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Chronic Fatigue: 'No need to fear exercise'
By Peter Russell
WebMD UK Health News
Medically Reviewed by Dr Rob Hicks
14th January 2015 – People who have Chronic Fatigue Syndrome (CFS) should be encouraged to see exercise as a way of easing their symptoms of exhaustion rather than fearing that activity will make them feel worse, say researchers.
CFS, which is also known as myalgic encephalomyelitis (ME), is a condition in which the patient feels exhaustion that does not go away with rest or sleep. It is thought to affect around 250,000 people in the UK.
Anyone can get CFS, although it is more common in women than in men. It usually develops in the early 20s to mid-40s. Children can also be affected, usually between the ages of 13 and 15.
Slideshow: A visual guide to chronic fatigue syndrome
Controversial condition
The condition has been the subject of past controversy when some doctors doubted that the condition existed. It is now generally accepted that CFS/ME is real.
However, the role that physical activity should play in the lives of people with CFS has continued to be fiercely debated with many patients maintaining that exercise could actually make them more exhausted.
The PACE trial
A study in The Lancet in 2011 involving 641 patients – called the PACE trial – found that a gradually increasing exercise programme delivered by a physiotherapist and cognitive behavioural therapy (CBT) were the most effective treatments for the condition.
However, the researchers acknowledged that patients' organisations believed these treatments could be harmful and favoured specialist health care together with a 'pacing' approach in which patients set their activity levels according to how much energy they had.
For the latest study, published in The Lancet Psychiatry, researchers led by Professor Trudie Chalder from Kings College London analysed why graded exercise therapy (GET) and CBT were beneficial for patients.
In a statement, Professor Chalder says: "Although the PACE trial results suggest that CBT and GET offer safe and effective treatment options for a majority of CFS patients, the improvements seen in the trial were moderate. By identifying the mechanisms whereby some patients benefit from treatment, we hope that this will allow treatments to be developed, improved, or optimised."
Overcoming fear
The researchers found that the single most important factor in improving results was reducing fear of exercising among patients with CFS, accounting for up to 60% of the overall effect of CBT and GET on reducing symptoms.
Professor Chalder says: "Our results suggest that fearful beliefs can be changed by directly challenging such beliefs (as in CBT) or by simple behaviour change with a graded approach to the avoided activity (as in GET).
"Clinically, the results suggest that therapists delivering CBT could encourage more physical activities such as walking, which might enhance the effect of CBT and could be more acceptable to patients."
Reaction
Action for ME said the improvements to patients' symptoms in the trial were moderate and that one-size-fits-all treatment approaches for CFS do not work.
Sonya Chowdhury, the charity's CEO, says in a statement: "The significance of the term 'fear avoidance' is paramount. This does not mean that ME or CFS is a psychological illness. Nor do we believe that people with ME are afraid of taking part in appropriate activity or exercise – appropriate activity might involve a short walk or, for someone with severe ME, small movements or even sitting up in bed.
"In this context, fear avoidance is a well-documented factor that can affect the experience of any chronic pain condition, regardless of pathology."
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Reviewed on January 14, 2015
Gently motivating those with chronic fatigue ease symptoms
January 14, 2015
For those who have chronic fatigue syndrome (CFS), the thought of exercise can be daunting. But researchers have found that by gently reminding them to exercise boosts their confidence to do so, thus easing their symptoms.
The study was done through an analysis of how cognitive behavior therapy (CBT) and graded exercise therapy (GET) help reduce fatigue and improve physical function in people with CFS.
“You’re not going to ask somebody who hasn’t been going out or engaging in any exercise for several years to suddenly get on their bike — you would want to do these things very gradually and carefully,” Trudie Chalder of King’s College London’s Institute of Psychiatry told a briefing.
“(But) our results suggest that fearful beliefs can be changed by directly challenging such beliefs, or by simple behavior change with a graded approach.”
CFS, sometimes called myalgic encephalomyelitis or ME, is a debilitating condition characterized by disabling physical and mental fatigue, poor concentration and memory, disturbed sleep and muscle and joint pain.
There is no cure and scientists don’t know what causes it, but it affects around 17 million people worldwide.
Key to warding off chronic fatigue syndrome identified
IANS | London
January 14, 2015 Last Updated at 15:06 IST
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Reducing fears that exercise or activity would make symptoms worse is the key to treating people with chronic fatigue syndrome (CFS), says a study.
CFS is a condition whose defining symptom is exhaustion. It affects everyday life with varying degrees of severity.
Existing treatments for CFS aim to reduce fatigue (exhaustion) and improve physical function by improving a patient's ability to walk, or to do everyday tasks which most people take for granted.
"Our results suggest that fearful beliefs can be changed by directly challenging such beliefs or by simple behaviour change with a graded approach to the avoided activity," said professor Trudie Chalder from Kings College London in Britain.
Fears that exercise or activity will make symptoms worse is an understandable reaction to CFS.
For the study, the researchers used a statistical method called mediation analysis to identify the factors, which are key to treating CFS.
Of all the mediating factors analysed, the researchers found that a reduction in fear avoidance beliefs was the strongest, accounting for up to 60 percent of the overall effect of two existing CFS therapies -- cognitive behaviour therapy (CBT) and graded exercise therapy (GET) -- on outcomes.
The findings could lead to new or improved therapies for CFS.
The study appeared in the journal The Lancet Psychiatry.
Exercise can help with ME, scientists say
Continue reading the main story
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Gentle, graded exercise can alleviate the symptoms of some people with myalgic encephalomyelitis (ME), also known as chronic fatigue syndrome, scientists have stressed.
People with ME sometimes fear physical activity can worsen their symptoms.
Reporting in the Lancet Psychiatry journal, scientists investigated how such concerns influenced the success of exercise therapies.
Charities stress there is no one-size-fits-all treatment.
Gradual exercise
About a quarter of a million people have ME in the UK, but there has been much debate about the most appropriate treatments. And the cause of the condition remains unknown.
Symptoms include:
Treatments offered on the NHS include:
- severe tiredness
- poor concentration
- disturbed sleep
- muscle and joint pain
But for many years people focused on adaptive pacing therapy - planning activity carefully to avoid fatigue.
- cognitive behavioural therapy - changing how people think and act
- graded exercise therapy - gradually increasing the amount of exercise a person does
A team of British researchers found behavioural and exercise therapies were better at reducing fatigue and disability than adaptive pacing strategies.
And a separate analysis by scientists from London and Oxford suggests these treatments work by helping people overcome fearful thoughts and behaviours - such as avoiding exercise in the belief it could make things worse.
Researchers say both beliefs and behaviours play a part in perpetuating fatigue and disability.
Short walk
Sonya Chowdhury, from the charity Action for ME, said this did not mean it was a psychological illness.
"Nor do we believe that people with ME are afraid of taking part in appropriate activity or exercise - appropriate activity might involve a short walk or for someone with severe ME, small movements or even sitting up in bed.
"Fear avoidance is a well-documented factor that can affect the experience of any chronic pain condition, regardless of pathology."
She pointed out that people with the most severe form of the disease, who are bed-bound, had not been included in this research.
Experts advise gradual increases in activity such as walking, working towards the more general recommendation of 30 minutes of physical exercise, five days a week.
They say it is important exercise therapy is carried out by trained staff and that both extreme activity and excessive rest are avoided.
Dr Neil Abbot said:
They pretend it's just Delayed-Onset Muscle Soreness - that thing where muscles ache a bit after exercising them. And they put their fingers in their ears any time someone mentions the 2-day CPET
