Chronic Fatigue: Do Sweat It

Exercise, psychotherapy help, but verdict's out on other methods

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By
HealthDay Reporter

THURSDAY, Sept. 20, 2001 (HealthDayNews) -- The best ways to treat chronic fatigue syndrome (CFS) may be exercise and seeing a shrink, at least until drugs, supplements and alternative therapies can be more precisely evaluated, says a new review of scientific studies on the disease.

The researchers say the methods used in the different studies were all over the map -- definitions and standards often varied considerably, making consensus hard. The researchers say more research with standardized parameters is vital to see how well these treatments really work.

Studies of CFS treatments are "quite limited," says lead review author Penny Whiting of the University of York in England. "The review cannot provide any definitive conclusions as to the best way of treating CFS. The [various] interventions demonstrated mixed results in terms of effectiveness." The findings appear in the latest issue of The Journal of the American Medical Association.

The United Kingdom Department of Health commissioned the review of all literature on the treatment and management of CFS as a part of an effort to create guidelines for treatment. Using medical databases and the Internet, Whiting and her colleagues analyzed 44 studies that evaluated different treatments for both children and adults with CFS.

CFS has an array of symptoms, including tiredness, headaches, sleep problems, difficulty concentrating, sore throat, tender lymph nodes and joint pain. To be diagnosed with CFS, the symptoms have to be present for six months or more after all other medical conditions have been ruled out, according to the Centers for Disease Control and Prevention (CDC). No one knows its causes, although some researchers suggest CFS is an immune system disease. The number of people in the United States with CFS is unknown, but the CDC estimates about 200 of every 100,000 people are affected.

"Cognitive behavioral therapy and graded exercise therapy show positive results in the treatment and management of CFS," Whiting says. "Drugs like immunoglobulin and hydrocortisone showed some limited effects, but overall the evidence was inconclusive." There wasn't enough evidence to tell how well treatments like drug therapies, supplements and alternative therapies worked, she says.

Cognitive behavioral therapy is psychotherapy which concentrates on thinking patterns and how they affect emotions and actions. Graded exercise therapy is a cautious, predetermined exercise program with increasing activity levels.

In an accompanying editorial, Dr. Simon Wessely of Guy's, King's and St Thomas' School of Medicine and Institute of Psychiatry warns that the review could "reinforce the fault lines that split CFS researchers and patients alike. Failure to respond positively to the challenges posed by the review will mean that [CFS] activists and their chosen researchers will continue their own dialogue among themselves, closing their minds to alternative views and approaches, despite supporting evidence." The study could reinforce the professional and scientific community's already skeptical view of CFS, Wessely says.

"Anything that suggests that you can exercise yourself out of an illness carries the risk of suggesting that an illness is all in person's head, and that's not the case here," says Kim Kenney, president and CEO of the Chronic Fatigue and Immune Dysfunction Syndrome Association of America in Charlotte, N.C.

But the fact that the review calls for the standardization of CFS research is good news, Kenney says. "It's a way of bringing greater understanding of the illness and its potential treatments."

Kenney says she's concerned that the public will interpret the review as a green light for unsupervised exercise. "Lay people seeing this report … may not understand the difference between graded exercise therapy, which is very careful rehabilitation used by professional therapists to gradually increase a person's activity and function over time. We don't want people going out and hitting the gym. What we want lay people to understand is that exercise, in the general sense, often causes relapse in CFS patients."

"That's one of the characteristics of the disease, and so the danger is that someone taking exercise may do themselves more harm than good," Kenney says.

What To Do

For more on CFS, see the CDC or the CFIDS Association of America.

And here's an interview with an expert on graded exercise therapy.

SOURCES: Interviews with Penny Whiting, M.Sc., University of York, York, England; Kim Kenney, president and CEO, Chronic Fatigue and Immune Dysfunction Syndrome Association of America, Charlotte, N.C.; Sept. 19, 2001, The Journal of the American Medical Association

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