Skip to main content
Top
Published in: International Journal of Behavioral Medicine 2/2015

01-04-2015

Effects of a Self-regulation Based Physical Activity Program (The “4-STEPS”) for Unexplained Chronic Fatigue: a Randomized Controlled Trial

Authors: M. Marques, V. De Gucht, I. Leal, S. Maes

Published in: International Journal of Behavioral Medicine | Issue 2/2015

Login to get access

Abstract

Background

This study aimed at assessing the effects of a self-regulation-based brief physical activity program for patients suffering from unexplained chronic fatigue, the “4-STEPS to control your fatigue program”.

Method

A 12-week randomized controlled trial was conducted. Adult patients meeting the CDC criteria for idiopathic chronic fatigue were randomized to either the control condition (standard care) or the intervention condition (4-STEPS). The 4-STEPS was based on self-regulation principles and consisted of motivational interviewing and self-regulation skills training. All patients were assessed at baseline and post-treatment (12 weeks) for fatigue severity (primary outcome) and impact, physical activity (leisure time physical activity, number of daily steps and personal activity goal progress), health-related quality of life, somatic distress and psychological distress (depression and anxiety).

Results

Ninety-one patients (45 intervention and 46 control patients) received the allocated intervention. At post-treatment, statistical analysis revealed a significant difference for subjective experience of fatigue (4.73 points; g = 0.51) in favour of the intervention group. Mixed design ANCOVAs showed a significant effect of the 4-STEPS on fatigue severity, leisure time physical activity, personal activity goal progress and health-related quality of life. No significant effects were found for number of daily steps and somatic and psychological distress.

