THURSDAY, Feb. 17 (HealthDay News) -- Patients struggling with
chronic fatigue syndrome may be helped the most when standard
treatment is coupled with cognitive behavior therapy or exercise
therapy, new British research suggests.
The apparent promise of cognitive behavior therapy and "graded
exercise therapy" offers considerable hope to patients combating
the complex condition characterized by profound tiredness, impaired
concentration, diminished memory, sleep difficulties and muscle and
joint pain, the study authors said.
The findings also support the somewhat controversial notion that
incremental adjustments in physical behavior and/or mental attitude
can ultimately have a positive impact on the disorder, the authors
The standard intervention, known as specialist medical care, is
centered around giving patients information about their condition,
advice on how to manage symptoms and assistance with coping
The research team behind the new study found little appreciable
benefit with a third alternate therapeutic approach that focuses on
helping patients strictly structure their activity and relaxation
routines to match their severely reduced energy levels. This
strategy, known as "adaptive pacing therapy," assumes that chronic
fatigue syndrome is not, in fact, reversible with behavioral
"Patients who received either graded exercise therapy or cognitive behavior therapy reported less fatigue and better function than those who received either adaptive pacing therapy or specialist medical care alone," said study author Dr. Peter D. White, a professor of psychological medicine at Barts and the London School of Medicine, and a psychiatrist at St Bartholomew's Hospital in London.
White and his colleagues report their findings in the Feb. 18
online edition of
The authors noted that it is not yet understood what gives rise
to chronic fatigue syndrome (CFS).
The cognitive behavioral therapy targets the building fear and
avoidance of activity that can exacerbate CFS. In effect, it seeks
to break a vicious cycle in which mental inhibitions actually
perpetuate and aggravate the underlying chronic fatigue.
Exercise therapy, also known as "GET," tries to reduce fatigue
and disability by gradually helping patients increase their
activity levels to improve their overall physical fitness.
To explore which therapies or combinations of therapies might be
best, 641 chronic fatigue patients from four different
rehabilitation centers in Britain were divided up into one of four
groups. Over the course of a year, all got standard specialist
medical care, while three of the groups received one additional
treatment: pacing therapy, cognitive therapy or exercise
White and his team found the greatest improvements in terms of
both fatigue levels and physical function were experienced by those
patients who were treated with standard therapy in combination with
either cognitive therapy or exercise therapy.
What's more, patients who got a combination of standard
treatment and pacing therapy fared no better than those who got
standard treatment alone.
Specifically, 60 percent of the standard/cognitive or
standard/GET patients experienced fatigue and function
improvements, while 30 percent reported "normal levels" of fatigue
and function. Half as many of the standard therapy alone or
standard/pacing patients reported normal fatigue and function
White noted that all the treatments were equally safe, and
serious reactions were rare.
"Patients now have a choice of two moderately effective and safe treatments that can help them towards a healthier life," he said.
Dr. Nancy Klimas, chief medical officer at the Chronic Fatigue
Center at the University of Miami Miller School of Medicine, noted
that the merits of various therapeutic approaches to chronic
fatigue syndrome are still a matter of debate.
"But here Dr. White is saying that cognitive behavioral therapy and graded exercise are moderately helpful, but not curative," she said. "And I would agree with that."
"On the other hand, it's also important to note that when we talk about helping patients increase their activity levels, we're talking about people who have very limited amounts of energy," Klimas added. "And you have to work within this 'energy envelope,' because if you push beyond the threshold they will relapse. So often, what we're talking about is about five minutes of exercise before taking a rest."
"In any case, I look at this as a first step," she said, "and anticipate more effective therapies, based on a better understanding of the biology of the illness, in the future."
For more on chronic fatigue syndrome, visit the
U.S. Centers for
Disease Control and Prevention.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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