Exercsie therapy for chronic fatigue syndrome

Chronic fatigue syndrome (CFS) is sometimes called myalgic encephalomyelitis (ME) and people who have this condition typically have persistent, medically unexplained fatigue, as well as symptoms such as musculoskeletal pain, sleep disturbance, headaches and impaired concentration and short-term memory.

It is a common, debilitating and serious health problem but there is no clear medical cause and so people who are affected often deal with misunderstanding of their condition from family, friends and healthcare professionals.

Clinical guidelines such as those of the National Institute for Health and Care Excellence (NICE) guideline recommend physical interventions, such as exercise therapy to help manage symptoms by helping people gradually reintroduce physical activity into their daily lives.

A recently updated Cochrane review sought to determine the effects of exercise therapy for patients with CFS as compared with any other intervention or control.

Here’s what they did

They searched electronic databases – 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. They also located unpublished or ongoing trials through the World Health Organization (WHO) International Clinical Trials Registry Platform (to May 2014) and screened reference lists of retrieved articles and contacted experts in the field for additional studies.

They searched for randomised controlled trials that included adults over 18 years of age, 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. Authors independently performed study selection, risk of bias assessments and data extraction.

Here’s what they found

They included eight studies with a total of 1518 participants, more than 90% of whom had a clear diagnosis of CFS.
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.

At the end of treatment

Fatigue was reduced although different scales were used across the 7 studies. 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).
Sleep was improved (MD -1.49, 95% CI -2.95 to -0.02; two studies, 323 participants),
Physical functioning was improved (MD 13.10, 95% CI 1.98 to 24.22; five studies, 725 participants)
Self-perceived changes in overall health was improved (RR 1.83, 95% CI 1.39 to 2.40; four studies, 489 participants).
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).

The authors concluded

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.

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.

The Musculoskeletal Elf’s view

This well conducted systematic review included eight studies that used different types of exercise as therapy. Seven studies included aerobic exercise therapy such as walking, swimming, cycling or dancing; and one 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.

So what is exercise therapy? Can we define it and most importantly is all exercise therapy equal or are some exercise therapy programmes more effective than others? Have a think about some of the issues below and send us your thoughts on the comments section below (scroll down) and let us know if you have other issues.

What do you think?

What do you think are the key characteristics of exercise therapy?

Type – concentric, eccentric, isometric, isotonic, isokinetic, plyometric, open chain, closed chain, aerobic, non-aerobic
Dose – intensity, repetitions, duration of sessions
Frequency – how often
Progression
Supervision – supervised by whom, self supervised, remote monitoring
Individual or group
Setting – home, community, clinical
Generic or joint specific

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Do you know that there is an evidence-based minimum set of items for reporting in systematic reviews and meta-analyses? This is called the Preferred Reporting Items for Systematic Reviews and Meta-Analyses or PRISMA statement and can be accessed through the website of the EQUATOR Network. The Elves use the PRISMA statement for critical appraisal of systematic reviews, although it is not a quality assessment instrument to gauge the quality of a systematic review.