Conclusion

The 4-STEPS program has significant beneficial effects at post-treatment. This brief self-regulation-based intervention looks promising for the management of unexplained chronic fatigue.
Trial Registration: ISRCTN70763996
Literature
1.
go back to reference Fukuda K, Strauss S, Hickie I, Sharpe M, Dobbins J, Komaroff A. The chronic fatigue syndrome: a comprehensive approach to its definition and study. Ann Intern Med. 1994;121:953–9.CrossRefPubMed Fukuda K, Strauss S, Hickie I, Sharpe M, Dobbins J, Komaroff A. The chronic fatigue syndrome: a comprehensive approach to its definition and study. Ann Intern Med. 1994;121:953–9.CrossRefPubMed
3.
6.
go back to reference Nijs J, Wallman K, Paul L. Chronic fatigue syndrome. In: Saxton JM, editor. Exercise and chronic disease: an evidence-based approach. New York: Routledge; 2011. p. 322–38. Nijs J, Wallman K, Paul L. Chronic fatigue syndrome. In: Saxton JM, editor. Exercise and chronic disease: an evidence-based approach. New York: Routledge; 2011. p. 322–38.
7.
go back to reference National Institute for Health and Clinical Excellence (NICE). Clinical guideline 53. Chronic fatigue syndrome/myalgic encephalomyelitis or encephalopathy: diagnosis and management of CFS/ME in adults and children. London; 2007. National Institute for Health and Clinical Excellence (NICE). Clinical guideline 53. Chronic fatigue syndrome/myalgic encephalomyelitis or encephalopathy: diagnosis and management of CFS/ME in adults and children. London; 2007.
8.
go back to reference Edmonds L, McGuire L, Price J. Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev. 2004;3, CD003200.PubMed Edmonds L, McGuire L, Price J. Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev. 2004;3, CD003200.PubMed
9.
go back to reference Price J, Mitchell E, Tidy E, Hunot V. Cognitive behaviour therapy for chronic fatigue syndrome in adults. Cochrane Database Syst Rev. 2008;3, CD001027.PubMed Price J, Mitchell E, Tidy E, Hunot V. Cognitive behaviour therapy for chronic fatigue syndrome in adults. Cochrane Database Syst Rev. 2008;3, CD001027.PubMed
13.
15.
go back to reference Carver CS, Scheier MF. On the self-regulation of behavior. New York: University Press; 1998.CrossRef Carver CS, Scheier MF. On the self-regulation of behavior. New York: University Press; 1998.CrossRef
17.
go back to reference Michie S, Abraham C, Whittington C, McAteer J, Gupta S. Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychol. 2009;28(6):690–701. doi:10.1037/a0016136.CrossRefPubMed Michie S, Abraham C, Whittington C, McAteer J, Gupta S. Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychol. 2009;28(6):690–701. doi:10.​1037/​a0016136.CrossRefPubMed
18.
go back to reference Sniehotta FF, Scholz U, Schwarzer R. Bridging the intention–behaviour gap: planning, self-efficacy, and action control in the adoption and maintenance of physical exercise. Psychol Health. 2005;20(2):143–60. doi:10.1080/08870440512331317670.CrossRef Sniehotta FF, Scholz U, Schwarzer R. Bridging the intention–behaviour gap: planning, self-efficacy, and action control in the adoption and maintenance of physical exercise. Psychol Health. 2005;20(2):143–60. doi:10.​1080/​0887044051233131​7670.CrossRef
19.
go back to reference Janssen V, Gucht V, Exel H, Maes S. A self-regulation lifestyle program for post-cardiac rehabilitation patients has long-term effects on exercise adherence. J Behav Med. 2013:1–14. doi:10.1007/s10865-012-9489-y. Janssen V, Gucht V, Exel H, Maes S. A self-regulation lifestyle program for post-cardiac rehabilitation patients has long-term effects on exercise adherence. J Behav Med. 2013:1–14. doi:10.​1007/​s10865-012-9489-y.
20.
go back to reference Knittle K, Gucht V, Hurkmans E, et al. Targeting motivation and self-regulation to increase physical activity among patients with rheumatoid arthritis: a randomised controlled trial. Clinic Rheumat. 2013:1–8. doi:10.1007/s10067-013-2425-x. Knittle K, Gucht V, Hurkmans E, et al. Targeting motivation and self-regulation to increase physical activity among patients with rheumatoid arthritis: a randomised controlled trial. Clinic Rheumat. 2013:1–8. doi:10.​1007/​s10067-013-2425-x.
21.
go back to reference Miller W, Rolnick S. Motivational interviewing: helping people change. 3rd ed. NY: The Guiford Press; 2012. Miller W, Rolnick S. Motivational interviewing: helping people change. 3rd ed. NY: The Guiford Press; 2012.
22.
go back to reference Lundhal BW, Kunz C, Brownell C, Tollefson D, Burke BL. A meta-analysis of motivational interviewing: tewnty-five years of empirical studies. Res Social Work Pract. 2010;20(2):137–60. doi:10.1177/1049731509347850.CrossRef Lundhal BW, Kunz C, Brownell C, Tollefson D, Burke BL. A meta-analysis of motivational interviewing: tewnty-five years of empirical studies. Res Social Work Pract. 2010;20(2):137–60. doi:10.​1177/​1049731509347850​.CrossRef
23.
go back to reference Marques M, De Gucht V, Maes S, Leal I. 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. BMC Public Health. 2012;12(202). doi:10.1186/1471-2458-12-202 Marques M, De Gucht V, Maes S, Leal I. 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. BMC Public Health. 2012;12(202). doi:10.​1186/​1471-2458-12-202
24.
go back to reference American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription. 8th ed. Baltimore: Lippincott Williams & Williams; 2009. American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription. 8th ed. Baltimore: Lippincott Williams & Williams; 2009.
25.
go back to reference Wagner D, Nisenbaum R, Heim C, Jones JF, Unger ER, Reeves WC. Psychometric properties of the CDC symptom inventory for assessment of chronic fatigue syndrome. Popul Health Metrics. 2005;3:8. doi:10.1186/1478-7954-3-8.CrossRef Wagner D, Nisenbaum R, Heim C, Jones JF, Unger ER, Reeves WC. Psychometric properties of the CDC symptom inventory for assessment of chronic fatigue syndrome. Popul Health Metrics. 2005;3:8. doi:10.​1186/​1478-7954-3-8.CrossRef
26.
