Exploring effective interventions for medically-unexplained fatigue states.

Download files
Access & Terms of Use
open access
Embargoed until 2018-06-30
Copyright: Sandler, Carolina
Altmetric
Abstract
Despite several decades of hypothesis driven research into the pathophysiology of chronic fatigue syndrome (CFS) and post cancer fatigue (PCF), the biological basis of these medically-unexplained fatigue states remains largely unknown. Although numerous placebo-controlled pharmacological trials have been conducted no curative treatment has been identified. This thesis explores effective interventions for the management of medically-unexplained fatigue disorders (CFS and PCF) in an observational clinical study, a randomised control trial, and an experimental study to explore the impact of varied exercise protocols on the fatigue state. The first study describes the evaluation of an individualised, modularised, 12-week, 11-session, multi-disciplinary cognitive behavioural therapy (CBT) and graded exercise therapy (GET) intervention delivered by exercise physiologists and clinical psychologists (n=264). The intervention was successfully applied and evaluated in a real-world setting. The second study was based on the strong similarities between PCF and CFS and hence the likelihood of similar responses to CBT and GET therapy. A randomised controlled trial (n=46) for patients with PCF was conducted in the outpatient setting comparing the CBT and GET intervention, with an education package. The CBT and GET intervention was more effective for patients with PCF. Both studies showed improvements in the primary outcome of self-reported fatigue validated by consistent changes in physical functioning and secondary outcomes of self-reported mood and social functioning. However, only a minority of patients experienced clinically-significant improvements in fatigue and function. Therefore, to explore possible means of enhancing the effectiveness of the GET intervention, high-intensity interval exercise was investigated in comparison to continuous exercise in patients with CFS in a randomised cross-over challenge study. This exercise-laboratory-based experiment showed that the two different exercise protocols of matched mechanical work induced comparable patterns of post-exertional exacerbation of fatigue and reduced functional status. Further studies to enhance response rates and the magnitude of improvement associated with CBT and GET are recommended.
Persistent link to this record
Link to Publisher Version
Link to Open Access Version
Additional Link
Author(s)
Sandler, Carolina
Supervisor(s)
Lloyd, Andrew
Barry, Benjamin
Creator(s)
Editor(s)
Translator(s)
Curator(s)
Designer(s)
Arranger(s)
Composer(s)
Recordist(s)
Conference Proceedings Editor(s)
Other Contributor(s)
Corporate/Industry Contributor(s)
Publication Year
2015
Resource Type
Thesis
Degree Type
PhD Doctorate
UNSW Faculty
Files
download public version.pdf 2.18 MB Adobe Portable Document Format
Related dataset(s)