For years, Stripy Lightbulb CIC has been raising concerns about the way national physical activity messaging overlooks people for whom exercise is not universally safe. This is not a new issue for the M.E./C.F.S. community to deal with. In fact, we wrote about it several years ago, quoting Chief Medical Officer, Chris Whitty directly when he said:
““There is no situation, there is no age, and no condition where exercise is not a good thing” Chris Whitty CMO (previously quoted in our 2022 blog)
This narrative has now resurfaced with the updating of the UK Chief Medical Officers’ Physical Activity Guidelines, which again emphasise that everyone can safely increase activity.
When publishing the updated guidelines on his X account today, Chris Whitty CMO wrote –
Today, the UK CMOs have published updated physical activity guidelines. These reflect stronger evidence on the benefits of increasing activity for anyone, but especially for the least active. Even small amounts of activity can have big benefits for health.
We should note that the guidelines also contain important caveats, but these are given a light touch and are not easy to find. Caveats that are rarely communicated in public‑facing messaging, and certainly not with the clarity required to protect people living with undiagnosed M.E./C.F.S., of which there are far too many. We are braced to get increasingly frustrated with media coverage this week, as all outlets praise the health benefits for exercise or increased activity for all.
The main public‑facing messaging (“The remarkable physical and mental health benefits of activity are available to all of us.”) is not accompanied by visible public warnings. Yet the full report contains several statements that clearly acknowledge that exercise is not safe for everyone.
1. Acute or unstable medical conditions
Page 10 of the PDF version states:
“People with acute or unstable medical conditions may need to restrict physical activity.”
2. Conditions requiring clinical assessment before increasing activity
Page 11 notes:
“Some individuals will require clinical assessment before increasing their physical activity levels.”
3. Pregnancy‑related contraindications
Page 25 includes:
“Women with pregnancy complications may need to avoid or modify physical activity.”
4. Disabilities and long‑term conditions requiring tailored activity
Page 32 states:
“People with long‑term conditions or disabilities may need adapted physical activity.”
These caveats are real, but they are buried in a 130‑page document that the general public will never read. They are not included in social media posts, infographics, or public campaigns, the places where most people encounter physical activity messaging.
The guidelines do not mention M.E./C.F.S. specifically. They do not mention post‑viral illness either, in the midst of an ongoing pandemic. They do not mention post‑exertional malaise (PEM), the hallmark symptom that makes exertion dangerous for people with M.E./C.F.S.
This omission matters because:
- Tens of thousands of people meet the diagnostic criteria for M.E./C.F.S. but have no diagnosis.
- Many have been told they are “just deconditioned”.
- Many have been encouraged to increase activity as a way to “build fitness”.
- They do not know that exercise is contraindicated for them.
When national figures say “almost everyone benefits from being more active,” these individuals wrongly hear: “This applies to me”, it also leads to pressure from well-meaning family or friends who encourage them to do more, even though the individual knows within themselves that they feel worse after exertion but don’t know why. This causes increased stigma.
The caveats in the CMO guidelines are technically correct, but practically useless for people with undiagnosed M.E./C.F.S.. Here’s why:
1. They are not visible in public messaging
The public sees the headline: “Any increase in activity is good for everyone.” They do not see the footnotes.
2. They rely on people knowing they have a condition
People living with undiagnosed M.E./C.F.S. do not know that exertion is unsafe for them. They do not know they should seek medical advice before increasing activity, and even if they do……
3. They rely on clinicians recognising ME/CFS, which many still do not
Even if someone does seek medical advice, many healthcare professionals still misinterpret M.E./C.F.S. symptoms as:
- deconditioning
- low fitness
- lack of motivation
- anxiety
- “normal tiredness”
This is not a criticism of individual clinicians, it is a reflection of a systemic knowledge gap, something we have slowly and doggedly been tackling with our educational output since 2019.
Until the knowledge base improves, “ask your doctor first” is not a meaningful safeguard.
4. They do not acknowledge PEM or activity intolerance
The guidelines assume that activity is universally beneficial unless a condition is severe or unstable. M.E./C.F.S. does not fit this model. Even mild M.E./C.F.S .can make exertion harmful.
5. They create a multi‑pronged risk
People with undiagnosed M.E./C.F.S. face:
- pressure from public messaging to increase activity
- pressure from clinicians who believe they are deconditioned
- pressure from employers, family, and peers who repeat the same messaging
- lack of diagnostic clarity
- lack of recognition of PEM
- lack of visible warnings in national campaigns
This combination increases the risk of harm, not hypothetically, but in lived reality.
The UK’s physical activity messaging is built on a narrative that CMO Chris Whitty has repeated for years: “Everyone benefits from exercise.”, and when the exceptions are hidden in lengthy or technical documents rather than communicated publicly, people with undiagnosed M.E./C.F.S pay the price.
What is needed now is not more generic reassurance but meaningful change: public‑facing and well-communicated caveats rather than buried footnotes, explicit acknowledgement of M.E./C.F.S. and PEM in national guidance, improved clinical education so that healthcare professionals recognise Post-Exertional Malaise when they see it, messaging that does not assume universal safety, and campaigns that recognise post‑viral illness as a significant public‑health issue. Until these changes are made, broad statements about physical activity, even when technically accurate, will continue to place people with undiagnosed M.E./C.F.S. at risk.
Our blog from 2022.
FAO: Exercise Professionals – When Overload Principle Can Be Harmful….
