Biokinetics and Chronic Fatigue Syndrome

Cochrane review on exercise as a treatment for Chronic Fatigue Syndrome

What is a Cochrane review?

Cochrane reviews are systematic reviews of primary research in human health care and health policy. Cochrane reviews are internationally recognized as the highest standard in evidence-based health care. They investigate the effects of interventions for prevention, treatment and rehabilitation. They also assess the accuracy of diagnostic tests for some conditions in a specific patient group and setting. Cochrane reviews are published online in the Cochrane Library (LINK).

Chronic fatigue syndrome: Chronic fatigue syndrome (CFS) is sometimes called myalgic encephalomyelitis (ME).

Prevalence: Research estimates that between 2 in 1000 and 2 in 100 adults in the USA are affected by CFS.

Symptoms: People with CFS often have long-lasting fatigue, joint pain, headaches, sleep problems, and poor concentration and short-term memory. These symptoms cause significant disability and distress for people affected by CFS.

Cause: There is no clear medical cause for CFS, so people who are affected often deal with misunderstanding of their condition from family, friends and healthcare professionals.

Exercise: National Institute for Health and Care Excellence (NICE) (LINK) guidelines recommend exercise therapy for individuals with CFS, and a previous review of the evidence suggested that exercise therapy was a promising approach to the treatment. It is thought that exercise therapy can help management of CFS symptoms by helping people gradually reintroduce physical activity into their daily lives.

Cochrane review version 1.0 (2004): The Cochrane review from 2004 showed that exercise therapy was a promising treatment for adults with CFS. Since the 2004 review, additional studies investigating the effectiveness and safety of exercise therapy for patients with CFS have been published.

Cochrane review version 2.0 (2014): The most recent Cochrane review on exercise as treatment for chronic fatigue syndrome was published in 2014, and is an update of the 2004 review.

What questions does the 2014 review aim to answer?

  • Is exercise therapy more effective than ‘passive’ treatments (e.g. waiting list, treatment as usual, relaxation, flexibility)?
  • Is exercise therapy more effective than other ‘active’ therapies (e.g. cognitive-behavioural therapy (CBT), pacing, medication)?
  • Is exercise therapy more effective when combined with another treatment than when given alone?
  • Is exercise therapy safer than other treatments?

Which studies were included in the review?

The Cochrane Library searched databases to find all high-quality studies of exercise therapy for CFS published up to May 2014.

Subjects: To be included in the review, studies had to be randomised controlled trials and include adults over 18 years of age, more than 90% of whom had a clear diagnosis of CFS.

Type of exercise: The Cochrane review included eight studies with a total of 1518 participants in the review. 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.

Further research needed: Researchers suggest that further studies should be carried out to discover what type of exercise is most beneficial for people affected by CFS, which intensity is best, the optimal length, as well as the most beneficial delivery method.

Evidence available was not sufficient to:

  • Show effects of exercise therapy on pain.
  • Show use of other healthcare services.
  • To allow assessment of rates of drop-out from exercise therapy programmes.

Summary:

1) Is exercise therapy more effective than ‘passive’ treatments (e.g. waiting list, treatment as usual, relaxation, flexibility)?

  • 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.

2) Is exercise therapy more effective than other ‘active’ therapies (e.g. cognitive-behavioural therapy (CBT), pacing, medication)?

  • One study suggests that exercise therapy was more effective than pacing strategies for reducing fatigue.
  • However exercise therapy was no more effective than CBT.

3) Is exercise therapy safer than other treatments?

  • Exercise therapy did not worsen symptoms for people with CFS.
  • Serious side effects were rare in all groups, but limited information makes it difficult to draw firm conclusions about the safety of exercise therapy.

Recommendations from the data available: FITT

F) Frequency of exercise: 3 to 5 days per week.
I) Intensity of exercise: Light activity
T) Type of exercise: Home based aerobic (cardio) and anaerobic (resistance training)
T) Time / duration of exercise: 5 to 15 minutes per session

Is Biokinetics for me?

Ask your Physician or GP if they feel that you may benefit from seeing an exercise specialist like a Biokineticist. Otherwise contact your local Biokineticist directly to discuss your case history. If you are not a suitable candidate the Biokineticist will refer you back to your Specialist for more information / treatment. A Biokineticist can see you for regular sessions (land based exercise / water based) or write you a structured exercise routine for homework.

Acknowledgements:

1) Cochrane Library (LINK)
2) Cochrane review on exercise as a treatment for Chronic Fatigue Syndrome (LINK)
Image: Cochrane Library – Our Logo (LINK)