A 45-year-old woman has recurrent depression and established ME/CFS. Her depression has shown only a partial response to an adequate trial of an

Question

A 45-year-old woman has recurrent depression and established ME/CFS. Her depression has shown only a partial response to an adequate trial of an SSRI. She experiences post-exertional malaise after exceeding her usual activity level and asks whether she should undertake a group exercise programme as an adjunctive treatment for depression. Which advice best accords with current NICE guidance?

Accepted Answer

Do not offer fixed-increment or generic exercise; if she chooses physical activity, use a personalised, flexibly adjusted programme within her energy limits, overseen by an ME/CFS specialist physiotherapist.

Answer

Recommend self-directed low-intensity walking with weekly increases, because low-intensity activity falls outside the NICE definition of graded exercise therapy.

Answer

Offer the standard moderate-intensity group exercise programme for depression, using preplanned increases provided that she gives informed consent.

Answer

Avoid all physical activity interventions permanently, because any planned increase in activity is contraindicated after a diagnosis of ME/CFS.

Answer

Recommend complete rest until post-exertional malaise resolves, followed by a fixed-increment programme beginning below her previous activity baseline.

Exercise and ME/CFS — MRCPsych Paper B MCQ