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Abstract
Objective: To investigate the effect of aerobic exercise training (AET) and cognitive-behavioral therapy (CBT) on chronic fatigue in patients with facioscapulohumeral muscular dystrophy (FSHD).
Methods: We performed a multicenter, assessor-blinded, randomized clinical trial (RCT). Fifty-seven patients with FSHD type 1 with severe chronic fatigue were randomly allocated to AET, CBT, or usual care (UC). Outcomes were assessed before treatment, following 16 weeks of intervention, and after a 12-week follow-up. A linear mixed model for repeated measurements was used to study the estimated group differences.
Results: Following treatment, both the AET (28 participants) and CBT (25 participants) intervention groups had less fatigue relative to the UC group (24 participants), with a difference of −9.1 for AET (95% confidence interval [CI] −12.4 to −5.8) and −13.3 for CBT (95% CI −16.5 to −10.2). These beneficial effects lasted through follow-up, with a difference of −8.2 for AET (95% CI −12.4 to −5.8) and −10.2 for CBT (95% CI −14.0 to −6.3). The patients who received CBT had an increase in registered and experienced physical activity, sleep quality, and social participation. The patients who received AET had an increase in registered physical activity only. The increase in registered physical activity in both groups and the improvement in social participation following CBT were still present at follow-up.
Conclusions: This RCT shows that AET and CBT can ameliorate chronic fatigue in patients with FSHD.
Classification of evidence: This study provides Class III evidence that, in patients with FSHD type 1 and severe chronic fatigue, AET or CBT reduces the severity of chronic fatigue.
GLOSSARY
- AET=
- aerobic exercise training;
- ARR=
- absolute risk reduction;
- CBT=
- cognitive-behavioral therapy;
- CI=
- confidence interval;
- CIS-activity=
- physical activity subscale of the Checklist Individual Strength;
- CIS-fatigue=
- fatigue subscale of the Checklist Individual Strength;
- FSHD=
- facioscapulohumeral muscular dystrophy;
- HRR=
- heart rate reserve;
- NHP-sleep=
- sleep subscale of the Nottingham Health Profile;
- NNT=
- number needed to treat;
- SFQ=
- Short Fatigue Questionnaire;
- SIP68-sb=
- social behavior subscale of the Sickness Impact Profile 68;
- UC=
- usual care;
- VAS=
- Visual Analogue Scale
Footnotes
↵* These authors contributed equally to this work.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received April 24, 2014.
- Accepted in final form August 21, 2014.
- © 2014 American Academy of Neurology
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