A self-help approach to exercise that is supervised remotely by a specialist physiotherapist may help people with chronic fatigue symptoms (CFS) to manage their condition and feel better, according to a new study published in The Lancet.
The finding comes from a trial of 200 people with CFS who were assigned either guided graded exercise self-help (GES group) in addition to specialist medical care or specialist medical care alone (control group). GES involves patients gradually increasing their level of physical activity, while being offered information and advice by a physiotherapist over the phone or using Skype™.
The self-help approach eliminates the need for patients to physically attend a specialist clinic, as they currently do when prescribed graded exercise therapy. This can be costly and access to clinics offering the therapy is often limited.
Offering the therapy as a self-help approach, supervised by a physiotherapist, could increase access and avoid the fatiguing effects of travel for the intervention.”
Lucy Clark, Lead author, Queen Mary University of London, UK.
Patients in the GES group were handed a booklet detailing a 6-step programme designed to help patients slowly and safely increase their physical activity levels over the course of 12 weeks. During the first 8 weeks, the GES participants also received up to four guidance sessions with a physiotherapist who could discuss their progress and provide advice.
Patients were encouraged to choose an exercise (most chose walking) that they could engage in five days a week, in addition to their everyday daily activities. Once a daily routine was established, the patients started to gradually increase the amount of exercise they were getting by adding no more than 20% to the amount of time spent on the chosen physical activity every week.
According to questionnaires completed at baseline and at 12 weeks, the mean fatigue score among the GES participants was 4 points lower than that amongst controls and the mean physical function score was 6 points higher than amongst controls.
Around one-fifth (18%) of GES participants reported feeling “much better” or “very much better” when rating their overall health, compared with only one in 20 (4%) of those in the control group. No patients reported any adverse side effects as a result of GES.
“We found that a self-help approach to a graded exercise programme, guided by a therapist, was safe and also helped to reduce fatigue for some people with chronic fatigue syndrome, suggesting that GES might be useful as an initial treatment for patients to help manage symptoms of chronic fatigue syndrome. We are now looking at whether the effects were maintained beyond 12 weeks,” says Clark.
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