Randomised controlled trial of patient education to encourage graded exercise in chronic fatigue syndrome

doi:10.1136/bmj.322.7283.387

BMJ 2001;322:387 ( 17 February )

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Randomised controlled trial of patient education to encourage graded exercise in chronic fatigue syndrome

Pauline Powell, senior clinical therapist, ^a Richard P Bentall, professor of experimental clinical psychology, ^b Fred J Nye, consultant physician, ^a Richard H T Edwards, professor of medicine. ^c

^a Regional Infectious Diseases Unit, University Hospital Aintree, Liverpool L9 7AL, ^b Department of Psychology, Coupland 1 Building, University of Manchester, Manchester M13 9PL, ^c Department of Medicine, University of Liverpool, Liverpool L69 3GA

Correspondence to: R P Bentall bentall{at}psy.man.ac.uk

Objective: To assess the efficacy of an educational interventionexplaining symptoms to encourage graded exercise in patients withchronic fatiguesyndrome.
Design: Randomised controlledtrial.
Setting: Chronic fatigue clinic and infectious diseasesoutpatientclinic.
Subjects: 148 consecutively referred patients fulfillingOxford criteria for chronic fatiguesyndrome.
Interventions: Patients randomised to the control group receivedstandardised medical care. Patients randomised to interventionreceived two individual treatment sessions and two telephone followup calls, supported by a comprehensive educational pack, describingthe role of disrupted physiological regulation in fatigue symptomsand encouraging home based graded exercise. The minimum interventiongroup had no further treatment, but the telephone interventiongroup received an additional seven follow up calls and the maximumintervention group an additional seven face to face sessions overfourmonths.
Main outcome measure: A score of $>=$ 25 or an increase of $>=$ 10 on theSF-36 physical functioning subscale (range 10 to 30) 12 monthsafterrandomisation.
Results: 21 patients dropped out, mainly from the interventiongroups. Intention to treat analysis showed 79 (69%) of patientsin the intervention groups achieved a satisfactory outcome inphysical functioning compared with two (6%) of controls, who receivedstandardised medical care (P<0.0001). Similar improvements wereobserved in fatigue, sleep, disability, and mood. No significantdifferences were found between the three interventiongroups.
Conclusions: Treatment incorporating evidence based physiologicalexplanations for symptoms was effective in encouraging self managedgraded exercise. This resulted in substantial improvement comparedwith standardised medicalcare.

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Rapid Responses:

Read all Rapid Responses

Medical accountability: Gurli Bagnall
bmj.com, 18 Feb 2001 [Full text]
Response to Powell et al: Ellen Goudsmit
bmj.com, 20 Feb 2001 [Full text]
The weakest link: A Chaudhuri
bmj.com, 21 Feb 2001 [Full text]
I Beg To Differ...: Roma Eales
bmj.com, 23 Feb 2001 [Full text]
The Importance of a Therapeutic Partnership with M.E. (CFS) patients: Chris Clark
bmj.com, 23 Feb 2001 [Full text]
Is it time to utilise markers for CFS(ME): Andrew Wright
bmj.com, 25 Feb 2001 [Full text]
Reply to our critics: Richard Bentall
bmj.com, 27 Feb 2001 [Full text]
Results are not consistent with feedback from patients: Charles Shepherd
bmj.com, 28 Feb 2001 [Full text]
Unfair response is most revealing: Sarah David
bmj.com, 28 Feb 2001 [Full text]
Re: Reply to our critics: Gurli Bagnall
bmj.com, 1 Mar 2001 [Full text]
Getting the balance right: P D White
bmj.com, 2 Mar 2001 [Full text]
Which patients did they study?: David Axford
bmj.com, 2 Mar 2001 [Full text]
Changing behaviour requires more than patient education -: Pradeep Jayasuriya
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CBT five-year follow-up: Horace Reid
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Expertise in Exercise: C McKelvey
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