title: Heart rate variability biofeedback therapy and graded exercise training in management of chronic fatigue syndrome: An exploratory pilot study.
abstract: Chronic fatigue syndrome (CFS) is characterised by persistent fatigue, exhaustion, and several physical complaints. Research has shown cognitive behavioural therapy (CBT) and graded exercise training (GET) to be the most effective treatments. In a first step we aimed to assess the efficacy of heart rate variability biofeedback therapy (HRV-BF) as a treatment method comprising cognitive and behavioural strategies and GET in the pilot trial. In a second step we aimed to compare both interventions with regard to specific parameters.
  
  
  
  The study was conducted in an outpatient treatment setting. A total of 28 women with CFS (50.3±9.3years) were randomly assigned to receive either eight sessions of HRV-BF or GET. The primary outcome was fatigue severity. Secondary outcomes were mental and physical quality of life and depression. Data were collected before and after the intervention as well as at a 5-month follow-up.
  
  
  
  General fatigue improved significantly after both HRV-BF and GET. Specific cognitive components of fatigue, mental quality of life, and depression improved significantly after HRV-BF only. Physical quality of life improved significantly after GET. There were significant differences between groups regarding mental quality of life and depression favouring HRV-BF.
  
  
  
  Both interventions reduce fatigue. HRV-BF seems to have additional effects on components of mental health, including depression, whereas GET seems to emphasise components of physical health. These data offer implications for further research on combining HRV-BF and GET in patients with CFS.
  
  
  
  The described trial has been registered at the International Clinical Trials Registry Platform following the number DRKS00005445.
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Hospital, University of Tuebingen, Germany. Electronic address: petra.windthorst@med.uni-tuebingen.de.
authors.forename: Petra
authors.initials: P
authors.lastname: Windthorst
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Hospital, University of Tuebingen, Germany. Electronic address: nazar.mazurak@gmail.com.
authors.forename: Nazar
authors.initials: N
authors.lastname: Mazurak
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Hospital, University of Tuebingen, Germany. Electronic address: marvin.kuske@gmx.de.
authors.forename: Marvin
authors.initials: M
authors.lastname: Kuske
authors.affiliation: Department of Sports Medicine, University Hospital, University of Tuebingen, Germany. Electronic address: arno.hipp@uni-tuebingen.de.
authors.forename: Arno
authors.initials: A
authors.lastname: Hipp
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Hospital, University of Tuebingen, Germany. Electronic address: katrin.giel@med.uni-tuebingen.de.
authors.forename: Katrin E
authors.initials: KE
authors.lastname: Giel
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Hospital, University of Tuebingen, Germany. Electronic address: paul.enck@uni-tuebingen.de.
authors.forename: Paul
authors.initials: P
authors.lastname: Enck
authors.affiliation: Department of Sports Medicine, University Hospital, University of Tuebingen, Germany. Electronic address: andreas.niess@med.uni-tuebingen.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Nieß
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Hospital, University of Tuebingen, Germany. Electronic address: stephan.zipfel@med.uni-tuebingen.de.
authors.forename: Stephan
authors.initials: S
authors.lastname: Zipfel
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Hospital, University of Tuebingen, Germany. Electronic address: martin.teufel@med.uni-tuebingen.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Teufel
mesh_terms: D000328:Adult; D001676:Biofeedback, Psychology / Q000379:methods*; D003131:Combined Modality Therapy; D005081:Exercise Therapy / Q000379:methods*; D015673:Fatigue Syndrome, Chronic / Q000523:psychology* / Q000534:rehabilitation*; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects
keywords: Chronic fatigue syndrome; Depression; Graded exercise training; Heart rate variability biofeedback; Quality of life