Review Functional neurological disorder, physical activity and exercise: What we know and what we can learn from comorbid disorders 2024 Boylan et al

The level of ignorance about ME/CFS is clear from their use of the term PEF instead of PEM, and describing it thus:

And then of course supporting PACE and arguing against NICE.

 

Wow. “Favours pacing over GET/CBT”. Nope that’s a misrepresentation. Unlike you lot it actually accepts that GET can cause harm. You prefer to rely on low/very low quality research.

 

The authors are all at Brigham hospital, Boston.
Out of curiosity I looked at what references they used for ME/CFS:

 

In this traditional narrative literature review,​

Off to a bad start. (I am not a fan of narrative reviews at the best of times, traditional or otherwise. They are mostly just pseudo-scientific manifestos promoting the authors' ideological prejudices, in my humble opinion.)

(Also, FBM is fibromyalgia.)

The best available research on treatment for CFS comes from the 2011 Pacing, graded Activity, and Cognitive behavioral therapy (PACE) trial​

Of course, we start here. Because all roads in the pychosomatic/FND map of 'CFS' lead back to PACE. The rehabilitation project of PACE is gathering pace, zombie-like it must never be allowed to die.

(Note their persistent use of CFS throughout this document, and the casual conflating of it, and all the other listed conditions, with FND. The whole paper also persistently and continuously conflates association with causation, or fails to distinguish between them.)

a RCT​

PACE was denied controlled status, for good reason, one of the things the reviewers did get correct. The only mentions of controlled in PACE are in the citations it used.

Besides, I thought the psychosomatic club now regard RCTs as passé, indeed inappropriate? Or is that only when they don't support their 'clinical experience'? Is it still a status to be desired, where convenient?

showed that individualized graded exercise therapy (GET) in conjunction with CBT was most effective at reducing fatigue and improving physical function after one year​

Only by the post-hoc fiddle, and only on subjective measures, and even the PACE authors had to concede it didn't demonstrate any benefit over APT or SMC at the much more important 2.5 year long-term follow-up. The fact that the authors of this paper did not mention these two facts tells you everything you need to know about their competence, diligence, or integrity.

Since the 2011 trial, many other studies have shown that graded exercise therapy improves quality of life, ability to work, physical functioning, anxiety, and depression [54], [55]. Synthesis of the Physiotherapy Evidence Database (PEDro) showed that there is moderate evidence that exercise can improve fatigue, sleep, physical functioning, and overall health in patients with CFS who are well enough to attend an outpatient clinic, irrespective of type of exercise [51], [55].​

News to me. Let me guess, all 'improvements' are on subjective self-report measures, with no support from objective measures, and vanish into thin air when examined robustly, or otherwise don't support the claim. [Checks citations: Yep, for 54, a Chalder paper. Have not seen 55 yet. For 51, read on:]

Reference 51 does not support their claim. It in fact gives PACE, and the model on which it is based (i.e. more or less the same one being advocated in this paper), a good kicking. Even worse, it recommends pacing, not GET nor any other form of exercise therapy.

Importantly, the PACE trial showed that GET was more effective than adaptive pacing therapy (APT, or pacing).​

No, it did not. See previous point about 2.5 year follow-up results. Furthermore, and critically, the version of pacing (APT) tested in PACE was not as understood and practiced by patients, and its results cannot be generalised.

FND and CFS experts have published their serious concerns with the new NICE guidelines, arguing that pacing may actually be harmful to CFS care [56], [57].​

Which 'concerns' were comprehensively refuted by the NICE team. The authors also failed to cite NICE's refutation.

All in all, though it remains controversial in light of the new guidelines,​

Only because some cannot accept the results of a robust independent assessment of their shoddy work, and insist on manufacturing a controversy where there should be none.

the most effective and studied treatment for CFS appears to be GET and CBT, and their success in CFS should prompt application in patients with FND.​

And, of course, it recommends GET and CBT for everybody, with a nifty diagram to help visual the latest version of the psychosomatic fable – it's the autonomic nervous system wot dun it. No, really, we got it right this time.

This article is the usual propaganda sludge. One of those that just gets worse the more you read it and check its citations. The amount of literature you have to wilfully ignore or misinterpret to make the claims it has is breathtaking. But not in the slightest bit surprising. Par for the course, I am afraid.

Shame on the reviewers for passing it and the journal for publishing it.