Disability evaluation in chronic fatigue syndrome: associations between exercise capacity and activity limitations/participation restrictions Exercise performance and chronic pain in chronic fatigue syndrome: the role of pain catastrophizing. Kinesiophobia in chronic fatigue syndrome: assessment and associations with disability. Can exercise limits prevent post-exertional malaise in chronic fatigue syndrome? An uncontrolled clinical trial A Systematic Review of Probiotic Interventions for Gastrointestinal Symptoms and Irritable Bowel Syndrome in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) Functional status in patients with chronic fatigue syndrome, other fatiguing illnesses, and healthy individuals. Functional Incapacity and Physical and Psychological Symptoms: How They Interconnect in Chronic Fatigue Syndrome Measuring disability in patients with chronic fatigue syndrome: reliability and validity of the Work and Social Adjustment Scale. A placebo-controlled, double-blind, randomized controlled trial of a natural killer cell stimulant (BioBran MGN-3) in chronic fatigue syndrome. Pain physiology education improves pain beliefs in patients with chronic fatigue syndrome compared with pacing and self-management education: a double-blind randomized controlled trial. A controlled clinical trial with a specifically configured RNA drug, poly(I).poly(C12U), in chronic fatigue syndrome. Functional status of persons with chronic fatigue syndrome in the Wichita, Kansas, population Dietary intervention in chronic fatigue syndrome. Intravenous immunoglobulin is ineffective in the treatment of patients with chronic fatigue syndrome. Distinguishing patients with chronic fatigue from those with chronic fatigue syndrome: a diagnostic study in UK primary care. Multidisciplinary rehabilitation treatment versus cognitive behavioural therapy for patients with chronic fatigue syndrome: a randomized controlled trial. A Randomized Controlled Trial of Qigong Exercise on Fatigue Symptoms, Functioning, and Telomerase Activity in Persons with Chronic Fatigue or Chronic Fatigue Syndrome A population-based study of the clinical course of chronic fatigue syndrome A community-based study of chronic fatigue syndrome. Effects of Qigong Exercise on Fatigue, Anxiety, and Depressive Symptoms of Patients with Chronic Fatigue Syndrome-Like Illness: A Randomized Controlled Trial 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 The effect of a polynutrient supplement on fatigue and physical activity of patients with chronic fatigue syndrome: a double-blind randomized controlled trial. Fatigue and chronic fatigue syndrome-like complaints in the general population.
Objective : In an attempt to examine whether impairments in cardiorespiratory fitness are associated with daily functioning in patients with chronic fatigue syndrome ( CFS ) , this study addresses the correlations between exercise capacity and activity limitations /participation restrictions . Design : Prospect i ve observational study . Setting : An outpatient tertiary care , chronic fatigue clinic at the Vrije Universiteit Brussel ( VUB ) , Belgium . Subjects : Seventy-seven patients fulfilling the 1994 Centers for Disease Control and Prevention ( CDC ) case definition for CFS . Interventions : All patients filled in the Chronic Fatigue Syndrome Activities and Participation Question naire ( CFS-APQ ) and performed a maximal exercise stress test on a bicycle ergometer . Heart rate was monitored continuously by use of an electrocardiograph .  Metabolic and ventilatory parameters were measured through spirometry .  Results : A statistically significant correlation between the score obtained with the CFS-APQ and the body weight-adjusted peak oxygen uptake ( Spearman rho = -0.32 ; p = 0.005 ) , functional aerobic impairment ( rho = 0.33 ; p = 0.004 ) , workload/body weight ( rho = -0.30 ; p = 0.009 ) , exercise duration ( rho = -0.30 ; p = 0.008 ) , and the percentage of target heart rate achieved ( rho = -0.33 ; p = 0.004 ) was observed . The correlations between the remaining exercise capacity parameters and the scores obtained with the CFS-APQ all indicated a trend towards association ( 0.01<p<0.05 ) . Conclusions : These results suggest a moderate association between exercise capacity and activity limitations /participation restrictions in patients with CFS . The observed correlations lack strength to predict activity limitations / participation restriction based on exercise capacity parameters . Disability evaluation in CFS should therefore encompass both exercise capacity testing and measurements at the activity/participation dimension OBJECTIVES This study aim ed to examine the associations between bodily pain , pain catastrophizing , depression , activity limitations /participation restrictions , employment status , and exercise performance in female patients with chronic fatigue syndrome ( CFS ) who experience widespread pain . DESIGN Cross-sectional observational study . SETTING A university-based clinic . PATIENTS Thirty-six female CFS patients who experienced widespread pain . OUTCOME MEASURES Patients filled in the  Medical Outcomes Short-Form 36 Health Status Survey ,  the  Chronic Fatigue Syndrome Activities and Participation Question naire , the Beck Depression Inventory , and the Pain Catastrophizing Scale , and underwent a maximal exercise stress test with continuous monitoring of electrocardiographic and ventilatory parameters . RESULTS Pain catastrophizing was related to bodily pain ( r = -0.70 ) , depression ( r = 0.55 ) , activity limitations /participation restrictions ( r = 0.68 ) , various aspects of quality of life ( r varied between -0.51 and -0.64 ) , and exercise capacity ( r varied between -0.41 and -0.61 ) . Based on hierarchical multiple regression analysis , pain catastrophizing accounted for 41 % of the variance in bodily pain in female CFS patients who experience chronic widespread musculoskeletal pain . Among the three subscale scores of the Pain Catastrophizing Scale , helplessness and rumination rather than magnification were strongly related to bodily pain . Neither pain catastrophizing nor depression was related to employment status . CONCLUSIONS These data provide evidence favoring a significant association between pain catastrophizing , bodily pain , exercise performance , and self-reported disability in female patients with CFS who experience widespread pain . Further prospect i ve longitudinal study ing of these variables is required OBJECTIVES To investigate aspects of the validity of the total scores of the Tampa Scale for Kinesiophobia ( TSK ) , Dutch Version , which was modified to make it an appropriate question naire for the assessment of kinesiophobia ( fear of movement ) in chronic fatigue syndrome ( CFS ) patients ( the Dutch TSK-CFS ) , and , using this assessment tool , to examine the associations between kinesiophobia , exercise capacity , and activity limitations and participation restrictions in patients with CFS . DESIGN Prospect i ve observational studies . SETTING An outpatient fatigue clinic . PARTICIPANTS In the first study , 40 patients fulfilling the 1994 US Centers for Disease Control and Prevention ( CDC ) criteria for CFS were enrolled . The sample of the second study consisted of 51 CDC-defined patients with CSF . INTERVENTIONS Not applicable . Main outcome measures Study 1 : Subjects completed a set of question naires ; the Utrechtse Coping List ( UCL ) , the Dutch TSK-CFS , and the Dutch Baecke Question naire of Habitual Physical Activity . Study 2 : All patients completed 2 question naires (  Chronic Fatigue Syndrome Activities and Participation Question naire [ CFS-APQ ] , Dutch TSK-CFS ) and performed a maximal exercise stress test on a bicycle ergometer . The heart rate was monitored continuously by use of an electrocardiograph .  Metabolic and ventilatory parameters were measured through spirometry . RESULTS Study 1 : The Cronbach alpha coefficient for the individual item scores on the TSK-CFS was .80 . The total scores on the Dutch TSK-CFS showed a statistically significant correlation with both the avoidance/abide subscale of the UCL ( Spearman rho=.35 , P=.029 ) and the total score of the Baecke Question naire ( rho=-.45 , P=.004 ) . Study 2 : The total scores on the Dutch TSK-CFS showed a statistically significant correlation with the total scores on the CFS-APQ ( rho=.39 , P=.004 ) . No statistically significant associations were observed between the exercise capacity parameters and the total scores on the Dutch TSK-CFS . CONCLUSIONS These results provide evidence for the internal consistency and the convergent and congruent validity of the scores obtained by use of the Dutch TSK-CFS . Kinesiophobia appears to be associated with activity limitations /participation restrictions but not with exercise capacity in patients with CFS Objective : It was hypothesized that the use of exercise limits prevents symptom increases and worsening of their health status following a walking exercise in people with chronic fatigue syndrome . Design : An uncontrolled clinical trial ( semi-experimental design ) . Setting : Outpatient clinic of a university department . Subjects : Twenty-four patients with chronic fatigue syndrome . Interventions : Subjects undertook a walking test with the two concurrent exercise limits . Each subject walked at an intensity where the maximum heart rate was determined by heart rate corresponding to the respiratory exchange ratio = 1.0 derived from a previous submaximal exercise test and for a duration calculated from how long each patient felt they were able to walk . Main outcome measures : The Short Form 36 Health Survey or SF-36 , the Chronic Fatigue Syndrome Symptom List , and the Chronic Fatigue Syndrome — Activities and Participation Question naire were filled in prior to , immediately after and 24 hours after exercise . Results : The fatigue increase observed immediately post-exercise ( P= 0.006 ) returned to pre-exercise levels 24 hours post-exercise . The increase in pain observed immediately post-exercise was retained at 24 hours post-exercise ( P=0.03 ) . Fourteen of the 24 subjects experienced a clinical ly meaningful change in bodily pain ( change of SF-36 bodily pain score ≥10 ) ; 6 indicated that the exercise bout had slightly worsened their health status , and 2 had a clinical ly meaningful decrease in vitality ( change of SF-36 vitality score ≥20 ) . There was no change in activity limitations /participation restrictions . Conclusion : It was shown that the use of exercise limits ( limiting both the intensity and duration of exercise ) prevents important health status changes following a walking exercise in people with chronic fatigue syndrome , but was unable to prevent short-term symptom increases Gastrointestinal ( GI ) symptoms and irritable bowel ( IB ) symptoms have been associated with chronic fatigue syndrome/myalgic encephalomyelitis ( CFS/ME ) . The aim of this study was to conduct a systematic review of these symptoms in CFS/ME , along with any evidence for probiotics as treatment . Pubmed , Scopus , Medline ( EBSCOHost ) and EMBASE data bases were search ed to source relevant studies for CFS/ME . The review included any studies examining GI symptoms , irritable bowel syndrome ( IBS ) and /or probiotic use . Studies were required to report criteria for CFS/ME and study design , intervention and outcome measures . Quality assessment was also completed to summarise the level of evidence available . A total of 3381 publications were returned using our search terms . Twenty-five studies were included in the review . R and omised control trials were the predominant study type ( n = 24 ) . Most of the studies identified examined the effect of  probiotic supplementation on the improvement of IB symptoms in IBS patients , or IB symptoms in CFS/ME patients , as well as some other significant secondary outcomes ( e.g. quality of life , other gastrointestinal symptoms , psychological symptoms ) . The level of evidence identified for the use of  probiotics  in IBS was excellent in quality ; however , the evidence available for the use of probiotic interventions in CFS/ME was poor and limited . There is currently insufficient evidence for the use of probiotics in CFS/ME patients , despite probiotic interventions being useful in IBS . The studies pertaining to probiotic interventions in CFS/ME patients were limited and of poor quality overall . St and ardisation of protocol s and methodology in these studies is required BACKGROUND Chronic fatigue syndrome ( CFS ) is a condition that may be associated with substantial disability . The Medical Outcomes Study Short-Form General Health Survey ( SF-36 ) is an instrument that has been widely used in outpatient population s to determine functional status . Our objectives were to describe the usefulness of the SF-36 in CFS patients and to determine if subscale scores could distinguish patients with CFS from subjects with unexplained chronic fatigue ( CF ) , major depression ( MD ) , or acute infectious mononucleosis ( AIM ) , and from healthy control subjects ( HC ) . An additional goal was to ascertain if subscale scores correlated with the signs and symptoms of CFS or the presence of psychiatric disorders and fibromyalgia . DESIGN Prospect ively collected case series . SETTING Patients with CFS and CF were seen in a university-based referral clinic and had undergone a complete medical and psychiatric evaluation . Other study subjects were recruited from the community to participate in research studies . PARTICIPANTS The study included 185 patients with CFS , 246 with CF , 111 with AIM , and 25 with MD . There were 99 HC subjects . MEASURES The  SF-36 and a structured psychiatric interview  were used . The SF-36 contains 8 subscales : physical , emotional , social , and role functioning , body pain , mental health , vitality , and general health- and a structured psychiatric interview .  RESULTS Performance characteristics ( internal reliability coefficients , convergent validity ) of the SF-36 were excellent . A strikingly consistent pattern was found for the physical functioning , role functioning , social functioning , general health , and body pain subscales , with the lowest scores in CFS patients , intermediate scores in AIM patients , and the highest scores in the HC subjects . The CFS patients had significantly lower scores than patients with CF alone on the physical functioning ( P < or = 0.01 ) , role functioning ( P < or = 0.01 ) , and body pain ( P < or = 0.001 ) subscales . The emotional functioning and mental health scores were worst among those with MD . The presence of fibromyalgia , being unemployed , and increasing fatigue severity all were associated with additional functional limitations across multiple functional domains , with increasing fatigue appearing to have the greatest effect . CONCLUSIONS The SF-36 is useful in assessing functional status in patients with fatiguing illnesses . Patients with CFS and CF have marked impairment of their functional status . The severity and pattern of impairment as documented by the SF-36 distinguishes patients with CFS and CF from those with MD and AIM , and from HC , but does not discriminate between CF and CFS Background : It has been argued that perceived functional incapacity might be a primary characteristic of chronic fatigue syndrome ( CFS ) and could be explained by physical symptoms . If so , it could be expected to be closely associated with physical , but not psychological symptoms . The study tests this hypothesis . Sampling and Methods : The sample consisted of 73 patients , with a diagnosis of CFS according to the Oxford criteria , r and omly selected from clinics in the Departments of Immunology and Psychiatry at St. Bartholomew ’s Hospital , London . The degree of fatigue experienced by patients was assessed using the  Chalder Fatigue Question naire and a visual analogue scale . Self-rated instruments were used to measure physical and social functioning , quality of life , and physical and psychological symptoms . Results : Principal-component analysis of all scale scores revealed 2 distinct components , explaining 53 % of the total variance . One component was characterized by psychological symptoms and generic quality of life indicators , whilst the other component was made up of physical symptoms , social and physical