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Cochrane Review: Exercise as treatment for patients with chronic fatigue syndrome, April 2017

I've searched but I can't spot this on the forum already.

I refuse to put this in the Research forum for, I think, obvious reasons.
What questions does this review aim to answer?

• Is exercise therapy more effective than ‘passive’ treatments (e.g. waiting list, treatment as usual, relaxation, flexibility)?

• Is exercise therapy more effective than other ‘active’ therapies (e.g. cognitive-behavioural therapy (CBT), pacing, medication)?

• Is exercise therapy more effective when combined with another treatment than when given alone?

• Is exercise therapy safer than other treatments?

Which studies were included in the review?

We searched databases to find all high-quality studies of exercise therapy for CFS published up to May 2014. To be included in the review, studies had to be randomised controlled trials and include adults over 18 years of age, more than 90% of whom had a clear diagnosis of CFS. We included eight studies with a total of 1518 participants in the review. Seven studies used aerobic exercise therapy such as walking, swimming, cycling or dancing; the remaining study used non-aerobic exercise. Most studies asked participants to exercise at home, between three and five times per week, with a target duration of 5 to 15 minutes per session using different means of incrementation.

What does evidence from the review tell us?

Moderate-quality evidence showed exercise therapy was more effective at reducing fatigue compared to ‘passive’ treatment or no treatment. Exercise therapy had a positive effect on people’s daily physical functioning, sleep and self-ratings of overall health.

One study suggests that exercise therapy was more effective than pacing strategies for reducing fatigue. However exercise therapy was no more effective than CBT.

Exercise therapy did not worsen symptoms for people with CFS. Serious side effects were rare in all groups, but limited information makes it difficult to draw firm conclusions about the safety of exercise therapy.

Evidence was not sufficient to show effects of exercise therapy on pain, use of other healthcare services, or to allow assessment of rates of drop-out from exercise therapy programmes.

What should happen next?

Researchers suggest that further studies should be carried out to discover what type of exercise is most beneficial for people affected by CFS, which intensity is best, the optimal length, as well as the most beneficial delivery method.

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.

Also note
http://www.cochrane.org/CD003200/DEPRESSN_exercise-treatment-patients-chronic-fatigue-syndrome
Even the URL they use points to the fact that they believe it falls into the realm of depression.
 

Tom Kindlon

Senior Member
Messages
1,734

Attachments

  • Larun_et_al-2017-The_Cochrane_Library.pdf
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Last edited:

Manganus

Senior Member
Messages
166
Location
Canary islands
If one reads the full version at that link, one will find detailed critical comments by Robert Courtney and me.
I tried, but didn't find. o_O

The last sentence on my screen reads:
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.
After that follows a handful of links.

 

Manganus

Senior Member
Messages
166
Location
Canary islands
Okay, I have uploaded the file here
Well written! :star::bouquet::star:

I think it was particularly clever to start with the PACE Trial where there was no improvement in fitness levels as measured
by a step test, contrasting with the many positive results from subjective self-report measures in the trial.

Also your ending was clever! :)

Edit:
I discover that I only read the first part of your two original commentaries.
 

dangermouse

Senior Member
Messages
430
I don't normally use bad language but I'm so fed up of this ridiculous nonsense keeping popping up that I really REALLY want to!

It stinks.

It irks me that people will read this stuff and (if they don't know better) believe it.

I am one of many patients that have been harmed by this kind of psych-nonsense. How many more must suffer before it is stopped?

I know that a small group of people depend on this work for their jobs and credibility, but they've had their run now, it's time to move on and leave this battered group of patients alone.

I'd rather have no treatment than bad treatment whilst I wait for genuine research done by talented, compassionate scientists to develop treatment that actually works.

:bang-head:
 

Sean

Senior Member
Messages
7,378
I know that a small group of people depend on this work for their jobs and credibility, but they've had their run now, it's time to move on and leave this battered group of patients alone.
It was time 20 years ago, and that is being generous.

I'd rather have no treatment than bad treatment whilst I wait for genuine research
Me too.