
A review on cognitive behavioral therapy (CBT) and graded exercise therapy
(GET) in myalgic encephalomyelitis (ME) / chronic fatigue syndrome (CFS):
CBT/GET is not only ineffective and not evidence-based, but also potentially
harmful for many patients with ME/CFS.
Twisk FN, Maes M.
ME-de-patiŽnten Foundation, Limmen, the Netherlands.
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