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Cochrane Has Published An Update Of Its Review Of Exercise Therapy For ME/CFS

Saturday 5 October 2019


From the ME Advocacy Network Australia on Facebook:


ME Advocacy Network Australia

*** Cochrane has published an update of its review of exercise therapy for ME/CFS ***

Thursday October 3, 2019

This review was the subject of a formal complaint, submitted by Robert Courtney and based on his and Tom Kindlon’s work. The complaint was lodged in early 2018. Cochrane has been working with the authors of the review to address the concerns in the complaint for over a year.

Sadly, but unsurprisingly for those who have been following this saga, the updated review doesn’t really address the issues raised in the complaint. The updated review concludes that:

“Low‐to moderate‐certainty evidence suggests that exercise therapy may contribute to alleviation of some of the symptoms of chronic fatigue syndrome (CFS), especially fatigue.“

This conclusion is inappropriate, as the studies in this review are unblinded trials using subjective outcome measures, which are highly subject to bias. The recent Vink & Vink-Niese (2018) re-analysis of the studies in this Cochrane review concluded that: “The analysis of the objective outcomes in the trials provides sufficient evidence to conclude that graded exercise therapy is an ineffective treatment”.

You can read the full Vink & Vink-Niese (2018) review here:…/pdf/10.1177/2055102918805187

The updated review has also concluded that “the evidence about adverse effects is uncertain”. This is an improvement on the previous version of the review, which claimed that “no evidence suggests that exercise therapy may worsen outcomes”.

However, this updated conclusion is misleading. While the trials in the review might not provide evidence of harm (or of safety), that doesn’t mean that there isn’t any evidence of harm from GET. As #MEAction noted in its response, patient surveys from around the world consistently find high rates of harm from GET, and there is mounting biomedical evidence showing an abnormal physiological response to exertion in people with ME/CFS.

You can read #MEAction’s response here:

Importantly, the new Editor-in-Chief, Dr Karla Soares-Weiser, has acknowledged that the update doesn’t address all the issues and has pledged to undertake a full update of this review and to include patient advocacy groups in the process. This process will commence in 2020.…/publication-cochrane-review-exer…


Full article…



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