nach oben

International Journal of Behavioral Medicine

Erschienen in:

01.04.2015

Effects of a Self-regulation Based Physical Activity Program (The “4-STEPS”) for Unexplained Chronic Fatigue: a Randomized Controlled Trial

verfasst von: M. Marques, V. De Gucht, I. Leal, S. Maes

Erschienen in: International Journal of Behavioral Medicine | Ausgabe 2/2015

Einloggen, um Zugang zu erhalten

Abstract

Background

This study aimed at assessing the effects of a self-regulation-based brief physical activity program for patients suffering from unexplained chronic fatigue, the “4-STEPS to control your fatigue program”.

Method

A 12-week randomized controlled trial was conducted. Adult patients meeting the CDC criteria for idiopathic chronic fatigue were randomized to either the control condition (standard care) or the intervention condition (4-STEPS). The 4-STEPS was based on self-regulation principles and consisted of motivational interviewing and self-regulation skills training. All patients were assessed at baseline and post-treatment (12 weeks) for fatigue severity (primary outcome) and impact, physical activity (leisure time physical activity, number of daily steps and personal activity goal progress), health-related quality of life, somatic distress and psychological distress (depression and anxiety).

Results

Ninety-one patients (45 intervention and 46 control patients) received the allocated intervention. At post-treatment, statistical analysis revealed a significant difference for subjective experience of fatigue (4.73 points; g = 0.51) in favour of the intervention group. Mixed design ANCOVAs showed a significant effect of the 4-STEPS on fatigue severity, leisure time physical activity, personal activity goal progress and health-related quality of life. No significant effects were found for number of daily steps and somatic and psychological distress.

Conclusion

The 4-STEPS program has significant beneficial effects at post-treatment. This brief self-regulation-based intervention looks promising for the management of unexplained chronic fatigue.

Trial Registration: ISRCTN70763996

Fukuda K, Strauss S, Hickie I, Sharpe M, Dobbins J, Komaroff A. The chronic fatigue syndrome: a comprehensive approach to its definition and study. Ann Intern Med. 1994;121:953–9.CrossRefPubMed

Afari N, Buchwald D. Chronic fatigue syndrome: a review. Am J Psychiatry. 2003;160:221–36. doi:10.1176/appi.ajp.160.2.221.CrossRefPubMed

Prins JB, Vand der Meer JWM, Bleijenberg G. Chronic fatigue syndrome. Lancet. 2006;367:346–55.CrossRefPubMed

Clark L, White P. The role of deconditioning and therapeutic exercise in chronic fatigue syndrome (CFS). J Ment Health. 2005;14(3):237–52. doi:10.1080/09638230500136308.CrossRef

Fulcher K, White P. Strength and physiological response to exercise in patients with chronic fatigue syndrome. J Neurol Neurosurg Psychiatry. 2000;69:302–7. doi:10.1136/jnnp.69.3.302.CrossRefPubMedCentralPubMed

Nijs J, Wallman K, Paul L. Chronic fatigue syndrome. In: Saxton JM, editor. Exercise and chronic disease: an evidence-based approach. New York: Routledge; 2011. p. 322–38.

National Institute for Health and Clinical Excellence (NICE). Clinical guideline 53. Chronic fatigue syndrome/myalgic encephalomyelitis or encephalopathy: diagnosis and management of CFS/ME in adults and children. London; 2007.

Edmonds L, McGuire L, Price J. Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev. 2004;3, CD003200.PubMed

Price J, Mitchell E, Tidy E, Hunot V. Cognitive behaviour therapy for chronic fatigue syndrome in adults. Cochrane Database Syst Rev. 2008;3, CD001027.PubMed

10.

Castell BD, Kazantsis N, Moss-Morris R. Cognitive behavioral therapy and graded exercise for chronic fatigue syndrome: a meta-analysis. Clin Psychol Sci Pract. 2011;18(4):311–24. doi:10.1111/j.1468-2850.2011.01262.x.CrossRef

11.

Malouff JM, Thorsteinsson EB, Rooke SE, Bhullar N, Schutte NS. Efficacy of cognitive behavioral therapy for chronic fatigue syndrome: a meta-analysis. Clin Psychol Rev. 2008;28(5):736–45. doi:10.1016/j.cpr.2007.10.004.CrossRefPubMed

12.

Knoop H, Van der Meer J, Bleijenberg G. Guided self-instructions for people with chronic fatigue syndrome: a randomised controlled trial. Br J Psychiatry. 2008;190:340–1. doi:10.1192/bjp.bp.108.051292.CrossRef

13.

Tummers M, Knoop H, van Dam A, Bleijenberg G. Implementing a minimal intervention for chronic fatigue syndrome in a mental health centre: a randomized controlled trial. Psychol Med. 2012;42(10):2205–15. doi:10.1017/S0033291712000232.CrossRefPubMed

14.

Powell P, Bentall R, Nye F, Edwards R. Randomised controlled trial of patient education to encourage graded exercise in chronic fatigue syndrome. BMJ. 2001;322:387. doi:10.1136/bmj.322.7283.387.CrossRefPubMedCentralPubMed

15.

Carver CS, Scheier MF. On the self-regulation of behavior. New York: University Press; 1998.CrossRef

16.

Maes S, Karoly P. Self-regulation assessment and intervention in physical health and illness: a review. Appl Psychol: Int Rev. 2005;54(29):267–99. doi:10.1111/j.1464-0597.2005.00210.x.CrossRef

17.

Michie S, Abraham C, Whittington C, McAteer J, Gupta S. Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychol. 2009;28(6):690–701. doi:10.1037/a0016136.CrossRefPubMed

18.

Sniehotta FF, Scholz U, Schwarzer R. Bridging the intention–behaviour gap: planning, self-efficacy, and action control in the adoption and maintenance of physical exercise. Psychol Health. 2005;20(2):143–60. doi:10.1080/08870440512331317670.CrossRef

19.

Janssen V, Gucht V, Exel H, Maes S. A self-regulation lifestyle program for post-cardiac rehabilitation patients has long-term effects on exercise adherence. J Behav Med. 2013:1–14. doi:10.1007/s10865-012-9489-y.

20.

Knittle K, Gucht V, Hurkmans E, et al. Targeting motivation and self-regulation to increase physical activity among patients with rheumatoid arthritis: a randomised controlled trial. Clinic Rheumat. 2013:1–8. doi:10.1007/s10067-013-2425-x.

21.

Miller W, Rolnick S. Motivational interviewing: helping people change. 3rd ed. NY: The Guiford Press; 2012.

22.

Lundhal BW, Kunz C, Brownell C, Tollefson D, Burke BL. A meta-analysis of motivational interviewing: tewnty-five years of empirical studies. Res Social Work Pract. 2010;20(2):137–60. doi:10.1177/1049731509347850.CrossRef

23.

Marques M, De Gucht V, Maes S, Leal I. Protocol for the “Four steps to control your fatigue (4-STEPS)” randomised controlled trial: a self-regulation based physical activity intervention for patients with unexplained chronic fatigue. BMC Public Health. 2012;12(202). doi:10.1186/1471-2458-12-202

24.

American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription. 8th ed. Baltimore: Lippincott Williams & Williams; 2009.

25.

Wagner D, Nisenbaum R, Heim C, Jones JF, Unger ER, Reeves WC. Psychometric properties of the CDC symptom inventory for assessment of chronic fatigue syndrome. Popul Health Metrics. 2005;3:8. doi:10.1186/1478-7954-3-8.CrossRef

26.

De Marques M, Gucht V, Gouveia MJ, Cordeiro A, Maes S. Psychometric properties of the Portuguese version of the Checklist of Individual Strength (CIS20-P). Psychol Commun Health. 2013;22(1):11–8. doi:10.5964/pch.v2i1.57.CrossRef

27.

Vercoulen J, Alberets M, Bleijenberg G. De Checklist Individual Strength (CIS). Gedragstherapie. 1999;32:31–6.

28.

De Vree B, van der Werf S, Prins J, Bazlmans E, Vercoulen J, Servaes P. Meetinstrumenten bij chronische vermoeidheid. Gedragstherapie. 2002;35:157–64.

29.

Cleeland C, Ryan K. Pain assessment: global use of the brief pain inventory. Ann Acad Med Singap. 1994;23:129–38.PubMed

30.

Wendel-Vos G, Schuit A, Saris W, Kromhout D. Reproducibility and relative validity of the short questionnaire to assess health-enhancing physical activity. J Clin Epidemiol. 2003;56:1163–9. doi:10.1016/S0895-4356(03)00220-8.CrossRefPubMed

31.

Ainsworth B, Haskell W, Whitt M, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000;32 Suppl 9:498–504.CrossRef

32.

Ainsworth B, Haskell W, Herrmann S, et al. Compendium of Physical Activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011;43(8):1575–81. doi:10.1249/MSS.0b013e31821ece12.CrossRefPubMed

33.

Welk GJ, Differding JA, Thompson RW, Blair SN, Dziura J, Hart P. The utility of the Digi-walker step counter to assess daily physical activity patterns. Med Sci Sports Exerc. 2000;32(9 Suppl):S481–8.CrossRefPubMed

34.

Le Masurier GC, Tudor-Locke C. Comparison of pedometer and accelerometer accuracy under controlled conditions. Med Sci Sports Exerc. 2003;35(5):867–71. doi:10.1249/01.MSS.0000064996.63632.10.CrossRefPubMed

35.

