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Exercise therapy for chronic fatigue syndrome

Discussion in 'Latest ME/CFS Research' started by hixxy, Dec 21, 2016.

  1. hixxy

    hixxy Senior Member

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    Cochrane Database Syst Rev. 2016 Dec 20;12:CD003200. [Epub ahead of print]

    Exercise therapy for chronic fatigue syndrome

    Larun L, Brurberg KG, Odgaard-Jensen J, Price JR.

    Abstract

    BACKGROUND:
    Chronic fatigue syndrome (CFS) is characterised by persistent, medically unexplained fatigue, as well as symptoms such as musculoskeletal pain, sleep disturbance, headaches and impaired concentration and short-term memory. CFS presents as a common, debilitating and serious health problem. Treatment may include physical interventions, such as exercise therapy, which was last reviewed in 2004.

    OBJECTIVES:
    The objective of this review was to determine the effects of exercise therapy (ET) for patients with CFS as compared with any other intervention or control.• Exercise therapy versus 'passive control' (e.g. treatment as usual, waiting-list control, relaxation, flexibility).• Exercise therapy versus other active treatment (e.g. cognitive-behavioural therapy (CBT), cognitive treatment, supportive therapy, pacing, pharmacological therapy such as antidepressants).• Exercise therapy in combination with other specified treatment strategies versus other specified treatment strategies (e.g. exercise combined with pharmacological treatment vs pharmacological treatment alone).

    SEARCH METHODS:
    We searched The Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (CCDANCTR), the Cochrane Central Register of Controlled Trials (CENTRAL) and SPORTDiscus up to May 2014 using a comprehensive list of free-text terms for CFS and exercise. We located unpublished or ongoing trials through the World Health Organization (WHO) International Clinical Trials Registry Platform (to May 2014). We screened reference lists of retrieved articles and contacted experts in the field for additional studies SELECTION CRITERIA: Randomised controlled trials involving adults with a primary diagnosis of CFS who were able to participate in exercise therapy. Studies had to compare exercise therapy with passive control, psychological therapies, adaptive pacing therapy or pharmacological therapy.

    DATA COLLECTION AND ANALYSIS:
    Two review authors independently performed study selection, risk of bias assessments and data extraction. We combined continuous measures of outcomes using mean differences (MDs) and standardised mean differences (SMDs). We combined serious adverse reactions and drop-outs using risk ratios (RRs). We calculated an overall effect size with 95% confidence intervals (CIs) for each outcome.

    MAIN RESULTS:
    We have included eight randomised controlled studies and have reported data from 1518 participants in this review. Three studies diagnosed individuals with CFS using the 1994 criteria of the Centers for Disease Control and Prevention (CDC); five used the Oxford criteria. Exercise therapy lasted from 12 to 26 weeks. Seven studies used variations of aerobic exercise therapy such as walking, swimming, cycling or dancing provided at mixed levels in terms of intensity of the aerobic exercise from very low to quite rigorous, whilst one study used anaerobic exercise. Control groups consisted of passive control (eight studies; e.g. treatment as usual, relaxation, flexibility) or CBT (two studies), cognitive therapy (one study), supportive listening (one study), pacing (one study), pharmacological treatment (one study) and combination treatment (one study). Risk of bias varied across studies, but within each study, little variation was found in the risk of bias across our primary and secondary outcome measures.Investigators compared exercise therapy with 'passive' control in eight trials, which enrolled 971 participants. Seven studies consistently showed a reduction in fatigue following exercise therapy at end of treatment, even though the fatigue scales used different scoring systems: an 11-item scale with a scoring system of 0 to 11 points (MD -6.06, 95% CI -6.95 to -5.17; one study, 148 participants; low-quality evidence); the same 11-item scale with a scoring system of 0 to 33 points (MD -2.82, 95% CI -4.07 to -1.57; three studies, 540 participants; moderate-quality evidence); and a 14-item scale with a scoring system of 0 to 42 points (MD -6.80, 95% CI -10.31 to -3.28; three studies, 152 participants; moderate-quality evidence). Serious adverse reactions were rare in both groups (RR 0.99, 95% CI 0.14 to 6.97; one study, 319 participants; moderate-quality evidence), but sparse data made it impossible for review authors to draw conclusions. Study authors reported a positive effect of exercise therapy at end of treatment with respect to sleep (MD -1.49, 95% CI -2.95 to -0.02; two studies, 323 participants), physical functioning (MD 13.10, 95% CI 1.98 to 24.22; five studies, 725 participants) and self-perceived changes in overall health (RR 1.83, 95% CI 1.39 to 2.40; four studies, 489 participants). It was not possible for review authors to draw conclusions regarding the remaining outcomes.Investigators compared exercise therapy with CBT in two trials (351 participants). One trial (298 participants) reported little or no difference in fatigue at end of treatment between the two groups using an 11-item scale with a scoring system of 0 to 33 points (MD 0.20, 95% CI -1.49 to 1.89). Both studies measured differences in fatigue at follow-up, but neither found differences between the two groups using an 11-item fatigue scale with a scoring system of 0 to 33 points (MD 0.30, 95% CI -1.45 to 2.05) and a nine-item Fatigue Severity Scale with a scoring system of 1 to 7 points (MD 0.40, 95% CI -0.34 to 1.14). Serious adverse reactions were rare in both groups (RR 0.67, 95% CI 0.11 to 3.96). We observed little or no difference in physical functioning, depression, anxiety and sleep, and we were not able to draw any conclusions with regard to pain, self-perceived changes in overall health, use of health service resources and drop-out rate.With regard to other comparisons, one study (320 participants) suggested a general benefit of exercise over adaptive pacing, and another study (183 participants) a benefit of exercise over supportive listening. The available evidence was too sparse to draw conclusions about the effect of pharmaceutical interventions.