functioning and indicators of fatigue . Conclusions : The findings suggest that perceived functional incapacity is a primary characteristic of CFS , which is manifested and /or explained by physical symptoms BACKGROUND Disability is a defining feature of chronic conditions , and it is an increasingly used measure of therapy effectiveness . The  Work and Social Adjustment Scale ( WSAS )  is a simple and clear measure of disability . Although the scale is widely used , no study has yet investigated its psychometric properties in patients with chronic fatigue syndrome ( CFS ) . METHODS Data from two sample s of patients were used , one from a multicenter r and omized controlled clinical trial of treatments for CFS ( n = 639 ) and the other from a clinic that specializes in CFS ( n=384 ) . All patients completed the WSAS as well as other measures . RESULTS Internal consistency and the Spearman-Brown split-half coefficient values indicated that the scale is reliable . CFS patients who had comorbid diagnoses of depression , anxiety or fibromyalgia had higher WSAS scores . High levels of disability were associated with high number of physical symptoms , severe fatigue , depression , anxiety , poor sleep quality and poor physical fitness , with correlation coefficients ranging between 0.41 and 0.11 . Lower scores on the WSAS were modestly associated with better physical functioning as well as higher levels of physical capacity as assessed by a walking test . Sensitivity to change was evaluated in a subgroup of patients who had undergone a course of cognitive behavioral therapy .  Disability significantly decreased after therapy and remained stable at follow-ups . CONCLUSION The WSAS is a reliable and valid assessment tool for disability in patients with CFS BACKGROUND Previous research has suggested that natural killer ( NK ) cell activity may be reduced in patients with chronic fatigue syndrome ( CFS ) . AIM To evaluate the effectiveness of a putative NK cell stimulant , BioBran MGN-3 , in reducing fatigue in CFS patients . DESIGN R and omized , double-blind , placebo-controlled trial . METHODS We recruited 71 patients with CFS ( according to the Centers for Disease Control 1994 criteria ) attending an out-patient specialist CFS service . Participants were given oral BioBran MGN-3 for 8 weeks ( 2 g three times per day ) or placebo equivalent . The primary outcome measure was the Chalder physical fatigue score . Self-reported fatigue measures , self- assessment of improvement , change in key symptoms , quality of life , anxiety and depression measures were also included . RESULTS Data were complete in 64/71 patients . Both groups showed marked improvement over the study duration , but without significant differences . Mean improvement in the Chalder fatigue score ( physical scale ) was 0.3 ( 95%CI -2.6 to 3.2 ) lower in the BioBran group . DISCUSSION The findings do not support a specific therapeutic effect for BioBran in CFS . The improvement showed by both groups over time highlights the importance of placebo controls when evaluating interventions in CFS OBJECTIVE To examine whether pain physiology education was capable of changing pain cognitions and pain thresholds in patients with chronic fatigue syndrome ( CFS ) and chronic widespread pain . DESIGN Double-blind r and omized controlled trial . SETTING Specialized chronic fatigue clinic in university hospital . PARTICIPANTS A r and om sample of patients ( N=48 ) with CFS patients ( 8 men , 40 women ) experiencing chronic pain , r and omly allocated to the control group ( n=24 ) or experimental group ( n=24 ) . Two women in the experimental group did not complete the study because of practical issues ( lack of time and restricted mobility ) . INTERVENTIONS One individual pain physiology education session ( experimental ) or 1 pacing and self-management education session ( control ) . MAIN OUTCOME MEASURES Algometry , the Neurophysiology of Pain Test , and question naires evaluating pain cognitions-the Pain Coping Inventory , the Pain Catastrophizing Scale , and the Tampa Scale for Kinesiophobia-version CFS-were completed immediately before and immediately after the intervention . RESULTS After the intervention , the experimental group demonstrated a significantly better underst and ing of the neurophysiology of pain ( P<.001 ) and a reduction of the Pain Catastrophizing Scale subscale " ruminating " ( P=.009 ) compared with controls . For these variables , moderate to large Cohen d effect sizes were revealed ( .79 - 2.53 ) . CONCLUSIONS A 30-minute educational session on pain physiology imparts a better underst and ing of pain and brings about less rumination in the short term . Pain physiology education can be an important therapeutic modality in the approach of patients with CFS and chronic pain , given the clinical relevance of inappropriate pain cognitions Chronic fatigue syndrome ( CFS ) is a physically debilitating illness associated with immunologic abnormalities , viral reactivation , and impairment of cognition . In a r and omized , multicenter , placebo-controlled , double-blind study of 92 patients meeting the CFS case definition of the Centers for Disease Control and Prevention , the response of several laboratory and clinical variables to an antiviral and immunomodulatory drug , poly(I).poly(C12U ) , was determined . Measures of clinical response included Karnofsky performance score , a cognition scale derived from a self-administered instrument assessing symptomatology ( SCL-90-R ) , an activities of daily living scale , and exercise treadmill performance . After 24 weeks , patients receiving poly(I).poly(C12U ) had higher scores for both global performance and perceived cognition than did patients receiving placebo . In particular , patients given poly(I).poly(C12U ) had increased Karnofsky performance scores ( P < .03 ) , exhibited a greater ability to do work during exercise treadmill testing ( P = .01 ) , displayed an enhanced capacity to perform the activities of daily living ( P < .04 ) , had a reduced cognitive deficit ( P = .05 ) , and required less use of other medications ( P < .05 ) Background Scant research has adequately addressed the impact of chronic fatigue syndrome on patients ' daily activities and quality of life . Enumerating specific problems related to quality of life in chronic fatigue syndrome patients can help us to better underst and and manage this illness . This study addresses issues of functional status in persons with chronic fatigue syndrome and other fatiguing illnesses in a population based sample , which can be generalized to all persons with chronic fatigue . Methods We conducted a r  and om telephone survey in Wichita , Kansas to identify persons with chronic fatigue syndrome and other fatiguing illnesses . Respondents reporting severe fatigue of at least 1 month 's duration and r and omly selected non-fatigued respondents were asked to participate in a detailed telephone interview . Participants were asked about symptoms , medical and psychiatric illnesses , and about physical , social , and recreational functioning . Those meeting the 1994 chronic fatigue syndrome case definition , as determined on the basis of their telephone responses , were invited for clinical evaluation to confirm a diagnosis of chronic fatigue syndrome . For this analysis , we evaluated  unemployment due to fatigue , number of hours per week spent on work , chores , and other activities ( currently and prior to the onset of fatigue ) , and energy level .  Results There was no difference between persons with chronic fatigue syndrome and persons with a chronic fatigue syndrome-like illness that could be explained by a medical or psychiatric condition for any of the outcomes we measured except for unemployment due to fatigue ( 15 % vs. 40 % , P < .01 ) . Persons with chronic fatigue syndrome and other fatiguing illnesses had substantially less energy and spent less time on hobbies , schooling , or volunteer work than did non-fatigued controls ( P < .01 ) . Conclusions Persons with chronic fatigue syndrome are as impaired as persons whose fatigue could be explained by a medical or psychiatric condition , and they have less energy than non-fatigued controls BACKGROUND Anecdotal reports and books have been published linking an over growth of C and ida Albicans with chronic fatigue syndrome ( CFS ) , suggesting dietary change as a treatment option . Little scientific data has been published to vali date this controversial theory . This study aims to determine the efficacy of dietary intervention on level of fatigue and quality of life ( QoL ) in individuals with CFS . METHODS A 24-week r and omized intervention study was conducted with 52 individuals diagnosed with CFS . Patients were r and omized to either a low sugar low yeast ( LSLY ) or healthy eating ( HE ) dietary interventions .  Primary outcome measures were fatigue as measured by the Chalder Fatigue Score and QoL measured by Medical Outcomes Survey Short Form-36 . RESULTS A high drop out rate occurred with 13 participants not completing the final evaluation ( 7HE/6LSLY ) . Intention to treat analysis showed no statistically significant differences on primary outcome measurements . CONCLUSION In this r and omized control trial , a LSLY diet appeared to be no more efficacious on levels of fatigue or QoL compared to HE . Given the difficulty with dietary compliance experienced by participants , especially in the LSLY group , it would appear HE guidance is a more pragmatic approach than advocating a complicated dietary regime PURPOSE To determine whether the reported therapeutic benefit of intravenous immunoglobulin in patients with chronic fatigue syndrome ( CFS ) is dose dependent . PATIENTS AND METHODS Ninety-nine adult patients , who fulfilled diagnostic criteria for CFS , participated in this double-blind , r and omized , and placebo-controlled trial . Patients received intravenous infusions with either a placebo solution ( 1 % albumin ) or one of three doses of immunoglobulin ( 0.5 , 1 , or 2 g/kg ) on a monthly basis for 3 months , followed by a treatment-free follow-up period of 3 months . Outcome was assessed by changes in a series of self-reported measures ( quality -of-life visual analog scales , st and ardized diaries of daily activities , the profile of mood states question naire ) and the Karnofsky performance scale . Cell-mediated immunity was evaluated by T-cell subset analysis and delayed-type hypersensitivity ( DTH ) skin testing . RESULTS No dose of intravenous immunoglobulin was associated with a specific therapeutic benefit . Adverse reactions , typically constitutional symptoms , were reported by 70 % to 80 % of patients , with no relationship to immunoglobulin treatment . CONCLUSIONS Intravenous immunoglobulin can not be recommended as a therapy for the treatment of CFS . A better underst and ing of the pathophysiology of this disorder is needed