title: A randomized controlled trial of group aerobic exercise in primary care patients with persistent, unexplained physical symptoms.
abstract: BACKGROUND
  The management of persistent, unexplained physical symptoms is challenging and often unsatisfactory for patients and doctors. Aerobic exercise training has benefited patients referred to secondary care with symptoms of chronic fatigue and fibromyalgia. It is not known if this approach is either possible or beneficial for patients with the broader range of persistent, unexplained symptoms found in primary care.
  
  
  OBJECTIVE
  To examine the feasibility and effects of aerobic exercise training in primary care patients with unexplained physical symptoms persisting more than 12 months.
  
  
  METHODS
  Randomized comparison (n = 228) of aerobic exercise with stretching as control among patients recruited from primary care. Training comprised 20, one-hour, sessions led by NHS physiotherapists. Adherence to training was recorded along with two groups of outcome measures: (i) documented symptoms and health care use, monitored from six months before to six months after training; and (ii) self-reported measures including emotional state and perceived disability, assessed before, during and six months after training.
  
  
  RESULTS
  Exercise training proved feasible: more than 70% of referred patients attended for assessment and were randomized to aerobic or control exercise; 78% of eligible patients attended the first session; and median attendance was 11 sessions for both programmes. Primary care consultations and prescriptions were significantly reduced in the 6 months after training; extent of reduction was related to attendance at training sessions, irrespective of type. Whilst self-reported measures improved similarly during both training programmes, improvements were unrelated to level of attendance.
  
  
  CONCLUSIONS
  For primary care patients with persistent, unexplained physical symptoms willing to be involved in exercise training, aerobic exercise offers no benefits over non-aerobic exercise. Whilst the observed reduction in primary health care use following exercise training is potentially of practical importance in a group of patients characterized by high consultation rates, improvement in patients' subjective state was not clearly attributable to exercise training.
authors.affiliation: Department of Psychiatry, University of Liverpool, UK. speters@liv.ac.uk
authors.forename: Sarah
authors.initials: S
authors.lastname: Peters
authors.forename: Ian
authors.initials: I
authors.lastname: Stanley
authors.forename: Mike
authors.initials: M
authors.lastname: Rose
authors.forename: Sue
authors.initials: S
authors.lastname: Kaney
authors.forename: Peter
authors.initials: P
authors.lastname: Salmon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002648:Child; D005081:Exercise Therapy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011320:Primary Health Care; D013001:Somatoform Disorders / Q000628:therapy*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome