Research abstract

Unexplained Chronic Fatigue (CF) is of unknown aetiology, but research suggests a multifactorial nature in which biological/physical, psychological and social fators interact.

Treatment approaches for CF target mainly perpetuating factors of fatigue chronicity, such as lack of physical activity. This thesis describes a brief self-regulation-based intervention targeting physical activity for patients with CF.

Prior to this intervention study we conducted a series of studies that were important for the development of the trial:

(1) a validation of a measure of fatigue severity for the language and population in which we intended to implement the intervention,

(2) a comparison of clinical characteristics and behavioural and cognitive determinants of CFS in a Dutch and a Portuguese patient sample, and

(3) a systematic review and meta-analysis of behavioural interventions with a graded activity component conducted with CF patients.

In a randomized controlled trial (n=91), the self-regulation based intervention led to significant sustained effects (1 year) on fatigue severity, quality of life and physical activity. Sustained benefits on fatigue severity were partially explained by progress on a personal physical activity goal, and use of self-regulation skills. Findings are discussed in terms of its implications for practice, methodological considerations and avenues for future research.

Concluding Remarks
The scope of this thesis was on the behavioral and selfregulatory factors associated with health behavior change and chronic fatigue management.

Informed by preliminary investigations, we developed and implemented a self-regulation based intervention targeting physical activity for CF(S) patients, the “4-STEPS to control your Fatigue”.

The 4-STEPS program, which was tested in a multicentre randomised controlled trial, lead to significant and sustained improvements in fatigue and in patients’ functioning and quality of life. The 4-STEPS also produced significant effects on the use of self-regulation skills and physical activity, especially progress towards a personal physical activity goal, partially explaining the sustained effects of the intervention upon fatigue severity.

Nonetheless, the 4-STEPS also presented limited effects for some of the outcomes assessed.

The limitations of each of the six empirical studies that were reviewed in this chapter point at the need to conduct more research on the behavioural and psychological mechanisms involved in CF(S) management. In spite of these limitations, we believe that this thesis positively contributes to the advance of
disease management in CF(S) patients.

Self-regulation, physical activity and unexplained chronic fatigue: from determinants to interventions, by Marta Moreira Marques, Phd thesis Leiden University, The Netherlands, January 13, 2015

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