before effective treatment can be developed BACKGROUND Chronic fatigue syndrome ( CFS ) has been defined , but many more patients consult in primary care with chronic fatigue that does not meet the criteria for CFS . General practitioners ( GPs ) do not generally use the CFS diagnosis , and have some doubt about the validity of CFS as an illness . AIM To describe the proportion of patients consulting their GP for fatigue that met the criteria for CFS , and to describe the social , psychological , and physical differences between patients with CFS and those with non-CFS chronic fatigue in primary care . DESIGN OF STUDY Baseline data from a trial of complex interventions for fatigue in primary care . SETTING Twenty-two general practice s located in London and the South Thames region of the United Kingdom recruited patients to the study between 1999 and 2001 . METHOD One hundred and forty-one patients who presented to their GP with unexplained fatigue lasting six months or more as a main symptom were recruited , and the Centers for Disease Control ( CDC ) case definition was applied to classify CFS . RESULTS Approximately two-thirds ( 69 % ) of patients had chronic fatigue  and not CFS . The duration of fatigue ( 32 months ) and perceived control over fatigue were similar between groups ; however , fatigue , functioning , associated symptoms , and psychological distress were more severe in the patients in the CFS group , who also consulted their GP significantly more frequently , were twice as likely to be depressed , and more than twice as likely to be unemployed . About half ( CFS = 50 % ; chronic fatigue = 55 % ) in each group attributed their fatigue to mainly psychological causes . CONCLUSIONS In primary care , CFS is a more severe illness than chronic fatigue , but non-CFS chronic fatigue is associated with significant fatigue and is reported at least twice as often . That half of patients , irrespective of CFS status , attribute their fatigue to psychological causes , more than is observed in secondary care , indicates an openness to the psychological therapies provided in that setting . More evidence on the natural history of chronic fatigue and CFS in primary care is required , as are trials of complex interventions . The results may help determine the usefulness of differentiating between chronic fatigue and CFS OBJECTIVES The aim of this trial was to evaluate the difference in treatment effect , at 26 and 52 weeks after the start of treatment , between cognitive behavioural therapy ( CBT ) and multidisciplinary rehabilitation treatment ( MRT ) for patients with chronic fatigue syndrome ( CFS ) . DESIGN Multicentre , r and omized controlled trial of patients with CFS . Participants were r and omly assigned to MRT or CBT . SETTING Four rehabilitation centres in the Netherl and s. SUBJECTS A total of 122 patients participated in the trial . MAIN OUTCOME MEASURES Primary outcomes were fatigue measured by the fatigue subscale of the Checklist Individual Strength and health-related quality of life measured by the Short-Form 36 . Outcomes were assessed prior to treatment and at 26 and 52 weeks after treatment initiation . RESULTS A total of 114 participants completed the assessment at 26 weeks , and 112 completed the assessment at 52 weeks . MRT was significantly more effective than CBT in reducing fatigue at 52 weeks . The estimated difference in fatigue between the two treatments was -3.02 [ 95 % confidence interval ( CI ) -8.07 to 2.03 ; P = 0.24 ] at 26 weeks and -5.69 ( 95 % CI -10.62 to -0.76 ; P = 0.02 ) at 52 weeks . Patients showed an improvement in quality of life over time , but between-group differences were not significant . CONCLUSION This study provides evidence that MRT is more effective in reducing long-term fatigue severity than CBT in patients with CFS . Although implementation in comparable population s can be recommended based on clinical effectiveness , it is advisable to analyse the cost-effectiveness and replicate these findings in another multicentre trial Background Chronic fatigue is common in the general population . Complementary therapies are often used by patients with chronic fatigue or chronic fatigue syndrome to manage their symptoms . Purpose This study aim ed to assess the effect of a 4-month qigong intervention program among patients with chronic fatigue or chronic fatigue syndrome . Methods Sixty-four participants were r and omly assigned to either an intervention group or a wait list control group . Outcome measures included fatigue symptoms , physical functioning , mental functioning , and telomerase activity . Results Fatigue symptoms and mental functioning were significantly improved in the qigong group compared to controls . Telomerase activity increased in the qigong group from 0.102 to 0.178 arbitrary units ( p < 0.05 ) . The change was statistically significant when compared to the control group ( p < 0.05 ) . Conclusion Qigong exercise may be used as an alternative and complementary therapy or rehabilitative program for chronic fatigue and chronic fatigue syndrome Background Chronic fatigue syndrome ( CFS ) presents a challenge for patients , health care providers , and health insurance groups because of its incapacitating nature , unknown cause , and poorly understood prognosis . We conducted a longitudinal population -based study to characterize the clinical course of CFS . Methods Sixty-five CFS subjects were identified from a r and om-digit-dialing