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An economic evaluation of the dry-needling, advice and graded exercise approach will also be conducted as a secondary aim in this trial.
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Within the physiotherapy profession this course of action has been questioned as not all believe that graded exercise is the preferred approach for all patients.
The NICE guidelines allude to a role for practice nurses as care coordinators and suggest that graded exercise and CBT (Cognitive Behavioural Therapy) approaches should be used in the management of patients with CFS/ME.
For example, if a mechanical approach did not decrease fear avoidance, then a graded exercise intervention would be applied.
11 A Cochrane review of graded exercise therapy concluded that some patients benefit from exercise, but that this approach is not always acceptable to patients.
"If you prescribe a graded exercise regime to a CFS patient with an energy-production impairment, you can do a lot of harm.
A recent re-analysis of data from the study has shown that graded exercise and CBT did not lead to recovery in patients.
Peak values were recorded for the maximal graded exercise test.
Respiratory gas exchange values were averaged every 30 s during the maximal graded exercise test.
During the first visit, they performed a maximal graded exercise test.
A graded exercise test to exhaustion (GXT) was then completed at a constant speed.
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