Is graded exercise better than cognitive behaviour therapy for fatigue? A UK randomized trial in primary care - PubMed (original) (raw)
Clinical Trial
Is graded exercise better than cognitive behaviour therapy for fatigue? A UK randomized trial in primary care
L Ridsdale et al. Psychol Med. 2004 Jan.
Abstract
Background: Patients frequently present with unexplained fatigue in primary care, but there have been few treatment trials in this context. We aimed to test cognitive behaviour therapy (CBT) and graded exercise therapy (GET) for patients presenting to their family doctor with fatigue. Secondly, we described the outcome for a cohort of patients who presented to the same doctors with fatigue, who received standard care, plus a booklet.
Method: This was a randomized trial, followed by a prospective cohort study. Twenty-two practices in SE England referred 144 patients aged 16 to 75 years with over 3 months of unexplained fatigue. Self-rated fatigue score, the hospital anxiety and depression rating scale, functional impairment, physical step-test performance and causal attributions were measured. In the trial six sessions of CBT or GET were randomly allocated.
Results: In the therapy groups the mean fatigue score decreased by 10 points (95% confidence interval (CI) = -25 to -15), with no significant difference between groups (mean difference = -1.3; CI = -3.9 to 1.3). Fewer patients attended for GET. At outcome one-half of patients had clinically important fatigue in both randomized groups, but patients in the group offered CBT were less anxious. Twenty-seven per cent of the patients met criteria for CFS at baseline. Only 25% of this subgroup recovered, compared to 60% of the subgroup that did not meet criteria for CFS.
Conclusions: Short courses of GET were not superior to CBT for patients consulting with fatigue of over 3 months in primary care. CBT was easier 'to sell'. Low recovery in the CFS subgroup suggests that brief treatment is too short.
Similar articles
- Exercise therapy for chronic fatigue syndrome.
Larun L, Brurberg KG, Odgaard-Jensen J, Price JR. Larun L, et al. Cochrane Database Syst Rev. 2016 Dec 20;12(12):CD003200. doi: 10.1002/14651858.CD003200.pub6. Cochrane Database Syst Rev. 2016. PMID: 27995604 Free PMC article. Updated. Review. - Exercise therapy for chronic fatigue syndrome.
Larun L, Brurberg KG, Odgaard-Jensen J, Price JR. Larun L, et al. Cochrane Database Syst Rev. 2015 Feb 10;(2):CD003200. doi: 10.1002/14651858.CD003200.pub3. Cochrane Database Syst Rev. 2015. PMID: 25674924 Updated. Review. - Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial.
White PD, Goldsmith KA, Johnson AL, Potts L, Walwyn R, DeCesare JC, Baber HL, Burgess M, Clark LV, Cox DL, Bavinton J, Angus BJ, Murphy G, Murphy M, O'Dowd H, Wilks D, McCrone P, Chalder T, Sharpe M; PACE trial management group. White PD, et al. Lancet. 2011 Mar 5;377(9768):823-36. doi: 10.1016/S0140-6736(11)60096-2. Epub 2011 Feb 18. Lancet. 2011. PMID: 21334061 Free PMC article. Clinical Trial. - Cognitive behavioural therapy in chronic fatigue syndrome: a randomised controlled trial of an outpatient group programme.
O'Dowd H, Gladwell P, Rogers CA, Hollinghurst S, Gregory A. O'Dowd H, et al. Health Technol Assess. 2006 Oct;10(37):iii-iv, ix-x, 1-121. doi: 10.3310/hta10370. Health Technol Assess. 2006. PMID: 17014748 Clinical Trial. - The effect of counselling, graded exercise and usual care for people with chronic fatigue in primary care: a randomized trial.
Ridsdale L, Hurley M, King M, McCrone P, Donaldson N. Ridsdale L, et al. Psychol Med. 2012 Oct;42(10):2217-24. doi: 10.1017/S0033291712000256. Epub 2012 Feb 28. Psychol Med. 2012. PMID: 22370004 Free PMC article. Clinical Trial.
Cited by
- Cost-effectiveness of Interventions for Chronic Fatigue Syndrome or Myalgic Encephalomyelitis: A Systematic Review of Economic Evaluations.
Cochrane M, Mitchell E, Hollingworth W, Crawley E, Trépel D. Cochrane M, et al. Appl Health Econ Health Policy. 2021 Jul;19(4):473-486. doi: 10.1007/s40258-021-00635-7. Epub 2021 Mar 1. Appl Health Econ Health Policy. 2021. PMID: 33646528 Free PMC article. - Behavioural modification interventions for medically unexplained symptoms in primary care: systematic reviews and economic evaluation.
Leaviss J, Davis S, Ren S, Hamilton J, Scope A, Booth A, Sutton A, Parry G, Buszewicz M, Moss-Morris R, White P. Leaviss J, et al. Health Technol Assess. 2020 Sep;24(46):1-490. doi: 10.3310/hta24460. Health Technol Assess. 2020. PMID: 32975190 Free PMC article. - Exercise therapy for chronic fatigue syndrome.
Larun L, Brurberg KG, Odgaard-Jensen J, Price JR. Larun L, et al. Cochrane Database Syst Rev. 2019 Oct 2;10(10):CD003200. doi: 10.1002/14651858.CD003200.pub8. Cochrane Database Syst Rev. 2019. PMID: 31577366 Free PMC article. Review. - Work Rehabilitation and Medical Retirement for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients. A Review and Appraisal of Diagnostic Strategies.
Vink M, Vink-Niese F. Vink M, et al. Diagnostics (Basel). 2019 Sep 20;9(4):124. doi: 10.3390/diagnostics9040124. Diagnostics (Basel). 2019. PMID: 31547009 Free PMC article. Review. - Cognitive behavioural therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective. Re-analysis of a Cochrane review.
Vink M, Vink-Niese A. Vink M, et al. Health Psychol Open. 2019 May 2;6(1):2055102919840614. doi: 10.1177/2055102919840614. eCollection 2019 Jan-Jun. Health Psychol Open. 2019. PMID: 31080632 Free PMC article. Review.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical
Miscellaneous