title: Randomised controlled trial of patient education to encourage graded exercise in chronic fatigue syndrome.
abstract: OBJECTIVE
  To assess the efficacy of an educational intervention explaining symptoms to encourage graded exercise in patients with chronic fatigue syndrome.
  
  
  METHODS
  Randomised controlled trial.
  
  
  METHODS
  Chronic fatigue clinic and infectious diseases outpatient clinic.
  
  
  METHODS
  148 consecutively referred patients fulfilling Oxford criteria for chronic fatigue syndrome.
  
  
  METHODS
  Patients randomised to the control group received standardised medical care. Patients randomised to intervention received two individual treatment sessions and two telephone follow up calls, supported by a comprehensive educational pack, describing the role of disrupted physiological regulation in fatigue symptoms and encouraging home based graded exercise. The minimum intervention group had no further treatment, but the telephone intervention group received an additional seven follow up calls and the maximum intervention group an additional seven face to face sessions over four months.
  
  
  METHODS
  A score of >/=25 or an increase of >/=10 on the SF-36 physical functioning subscale (range 10 to 30) 12 months after randomisation.
  
  
  RESULTS
  21 patients dropped out, mainly from the intervention groups. Intention to treat analysis showed 79 (69%) of patients in the intervention groups achieved a satisfactory outcome in physical functioning compared with two (6%) of controls, who received standardised medical care (P<0.0001). Similar improvements were observed in fatigue, sleep, disability, and mood. No significant differences were found between the three intervention groups.
  
  
  CONCLUSIONS
  Treatment incorporating evidence based physiological explanations for symptoms was effective in encouraging self managed graded exercise. This resulted in substantial improvement compared with standardised medical care.
authors.affiliation: Regional Infectious Diseases Unit, University Hospital Aintree, Liverpool L9 7AL.
authors.forename: P
authors.initials: P
authors.lastname: Powell
authors.forename: R P
authors.initials: RP
authors.lastname: Bentall
authors.forename: F J
authors.initials: FJ
authors.lastname: Nye
authors.forename: R H
authors.initials: RH
authors.lastname: Edwards
mesh_terms: D000328:Adult; D005081:Exercise Therapy / Q000379:methods*; D015673:Fatigue Syndrome, Chronic / Q000523:psychology / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D010353:Patient Education as Topic / Q000379:methods*; D016896:Treatment Outcome