Maes S, Karoly P, De Gucht V, Ruehlman LS, Heiser W: The self-regulation skills battery (SRSB). Leiden(NL)/Phoenix (AZ): Leiden University & Arizona State University; 2006.

36.

Ware JE, Kosinski M, Turner-Bowker DM, Gandek B. How to score version 2 of the SF-12® Health Survey. Lincoln: Quality Metric Incorporated; 2002.

37.

Kroenke K, Spitzer R, Williams J. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med. 2002;64:258–66.CrossRefPubMed

38.

Degoratis L. Brief Symptom Inventory: administration, scoring and procedures manual. 4th ed. Minneapolis: National Computer System; 1993.

39.

Faul F, Erdfelder E, Lang A, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioural and biomedical sciences. Behav Res Methods. 2007;39:175–91. doi:10.3758/BF03193146.CrossRefPubMed

40.

Stulemeijer M, de Jong L, Fiselier T, Hoogveld S, Bleijenberg G. Cognitive behaviour therapy for adolescents with chronic fatigue syndrome: randomised controlled trial. BMJ. 2005;330(7495):820. doi:10.1136/bmj.38301.587106.63.

41.

Hedges LV. Distribution Theory for glass’s estimator of effect size and related estimators. J Educ Behav Stat. 1981;6(2):107–28.CrossRef

42.

White PD, Goldsmith KA, Johnson AL, et al. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet. 2011;377(9768):823–36. doi:10.1016/S0140-6736(11)60096-2.CrossRefPubMedCentralPubMed

43.

Vos-Vromans DC, Smeets RJ, Rijnders LJ, et al. Cognitive behavioural therapy versus multidisciplinary rehabilitation treatment for patients with chronic fatigue syndrome: study protocol for a randomised controlled trial (FatiGo). Trials. 2012;13(1):71. doi:10.1186/1745-6215-13-71.CrossRefPubMedCentralPubMed

44.

Tudor-Locke C, Craig CL, Aoyagi Y, et al. How many steps/day are enough? For older adults and special populations. Int J Behav Nutr Phys Act. 2011;8(1):80. doi:10.1186/1479-5868-8-80.CrossRefPubMedCentralPubMed

45.

Wallman K, Morton A, Goodman C, Grove R, Guilfoyle A. Randomised controlled trial of graded exercise in chronic fatigue syndrome. Med J Aust. 2004;180(9):444–8.PubMed

46.

Moss-Morris R, Sharon C, Tobin R, Baldi J. A randomized controlled graded exercise trail for chronic fatigue syndrome: outcomes and mechanisms of change. J Health Psychol. 2005;10(2):245–59. doi:10.1177/1359105305049774.CrossRefPubMed

47.

Nijs J, Paul L, Wallman K. Chronic fatigue syndrome: an approach combining self-management with graded exercise to avoid exacerbations. J Rehabil Med. 2008;40:241–7. doi:10.2340/16501977-0185.CrossRefPubMed

48.

De Gucht V, Maes S. Explaining medically unexplained symptoms: toward a multidimensional theory-based approach to somatisation. J Psychosom Res. 2006;60:349–52. doi:10.1016/j.jpsychores.2006.01.021.CrossRefPubMed

49.

Schulz K, Altman D, Moher D, and the CONSORT Group. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med. 2010;8(1):18. doi:10.1136/bmj.c332.CrossRefPubMedCentralPubMed

Titel: Effects of a Self-regulation Based Physical Activity Program (The “4-STEPS”) for Unexplained Chronic Fatigue: a Randomized Controlled Trial
verfasst von: M. Marques
V. De Gucht
I. Leal
S. Maes
Publikationsdatum: 01.04.2015
Verlag: Springer US
Erschienen in: International Journal of Behavioral Medicine / Ausgabe 2/2015
Print ISSN: 1070-5503
Elektronische ISSN: 1532-7558
DOI: https://doi.org/10.1007/s12529-014-9432-4

Springer Medizin

Abstract

Background

Method

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 2/2015

Facilitating Participation in Health-Enhancing Physical Activity: A Qualitative Study of parkrun

Type A Behavior Pattern is not a Predictor of Premature Mortality

The Changeability and Predictive Value of Dysfunctional Cognitions in Cognitive Behavior Therapy for Chronic Tinnitus

The Relevance of Accuracy of Heartbeat Perception in Noncardiac and Cardiac Chest Pain

Do Depressive Symptoms Mediate the Relationship Between Hopelessness and Diurnal Cortisol Rhythm?

The Social Environment and Illness Uncertainty in Chronic Obstructive Pulmonary Disease