Chronic Fatigue Syndrome: A description of graded exercise treatment

doi:10.1016/S0031-9406(05)65554-X

Physiotherapy

Volume 84, Issue 5, May 1998, Pages 223-226

https://doi.org/10.1016/S0031-9406(05)65554-X Get rights and content

Summary

Patients with chronic fatigue syndrome complain of exercise intolerance and weakness, which may be partially related to lack of physical conditioning. Recent studies suggest that graded exercise therapy is a helpful treatment for the majority of patients. This article describes how to apply the treatment, adapted for clinical use. This incorporates recommendations and protocols for assessment of patients at baseline and throughout treatment, and details on monitoring of progression, through a low intensity graded exercise programme.

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Cited by (34)

Efficacy of a randomized controlled self-regulation based physical activity intervention for chronic fatigue: Mediation effects of physical activity progress and self-regulation skills
2017, Journal of Psychosomatic Research
Citation Excerpt :
GET is based on the assumption that aerobic exercise (e.g. brisk walking) or physical activity (e.g. housework, gardening) must be initiated at a level (intensity and frequency) that doesn't exacerbate symptoms and must be gradually increased until patients reach an optimal level of activity. GET follows the exercise prescription guidelines of the American College of Sports Medicine [13], tailored to each patient's initial level of physical capacity, and most interventions follow a similar protocol [14,15]. GET has been shown to have beneficial effects on chronic fatigue management [16–18].
Examine the medium-term effects of a brief physical activity (PA) self-regulation (SR) based intervention (4-STEPS program) for chronic fatigue, and explore the mediating effects of PA related variables and SR skills.
A two-arm randomized controlled trial (Usual Care vs 4-STEPS) was carried out. The 4-STEPS program consisted of Motivational Interviewing and SR-skills training. Fatigue severity (primary outcome) and impact, PA, health-related quality of life (HrQoL), and somatic and psychological distress were assessed at baseline, post-treatment (12 weeks) and 12 months follow-up.
Ninety-one patients (45 intervention and 46 controls) were included. At follow-up, there were significant treatment effects on fatigue severity (g = 0.72) and fatigue impact, leisure-time PA, and physical and psychological HrQoL. No significant effects were found for number of daily steps and somatic and psychological distress. Fatigue severity at follow-up was partially mediated by post-treatment progress on a personal PA goal (effect ratio = 18%).
Results suggest that a brief intervention, focusing on the formulation and pursuit of personal PA goals and the use of SR skills, produces sustained benefits for fatigue severity. Despite these promising results, dropout was high and the intervention was not beneficial for all secondary outcomes.
Differential effects of behavioral interventions with a graded physical activity component in patients suffering from Chronic Fatigue (Syndrome): An updated systematic review and meta-analysis
2015, Clinical Psychology Review
Citation Excerpt :
GET follows the exercise prescription guidelines of the American College of Sports Medicine (2013), tailored to each patient's initial level of physical capacity. Most GET interventions follow a similar protocol (Fulcher & White, 1998). GET is usually delivered by an exercise physiologist or physical therapist, and consists of supervised aerobic exercise sessions and/or home-based aerobic exercise prescription (e.g. walking).
An updated systematic review and meta-analysis was conducted to (1) evaluate the effects of behavioral and psychological interventions containing a graded physical activity component upon fatigue severity, physical functioning, physical activity and psychological distress, and to (2) examine potential moderator effects of trial characteristics (type of control, setting, provider, length of treatment, psychological component, flexibility in physical activity, and minimal face to face patient–provider contact). Pertinent content of selected studies was extracted and rated on a scale of methodological quality. Sixteen randomized controlled trials (N = 2004) were included in the meta-analyses. Significant small to medium effect sizes (Hedge's g = 0.25 to g = 0.66) were found for all outcomes at post-treatment (M = 5.2 months) and follow-up (M = 11.7 months), with the exception of physical activity at post-treatment (g = 0.11). The largest effects were found for fatigue severity (g = 0.61 to g = 0.66). Subgroup analyses revealed that minimal contact interventions had additional beneficial effects upon fatigue (g = 0.96) and depression (g = 0.85). Interventions provided by psychologists-psychotherapists and interventions conducted in secondary–tertiary settings also resulted in more beneficial effects on fatigue. We found some indication of publication bias. The small number of studies and variability between them are limitations of this study. Future research should explore additional moderating effects in order to improve the effectiveness of interventions.
Chronic fatigue syndrome
2008, Medicine
Fatigue is a common symptom. When it is chronic, disabling and unexplained by another condition, a diagnosis of chronic fatigue syndrome (CFS) may be appropriate. There is no known simple cause for CFS, but there is evidence for multiple contributing factors. Illness perpetuating factors include inactivity, a fear of making oneself worse and belief that the illness is permanent, and depression. Management should be directed to the perpetuating factors relevant to the particular patient. Much can be achieved by education and gentle encouragement back to normal activity. If specialist management is required, graded exercise therapy (GET) or cognitive–behavioural therapy (CBT) are of proven value.
Chronic fatigue syndrome
2008, Cognitive Behavioural Interventions in Physiotherapy and Occupational Therapy
Child and adolescent mental health
2007, Physiotherapy for Children
Functional somatic syndromes
2004, Psychology in the Physical and Manual Therapies

View all citing articles on Scopus

¹: Kathy Y Fulcher MSc is an exercise physiologist and was laboratory director of the National Sports Medicine Institute, London, and is now working as a freelance exercise and health consultant in Dublin.

²: Peter D White MD FRCP FRCPsych is a senior lecturer in psychological medicine.

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Chronic Fatigue Syndrome: A description of graded exercise treatment

Summary

Journal of Psychosomatic Research

Chest

Clinical Immunology and Immunopathology

Physiotherapy

American Journal of Medicine

ACSM's Guidelines for Exercise Testing and Prescription

Therapeutic Exercise

‘Review of findings for patients with chronic fatigue syndrome’

Reviews of Infectious Diseases

‘Perceived exertion rating as an indicator of somatic stress’

Scandinavian Journal of Rehabilitation Medicine

‘Infectious mononucleosis: 2. Relationship of bed rest and activity to prognosis’

Postgraduate Medicine