What is 'GET' or Graded Exercise Therapy?
G.E.T
Graded Exercise Therapy… Who's it for?
'GET' stands for 'Graded Exercise Therapy'. It is an approach for building physical activity in a person's life by being consistent, making gradual changes and responding to setbacks.
It can be used as a treatment for people with physical injuries, persistent pain, fatigue, mild depression and other medical conditions. It is also an approach which can be used by people without any particular medical condition to improve general overall wellbeing. The approach is most effective and safest if it is carried out with guidance from a health professional.
What are the key components?
Activity management: - it is important to minimise flare-ups of symptoms by using principles of pacing of activities. This may include pacing of physical and cognitive activities and establishing a consistent routine of eating and sleeping habits.
Choosing a physical activity: - this activity needs to be practical and, if at all possible enjoyable, to do. It needs to be an activity which fits with the context of the person's life. If the chosen activity is increased, it would result in significant improvements to the person’s life. The most common chosen activity is walking because it is often the easiest to fit in to the day and would have a hugely beneficial impact if it is possible to increase.
Setting a baseline: This needs to be an amount which would be possible to do on 5 to 6 consecutive days, without significant interference with the person's ability to do what they usually do in their life. Setting a baseline is one of the most important parts of the programme and is often a smaller amount of activity than people imagine it would be.
Gradual increases in activity: When it has been possible to sustain the activity for a week, without a setback, then the activity is increased by a small amount which is agreed with their therapist. For example, if the baseline was 5 minutes walking, they may choose to increase to 6 minutes. The initial phase of increases are focused on increasing the time of the activity, but keeping the intensity low. Later phases of rehabilitation, may build on the intensity by building gradual increases in activities which raise the heart rate.
Managing setbacks: When setbacks occur, it is helpful to reflect and identify triggers for the setback and make adaptations accordingly. It is also useful to create a 'setback plan' for managing difficult periods.
Precautions
For people with medical conditions, we recommend doing this under the guidance of an appropriately trained therapist in order to minimise setbacks and get the most from the process.
The importance of individualising GET
As with all therapies, these general principles will be adapted to the person's individual needs, and the context of their lives. Sometimes it is appropriate to change how GET is implemented, for example: choosing two activities to focus on instead of one, or not increasing the activity for a while during a period of change in the person's life or making increases more slowly than is usual.
How does it work?
There are different theories for this. The mechanisms by which GET works will be affected by the medical conditions the individual is experiencing. Regardless of the medical condition, GET is retraining the response of the bodily systems to physical activity, so that the person is able to do increasing amounts of activity. This may include changes to the person’s fitness (cadiovascular and muscular systems) as well as changes to how the brain, neural and immune system respond to physical activity. As more research is carried out, we will understand in more depth the mechanisms for the positive effects of Graded Exercise Therapy.