    AUTHORS' CONCLUSIONS:
    Patients with CFS may generally benefit and feel less fatigued following exercise therapy, and no evidence suggests that exercise therapy may worsen outcomes. A positive effect with respect to sleep, physical function and self-perceived general health has been observed, but no conclusions for the outcomes of pain, quality of life, anxiety, depression, drop-out rate and health service resources were possible. The effectiveness of exercise therapy seems greater than that of pacing but similar to that of CBT. Randomised trials with low risk of bias are needed to investigate the type, duration and intensity of the most beneficial exercise intervention.

    PMID: 27995604
    DOI: 10.1002/14651858.CD003200.pub6

    https://www.ncbi.nlm.nih.gov/pubmed/27995604
    http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003200.pub6/abstract
     
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  2. TigerLilea

    TigerLilea Senior Member

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    The usual load of crap! :bang-head:
     
  3. hixxy

    hixxy Senior Member

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    Yeah I only read the conclusion. That was enough to give me nausea for the rest of the day.
     
  4. Esther12

    Esther12 Senior Member

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  5. RogerBlack

    RogerBlack Senior Member

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    My impression, from glancing at trial protocols - only a couple - is that this tends to be very, very poorly measured.
    Neglecting self-reporting issues, have any of these studies done any serious followup on the people who have dropped out?
    If, for example, people stop coming in, do more trials than I think endeavour to actually contact them at multiple points if they don't get a response initially, for example?
     
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  6. AndyPR

    AndyPR Senior Member

    Also, five of the eight studies included used Oxford criteria so they can be discounted.
     
  7. alex3619

    alex3619 Senior Member

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    They have nominated themselves as being incapable of understanding flaws in scientific methodology or not bothering to investigate those. GIGO is very much a worry in these reviews. I would say BIBO but I am undecided if this qualifies as babble, though some of the studies they used do. The key points are the non-existence of objective outcome measures and a serious lack of awareness of the exercise physiology research in ME and CFS, and indeed they deny it exists.
     
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  8. HowToEscape?

    HowToEscape? Senior Member

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    Yep. Start by including mild depression as the effective criteria for the test cohort, and -surprise!- methods that work for mild depression work on that test cohort. Aaaand, while I've got too few minutes of cognitive function to waste on reading their babb.. err, 'science', I have a strong feeling there were fewer than 15% of severe cases included.
     
  9. Cinders66

    Cinders66 Senior Member

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    they forgot the rest of the heading ... is pretty useless and a laughable concept when energy production and feeling ill after exercise are key issues in ME.
     
  10. liverock

    liverock Senior Member

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    This is the only approved exercise therapy for our problem.

    Exercise for People with Fibro and CFS

    Begin by standing on a comfortable surface, where you have plenty of room at each side. With a 5-lb potato sack in each hand, extend your arms straight out from your sides and hold them there as long as you can. Try to reach a full minute, and then relax. Each day youll find that you can hold this position for just a bit longer.

    After a couple of weeks, move up to 10-lb potato sacks. Then try 50-lb potato sacks and then eventually try to get to where you can lift a 100-lb potato sack in each hand and hold your arms straight for more than a full minute. (Im at this level.)

    After you feel confident at that level, put a potato in each of the sacks.:lol:
     
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  11. slysaint

    slysaint Senior Member

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    oh no they're not.........sorry, still in panto mode
     
    AndyPR, Mel9, Chrisb and 1 other person like this.

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