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How does cognitive behaviour therapy reduce fatigue in patients with chronic fatigue syndrome? The role of physical activity

Published online by Cambridge University Press:  05 January 2010

J. F. Wiborg ,
H. Knoop ,
M. Stulemeijer ,
J. B. Prins  and
G. Bleijenberg
J. F. Wiborg*
Affiliation:
Expert Centre Chronic Fatigue and Department of Medical Psychology, Radboud University Nijmegen Medical Centre, The Netherlands
H. Knoop
Affiliation:
Expert Centre Chronic Fatigue and Department of Medical Psychology, Radboud University Nijmegen Medical Centre, The Netherlands
M. Stulemeijer
Affiliation:
Expert Centre Chronic Fatigue and Department of Medical Psychology, Radboud University Nijmegen Medical Centre, The Netherlands
J. B. Prins
Affiliation:
Expert Centre Chronic Fatigue and Department of Medical Psychology, Radboud University Nijmegen Medical Centre, The Netherlands
G. Bleijenberg
Affiliation:
Expert Centre Chronic Fatigue and Department of Medical Psychology, Radboud University Nijmegen Medical Centre, The Netherlands
*
*Address for correspondence: J. F. Wiborg, Expert Centre Chronic Fatigue, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, The Netherlands. (Email: j.wiborg@nkcv.umcn.nl)
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Abstract

Background

Cognitive behaviour therapy (CBT) is known to reduce fatigue severity in chronic fatigue syndrome (CFS). How this change in symptomatology is accomplished is not yet understood. The purpose of the present study was to determine whether the effect of CBT on fatigue is mediated by an increase in physical activity.

Method

Three randomized controlled trials were reanalysed, previously conducted to evaluate the efficacy of CBT for CFS. In all samples, actigraphy was used to assess the level of physical activity prior and subsequent to treatment or a control group period. The mediation hypothesis was analysed according to guidelines of Baron & Kenny [Journal of Personality and Social Psychology (1986)51, 1173–1182]. A non-parametric bootstrap approach was used to test statistical significance of the mediation effect.

Results

Although CBT effectively reduced fatigue, it did not change the level of physical activity. Furthermore, changes in physical activity were not related to changes in fatigue. Across the samples, the mean mediation effect of physical activity averaged about 1% of the total treatment effect. This effect did not yield significance in any of the samples.

Conclusions

The effect of CBT on fatigue in CFS is not mediated by a persistent increase in physical activity.

Keywords

Chronic fatigue syndromecognitive behaviour therapymechanisms of changemediation analysisphysical activity
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 8 , August 2010 , pp. 1281 - 1287
Copyright
Copyright © Cambridge University Press 2010

