Nathan Butler of Active Health Clinic and David Cunnington from SleepHub discuss what graded exercise therapy is and what is involved.
Transcript:
David Cunnington: So if I’ve got clients with fatigue and want to refer them for graded exercise therapy, what does that involve?
Nathan Butler: OK. Well, I think – I’m glad you said graded exercise therapy because graded exercise and graded exercise therapy are really different things and I think in the world – generally graded exercise therapy is actually used for chronic fatigue syndrome and other chronic illnesses and graded exercise therapy gets a very bad rap for sometimes I would say good reasons and sometimes very bad reasons.
So graded exercise is just really a principle of progressive overload and building up and it’s very much something that we use in the general population every day and we do a little bit more walking than we do a bit more than maybe running, et cetera.
Graded exercise therapy is not just the exercise but a combination of other things. So it involves pacing, exercise, sleep, setback planning and as well as goal setting.
David Cunnington: Yes.
Nathan Butler: So first of all, it’s important that we do pacing because with anything, we need a stable foundation to build from. So getting that is essential. Otherwise, we don’t know what’s contributing towards the person’s symptoms.
Exercise is the next thing that we do. So in graded exercise therapy, it’s really important to find an exercise baseline. So this is a level of exercise you can do every single day that doesn’t worsen how you feel or exacerbate your symptoms or even limit what you do. I mean there’s no point in saying, “I can go for a 15-minute walk but then I can’t make myself dinner.”
So it has to be sustainable. So for someone, this could be literally sitting up in bed. For another person, it might be a half hour walk. It really depends on where they start and as to what the right thing is. This is the importance of seeing someone who really knows what they’re talking about.
Now the next thing is goal setting. I mean we need to have a pathway and goal setting is not necessarily setting up something that’s not achievable. It’s more setting a pathway. So if you want to be able to walk and get your children from school or whether you wanted to be able to run 10 kilometres. I mean not all of us can do that anyway.
But we have to have a pathway to something that you want and that helps set us up or set up the rest of the program to meet your needs. The next thing is sleep and obviously you know a lot about this David.
It’s about a good rhythm, so what we call sleep hygiene, so times that you go to bed, waking up, meals, et cetera. Then after that we look at setback planning and I really find this as an essential part of what we do and this is what happens when things go wrong and it’s not necessarily because of what is prescribed, et cetera, but because of life events. I mean as the saying goes, it happens.
David Cunnington: Yeah.
Nathan Butler: So when we look at setback planning, first of all, we need to figure out what the trigger is, so whether it be physically, cognitively or emotionally or often a combination of that. Then we talk about certain things that we want to try and maintain, so just more daily routines and sleep and things like that.
Then the next thing often we cover but this really isn’t part of graded exercise therapy, but I think stress and anxiety management is really important and then sort of bringing things back in and how we use these tools to get back to school or work and that type of thing.
But I mean the key factor is that we do no harm and whatever is prescribed has to be within their limits and I think the way graded exercise therapy basically gets the bad rap is people are told just to exercise whereas that doesn’t really work and if we went to run a marathon tomorrow, I mean we’re not going to get the symptoms like someone with fatigue but we’re not going to be able to do it. We’re not going to pull out very well from it.
So it’s really important that if it’s something that someone wants to go and do, that they go and see a qualified practitioner, so either an exercise physiologist or physiotherapist that has a good amount of experience. That way, they’re putting themselves in the best position to get that best outcome.
David Cunnington: Great, thanks.
Nathan Butler: Pleasure.