GET is delivered in three phases over several sessions (e.g. 15 sessions in the PACE trial – see Table 1).
After assessment of the patient’s current physical capacity, and mutual negotiation of meaningful and functional physical goals, a baseline of physical activity is agreed upon and commenced, at a manageable low level of intensity.
Any activity that is titratable is appropriate, including walking, swimming, and the use of exercise machines. These activities can be mixed.
Increments of duration: duration of physical activity/exercise is then increased slowly (10–20%), once every 1–2 weeks.
Increasing intensity: intensity is increased by encouraging the patient to speed up the pace of their walk, increase the resistance on exercise machines or do an activity faster, using their heart rate monitor (HRM) as a guide.
However, increase in intensity is done with care and is likely to be done in stages. It can be useful to build up the intensity by adding in shorter bursts of higher intensity activity to the program; for example, starting with 1 minute of fast walking interspersed with 2 minutes of normal pace.
If increased symptoms occur after an increment, the patient is encouraged to stick at the current level until symptoms reduce, and then increase afterwards. However, activity is mutually reviewed on a regular basis, and plans may be adjusted depending on the patient’s general health and symptoms.