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References

Baron, RM, Kenny, DA (1986). The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology 51, 1173–1182.CrossRefGoogle ScholarPubMed
Black, CD, O'Connor, PJ, McCully, KK (2005). Increased daily physical activity and fatigue symptoms in chronic fatigue syndrome. Dynamic Medicine 4. Published online: 3 March 2005. doi:10.1186/1476-5918-4-3.CrossRefGoogle ScholarPubMed
Bleijenberg, G, Prins, JB, Bazelmans, E (2003). Cognitive-behavioral therapies. In Handbook of Chronic Fatigue Syndrome (ed. Jason, L. A., Fennell, P. A. and Taylor, R. R.), pp. 493–526. Wiley: New York.Google Scholar
Chambers, D, Bagnall, AM, Hempel, S, Forbes, C (2006). Interventions for the treatment, management and rehabilitation of patients with chronic fatigue syndrome/myalgic encephalomyelitis: an updated systematic review. Journal of the Royal Society of Medicine 99, 506–520.Google ScholarPubMed
Deale, A, Chalder, T, Marks, I, Wessely, S (1997). Cognitive behavior therapy for chronic fatigue syndrome: a randomized controlled trial. American Journal of Psychiatry 154, 408–414.Google ScholarPubMed
Deale, A, Chalder, T, Wessely, S (1998). Illness beliefs and treatment outcome in chronic fatigue syndrome. Journal of Psychosomatic Research 45, 77–83.CrossRefGoogle ScholarPubMed
Dittner, AJ, Wessely, S, Brown, RG (2004). The assessment of fatigue: a practical guide for clinicians and researchers. Journal of Psychosomatic Research 56, 157–170.CrossRefGoogle ScholarPubMed
Frazier, PA, Tix, AP, Barron, KE (2004). Testing moderator and mediator effects in counseling psychology research. Journal of Counseling Psychology 51, 115–134.CrossRefGoogle Scholar
Fukuda, K, Straus, SE, Hickie, I, Sharpe, MC, Dobbins, JG, Komaroff, A (1994). The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Annals of Internal Medicine 121, 953–959.CrossRefGoogle ScholarPubMed
Fulcher, KY, White, PD (1997). Randomised controlled trial of graded exercise in patients with the chronic fatigue syndrome. British Medical Journal 314, 1647–1652.CrossRefGoogle ScholarPubMed
Knoop, H, van der Meer, JW, Bleijenberg, G (2008). Guided self-instructions for people with chronic fatigue syndrome: randomised controlled trial. British Journal of Psychiatry 193, 340–341.CrossRefGoogle ScholarPubMed
Larun, L, McGuire, H, Edmonds, M, Odgaard-Jensen, J, Price, JR (2004). Exercise therapy for chronic fatigue syndrome. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD003200. doi: 10.1002/14651858.CD003200.pub2.Google Scholar
Malouff, JM, Thorsteinsson, EB, Rooke, SE, Bhullar, N, Schutte, NS (2008). Efficacy of cognitive behavioral therapy for chronic fatigue syndrome: a meta-analysis. Clinical Psychology Review 28, 736–745.CrossRefGoogle ScholarPubMed
Moss-Morris, R, Sharon, C, Tobin, R, Baldi, JC (2005). A randomized controlled graded exercise trial for chronic fatigue syndrome: outcomes and mechanisms of change. Journal of Health Psychology 10, 245–259.CrossRefGoogle ScholarPubMed
Preacher, KJ, Hayes, AF (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, and Computers 36, 717–731.CrossRefGoogle ScholarPubMed
Price, JR, Mitchell, E, Tidy, E, Hunot, V (2008). Cognitive behaviour therapy for chronic fatigue syndrome in adults. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD001027. doi: 10.1002/14651858.CD001027.pub2.Google ScholarPubMed
Prins, JB, Bleijenberg, G, Bazelmans, E, Elving, LD, de Boo, TM, Severens, JL, van der Wilt, GJ, Spinhoven, P, van der Meer, JW (2001). Cognitive behaviour therapy for chronic fatigue syndrome: a multicentre randomised controlled trial. Lancet 357, 841–847.CrossRefGoogle ScholarPubMed
Quarmby, L, Rimes, KA, Deale, A, Wessely, S, Chalder, T (2007). Cognitive-behaviour therapy for chronic fatigue syndrome: comparison of outcomes within and outside the confines of a randomised controlled trial. Behaviour Research and Therapy 45, 1085–1094.CrossRefGoogle ScholarPubMed
Sharpe, M, Hawton, K, Simkin, S, Surawy, C, Hackmann, A, Klimes, I, Peto, T, Warrell, D, Seagroatt, V (1996). Cognitive behaviour therapy for the chronic fatigue syndrome: a randomized controlled trial. British Medical Journal 312, 22–26.CrossRefGoogle ScholarPubMed
Stulemeijer, M, de Jong, LW, Fiselier, TJ, Hoogveld, SW, Bleijenberg, G (2005). Cognitive behaviour therapy for adolescents with chronic fatigue syndrome: randomised controlled trial. British Medical Journal 330. Published online: 7 December 2004. doi:10.1136/bmj.38301.587106.63.CrossRefGoogle ScholarPubMed
Vercoulen, JH, Swanink, CM, Fennis, JF, Galama, JM, van der Meer, JW, Bleijenberg, G (1994). Dimensional assessment of chronic fatigue syndrome. Journal of Psychosomatic Research 38, 383–392.CrossRefGoogle ScholarPubMed
Vercoulen, JH, Swanink, CM, Galama, JM, Fennis, JF, Jongen, PJ, Hommes, OR, van der Meer, JW, Bleijenberg, G (1998). The persistence of fatigue in chronic fatigue syndrome and multiple sclerosis: development of a model. Journal of Psychosomatic Research 45, 507–517.CrossRefGoogle ScholarPubMed
van der Werf, SP, Prins, JB, Vercoulen, JH, van der Meer, JW, Bleijenberg, G (2000). Identifying physical activity patterns in chronic fatigue syndrome using actigraphic assessment. Journal of Psychosomatic Research 49, 373–379.CrossRefGoogle ScholarPubMed
Wearden, AJ, Morriss, RK, Mullis, R, Strickland, PL, Pearson, DJ, Appleby, L, Campbell, IT, Morris, JA (1998). Randomised, double-blind, placebo-controlled treatment trial of fluoxetine and graded exercise for chronic fatigue syndrome. British Journal of Psychiatry 172, 485–490.CrossRefGoogle ScholarPubMed