NICE is aware of concerns about graded exercise therapy (GET) for people who are recovering from COVID-19. NICE’s guideline on ME/CFS (CG53) was published in 2007, many years before the current pandemic and it should not be assumed that the recommendations apply to people with fatigue following COVID19. The recommendations on graded exercise therapy in CG53 only apply to people with a diagnosis of ME/CFS as part of specialist care, and CG53 is clear that this should be part of an individualised, person-centred programme of care, with GET only recommended for people with mild to moderate symptoms.
As the guideline is currently being updated, it is possible that these recommendations may change. The evidence for and against graded exercise therapy is one of the important issues the guideline committee is considering. NICE plans to consult on the updated guidance in November 2020.
NHS England has recently published guidance on After-care needs of inpatients recovering from COVID-19 that includes advice on fatigue.
The ME Association gives the background to the NICE Statement in their article concerning the 'Clinician's Letter to NICE Results in Statement on Graded Exercise for Post-Covid-Syndrome'.
The MEA explained that the NICE statement was in response to a detailed letter to NICE that was prepared by Dr Charles Shepherd and Dr William Weir several weeks ago and which was signed by other members of the NICE ME/CFS clinical guideline committee.
The letter pointed out that recommendations in the current (2007) NICE guideline regarding the use of GET in ME/CFS could cause serious harm if applied to people who are failing to recover from COVID-19 and who are experiencing Post-Covid Syndrome and other complications.
The letter also pointed out that there is a need for guidance from NICE about the use of Pacing as a sensible and safe alternative to Graded Exercise Therapy in respect of Post-Covid Syndrome.
The MEA article also tells us that knowledgeable physiotherapists and occupational therapists, and the MEA, have all produced helpful guidance in this regard, but the message about the dangers of Graded Exercise Therapy, and the increased need for individualised, patient-centred, care is not being taken up by official sources of information.
The article also gives Dr Shepherd’s detailed response to the NICE Statement, plus links to -
- ME Association Statement on GET and the current NICE guideline.
- MEA Leaflet on the management of Post Viral Fatigue Syndrome and Post-Covid Syndrome.
In June, the MEA announced The New NICE Clinical Guideline on ME/CFS to be Published in April 2021.
Dr Charles Shepherd, Hon. Medical Adviser to the ME Association, and other M.E. experts, clinicians, and patient representatives, had continued to work on the new clinical guideline via remote meetings until NICE made the decision to suspend them as resources were directed towards the Covid-19 pandemic.
The meetings were recently reinstated and work now continues. Stakeholders can expect to receive the new draft guideline for comment and review from 10 November this year.
The recent Letter to Stakeholders was given on the MEA website -
As you will be aware, because of the need to prioritise work on COVID-19 guidance and to avoid drawing frontline staff away from their clinical work, NICE cancelled all guideline committee meetings. This included meetings for the ME/CFS guideline.
We have now rescheduled the remaining committee meetings for this guideline and agreed a revised timeline. This means that the consultation on the draft guideline will now start on 10 November, and the guideline will now publish on 21 April 2021.
Katie Stafford, Senior Guideline Coordinator, 24 June 2020
For further background information, see our previous NICE Guidelines: Coronavirus Covid-19, and ME/CFS blog dated 26 April.