survey of Wichita , Kansas residents and followed for up to 3 years . We evaluated changes in CFS classification ( partial or total remission , alternative medical or psychiatric diagnoses ) , CFS case-defining criteria , wellness scores , hours of activities and sleep , and  treatments used to reduce fatigue . Associations between risk factors and outcomes were determined by use of logistic regression and generalized estimating equations models . Results Only 20%-33 % of the subjects were classified as having CFS at follow-up , 56.9 % ever experienced partial or total remission , 10 % sustained total remission , and 23.1 % received alternative diagnoses , of which 20 % were sleep disorders . Higher fatigue severity scores and total number of symptoms were negatively associated with ever remitting . Duration of illness ≤ 2 years was positively associated with sustained remission . Unrefreshing sleep persisted in at least 79 % of the subjects across all periods but , as with most of the CFS symptoms , tended to be less frequent over time . The number of activities affected by fatigue decreased over time , while wellness scores increased . At any follow-up , more than 35 % of subjects reporting reduced fatigue used complementary and alternative medicine therapies , and of those subjects , at least 50 % thought these therapies were responsible for reducing their fatigue . Conclusions The clinical course of CFS was characterized by an intermittent pattern of relapse and remission . Remission rates documented by our population -based study were similar to those reported in clinical studies . Shorter illness duration was a significant predictor of sustained remission , and thus early detection of CFS is of utmost importance . The persistence of sleep complaints and identification of sleep disorders suggest that CFS subjects be evaluated for sleep disturbances , which could be treated BACKGROUND Most previous estimates of the prevalence of chronic fatigue syndrome ( CFS ) have derived largely from treated population s , and have been biased by differential access to health care treatment linked with sex , ethnic identification , and socioeconomic status . OBJECTIVE To assess the point prevalence of CFS in an ethnically diverse r and om community sample . DESIGN AND PARTICIPANTS A sample of 28,673 adults in Chicago , Ill , was screened by telephone  , and those with CFS-like symptoms were medically evaluated . MAIN OUTCOME MEASURES AND ANALYSES :  Self-report question naires , psychiatric evaluations , and complete medical examinations with laboratory testing  were used to diagnose patients with CFS . Univariate and multivariate statistical techniques were used to delineate the overall rate of CFS in this population , and its relative prevalence was subcategorized by sex , ethnic identification , age , and socioeconomic status . RESULTS There was a 65.1 % completion rate for the telephone interviews during the first phase of the study . Findings indicated that CFS occurs in about 0.42 % ( 95 % confidence interval , 0.29%-0.56 % ) of this r and om community-based sample . The highest levels of CFS were consistently found among women , minority groups , and persons with lower levels of education and occupational status . CONCLUSIONS Chronic fatigue syndrome is a common chronic health condition , especially for women , occurring across ethnic groups . Earlier findings suggesting that CFS is a syndrome primarily affecting white , middle-class patients were not supported by our findings Background . Anxiety/depressive symptoms are common in patients with chronic fatigue syndrome- ( CFS- ) like illness .  Qigong as a modality of complementary and alternative therapy has been increasingly applied by patients with chronic illnesses , but little is known about the effect of Qigong on anxiety/depressive symptoms of the patients with CFS-like illness . Purpose . To investigate the effects of Qigong on fatigue , anxiety , and depressive symptoms in patients with CFS-illness . Methods . One hundred and thirty-seven participants who met the diagnostic criteria for CFS-like illness were r and omly assigned to either an intervention group or a waitlist control group . Participants in the intervention group received 10 sessions of Qigong training twice a week for 5 consecutive weeks , followed by home-based practice for 12 weeks . Fatigue , anxiety , and depressive symptoms were assessed at baseline and postintervention . Results . Total fatigue score [ F(1,135 ) = 13.888 , P < 0.001 ] , physical fatigue score [ F(1,135 ) = 20.852 , P < 0.001 ] and depression score [ F(1,135 ) = 9.918 , P = 0.002 ] were significantly improved and mental fatigue score [ F(1,135 ) = 3.902 , P = 0.050 ] was marginally significantly improved in the Qigong group compared to controls . The anxiety score was not significantly improved in the Qigong group . Conclusion . Qigong may not only reduce the fatigue symptoms , but also has antidepressive effect for patients with CFS-like illness . Trial registration HKCTR-1200 Background Unexplained Chronic Fatigue is a medical condition characterized by the presence of persistent , severe and debilitating medically unexplained fatigue , leading to impaired functioning and lower quality of life . Research suggests that physical activity can contribute to the reduction of fatigue and other somatic symptoms and can thus significantly improve physical functioning and quality of life in these patients . Based on the self-regulation ( SR ) theory of behaviour change , we developed a brief physical activity program for patients suffering from unexplained chronic fatigue which focuses on the training of self-regulation skills , the " 4-STEPS to control your fatigue " program . Methods / Design This is a multi-centre , r and omised controlled trial ( RCT ) that will be carried out in local primary care centres and at the Portuguese Fibromyalgia and Chronic Fatigue Syndrome Patients Association . Patients aged between 18 and 65 and fulfilling operationalized criteria for Idiopathic Chronic Fatigue ( ICF ) and Chronic Fatigue Syndrome ( CFS ) will be recruited and r and omly allocated to st and ard care ( SC ) or st and ard care plus a self-regulation based physical activity program ( 4-STEPS ) . Patients will be assessed at baseline , after the intervention ( 3 months ) and at 12 months follow-up . The primary outcome is fatigue severity . Discussion The results of the RCT will provide information about the effectiveness of a brief self-regulation intervention for promoting physical activity in patients with unexplained chronic fatigue . If the program proves to be effective , it may be considered as an adjunctive treatment for these patients .Trial Registration IS RCT N : IS RCT BACKGROUND The efficacy of dietary supplements in chronic fatigue syndrome ( CFS ) is uncertain , with conflicting evidence . AIM To assess the effect of a polynutrient supplement on fatigue and physical activity of patients with CFS . DESIGN Prospect i ve r and omized placebo-controlled , double-blind trial . METHODS Fifty-three patients ( 16 males , 37 females ) fulfilling the CDC criteria of CFS . The entry criteria were a score on the Checklist Individual Strength subscale fatigue severity ( CIS fatigue ) > or=40 and a weighted sum score of > or=750 for the eight subscales of the Sickness Impact Profile ( SIP8 ) and no use of nutritional supplements in the 4 weeks prior to entry . The exclusion criteria were pregnancy and lactose intolerance . The intervention-a polynutrient supplement containing several vitamins , minerals and (co)enzymes , or placebo , twice daily for 10 weeks-was preceded by 2 weeks of baseline measurements . Outcome measurements took place in week 9 and 10 of the intervention . Five participants dropped out ( 4 supplement , 1 placebo ) . The main outcome measures were CIS fatigue score , number of CDC symptoms and SIP8 score . Efficacy analyses were performed on an intention-to-treat basis . RESULTS No significant differences were found between the placebo and the treated group on any of the outcome measures : CIS fatigue + 2.16 ( 95%CI -4.3 to + 4.39 , p=0.984 ) ; CDC symptoms + 0.42 ( 95%CI -0.61 to + 1.46 , p=0.417 ) ; SIP8 + 182 ( 95%CI -165 to + 529 , p=0.297 ) . No patient reported full recovery . DISCUSSION The findings do not support the use of a broad-spectrum nutritional supplement in treating CFS-related symptoms BACKGROUND Most knowledge on chronic fatigue ( CF ) and chronic fatigue syndrome ( CFS ) is based on clinical studies , not representative of the general population . This study aim ed to assess the prevalence of fatigue in an adult general population and to identify associations with lifestyle factors . METHODS Total 22,500 residents of Nijmegen were selected at r and om and interviewed by question naire . Data on 9062 respondents ( 43 % response ) were analysed , taken into account age , gender and concomitant disease . Subjects were classified into four groups : not fatigued ( NF , reference group ) , short-term fatigue ( SF , < 6 months ) , chronic fatigue ( CF , > or=6 months ) and CFS-like fatigue ( in accordance with the Center for Disease Control criteria for CFS , without clinical confirmation ) . RESULTS Our study population showed the following breakdown : NF 64.4 % ( 95 % CI 63.6 - 65.6 % ) , SF 4.9 % ( 95 % CI 4.5 - 5.4 % ) , CF 30.5 % ( 95 % CI 29.5 - 31.4 % ) and CFS-like fatigue 1.0 % ( 95 % CI 0.8 - 1.2 % ) . Compared with the NF group , more of the CFS respondents were female [ odds ratio ( OR ) = 1.9 ] , obese ( OR = 4.1 ) , using analgesics ( OR = 7.8 ) , had a low alcohol intake ( OR = 0.4 ) , were eating less healthy food ( OR = 0.5 ) and were physically less active ( OR = 0.1 ) . These associations largely applied to the SF and CF group . The fatigue could have been due to a concomitant disease in 34 and 55.5 % of the SF and CF cases , respectively . CONCLUSION The prevalence of CF in the general population appears to be much higher than previously indicated . Even with strict criteria for CFS , it is estimated that approximately 1 % of the adult population experiences this condition . Interestingly , a large part of this group remains unrecognized by the general practitioner . A striking similarity in lifestyle pattern between SF , CF and CFS calls for further research
Limited evidence was found for the psychometric properties and clinical usability of these instruments .
However , the CFS-activities and participation question naire ( APQ ) is a disease-specific instrument with moderate content and construct validity .
PURPOSE To summarize measurement instruments used to evaluate activity limitations and participation restrictions in patients with chronic fatigue syndrome ( CFS ) and review the psychometric properties of these instruments .
Chronic fatigue syndrome causes activity limitations and participation restrictions in one or more areas of life .