go back to reference De Marques M, Gucht V, Gouveia MJ, Cordeiro A, Maes S. Psychometric properties of the Portuguese version of the Checklist of Individual Strength (CIS20-P). Psychol Commun Health. 2013;22(1):11–8. doi:10.5964/pch.v2i1.57.CrossRef De Marques M, Gucht V, Gouveia MJ, Cordeiro A, Maes S. Psychometric properties of the Portuguese version of the Checklist of Individual Strength (CIS20-P). Psychol Commun Health. 2013;22(1):11–8. doi:10.​5964/​pch.​v2i1.​57.CrossRef
27.
go back to reference Vercoulen J, Alberets M, Bleijenberg G. De Checklist Individual Strength (CIS). Gedragstherapie. 1999;32:31–6. Vercoulen J, Alberets M, Bleijenberg G. De Checklist Individual Strength (CIS). Gedragstherapie. 1999;32:31–6.
28.
go back to reference De Vree B, van der Werf S, Prins J, Bazlmans E, Vercoulen J, Servaes P. Meetinstrumenten bij chronische vermoeidheid. Gedragstherapie. 2002;35:157–64. De Vree B, van der Werf S, Prins J, Bazlmans E, Vercoulen J, Servaes P. Meetinstrumenten bij chronische vermoeidheid. Gedragstherapie. 2002;35:157–64.
29.
go back to reference Cleeland C, Ryan K. Pain assessment: global use of the brief pain inventory. Ann Acad Med Singap. 1994;23:129–38.PubMed Cleeland C, Ryan K. Pain assessment: global use of the brief pain inventory. Ann Acad Med Singap. 1994;23:129–38.PubMed
31.
go back to reference Ainsworth B, Haskell W, Whitt M, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000;32 Suppl 9:498–504.CrossRef Ainsworth B, Haskell W, Whitt M, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000;32 Suppl 9:498–504.CrossRef
33.
go back to reference Welk GJ, Differding JA, Thompson RW, Blair SN, Dziura J, Hart P. The utility of the Digi-walker step counter to assess daily physical activity patterns. Med Sci Sports Exerc. 2000;32(9 Suppl):S481–8.CrossRefPubMed Welk GJ, Differding JA, Thompson RW, Blair SN, Dziura J, Hart P. The utility of the Digi-walker step counter to assess daily physical activity patterns. Med Sci Sports Exerc. 2000;32(9 Suppl):S481–8.CrossRefPubMed
35.
go back to reference Maes S, Karoly P, De Gucht V, Ruehlman LS, Heiser W: The self-regulation skills battery (SRSB). Leiden(NL)/Phoenix (AZ): Leiden University & Arizona State University; 2006. Maes S, Karoly P, De Gucht V, Ruehlman LS, Heiser W: The self-regulation skills battery (SRSB). Leiden(NL)/Phoenix (AZ): Leiden University & Arizona State University; 2006.
36.
go back to reference Ware JE, Kosinski M, Turner-Bowker DM, Gandek B. How to score version 2 of the SF-12® Health Survey. Lincoln: Quality Metric Incorporated; 2002. Ware JE, Kosinski M, Turner-Bowker DM, Gandek B. How to score version 2 of the SF-12® Health Survey. Lincoln: Quality Metric Incorporated; 2002.
37.
go back to reference Kroenke K, Spitzer R, Williams J. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med. 2002;64:258–66.CrossRefPubMed Kroenke K, Spitzer R, Williams J. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med. 2002;64:258–66.CrossRefPubMed
38.
go back to reference Degoratis L. Brief Symptom Inventory: administration, scoring and procedures manual. 4th ed. Minneapolis: National Computer System; 1993. Degoratis L. Brief Symptom Inventory: administration, scoring and procedures manual. 4th ed. Minneapolis: National Computer System; 1993.
39.
go back to reference Faul F, Erdfelder E, Lang A, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioural and biomedical sciences. Behav Res Methods. 2007;39:175–91. doi:10.3758/BF03193146.CrossRefPubMed Faul F, Erdfelder E, Lang A, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioural and biomedical sciences. Behav Res Methods. 2007;39:175–91. doi:10.​3758/​BF03193146.CrossRefPubMed
40.
go back to reference Stulemeijer M, de Jong L, Fiselier T, Hoogveld S, Bleijenberg G. Cognitive behaviour therapy for adolescents with chronic fatigue syndrome: randomised controlled trial. BMJ. 2005;330(7495):820. doi:10.1136/bmj.38301.587106.63. Stulemeijer M, de Jong L, Fiselier T, Hoogveld S, Bleijenberg G. Cognitive behaviour therapy for adolescents with chronic fatigue syndrome: randomised controlled trial. BMJ. 2005;330(7495):820. doi:10.​1136/​bmj.​38301.​587106.​63.
41.
go back to reference Hedges LV. Distribution Theory for glass’s estimator of effect size and related estimators. J Educ Behav Stat. 1981;6(2):107–28.CrossRef Hedges LV. Distribution Theory for glass’s estimator of effect size and related estimators. J Educ Behav Stat. 1981;6(2):107–28.CrossRef
43.
go back to reference Vos-Vromans DC, Smeets RJ, Rijnders LJ, et al. Cognitive behavioural therapy versus multidisciplinary rehabilitation treatment for patients with chronic fatigue syndrome: study protocol for a randomised controlled trial (FatiGo). Trials. 2012;13(1):71. doi:10.1186/1745-6215-13-71.CrossRefPubMedCentralPubMed Vos-Vromans DC, Smeets RJ, Rijnders LJ, et al. Cognitive behavioural therapy versus multidisciplinary rehabilitation treatment for patients with chronic fatigue syndrome: study protocol for a randomised controlled trial (FatiGo). Trials. 2012;13(1):71. doi:10.​1186/​1745-6215-13-71.CrossRefPubMedCentralPubMed
45.
go back to reference Wallman K, Morton A, Goodman C, Grove R, Guilfoyle A. Randomised controlled trial of graded exercise in chronic fatigue syndrome. Med J Aust. 2004;180(9):444–8.PubMed Wallman K, Morton A, Goodman C, Grove R, Guilfoyle A. Randomised controlled trial of graded exercise in chronic fatigue syndrome. Med J Aust. 2004;180(9):444–8.PubMed
Metadata
Title
Effects of a Self-regulation Based Physical Activity Program (The “4-STEPS”) for Unexplained Chronic Fatigue: a Randomized Controlled Trial
Authors
M. Marques
V. De Gucht
I. Leal
S. Maes
Publication date
01-04-2015
Publisher
Springer US
Published in
International Journal of Behavioral Medicine / Issue 2/2015
Print ISSN: 1070-5503
Electronic ISSN: 1532-7558
DOI
https://doi.org/10.1007/s12529-014-9432-4

Other articles of this Issue 2/2015

International Journal of Behavioral Medicine 2/2015 Go to the issue