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Key Takeaways 

  • Talk therapy and physical exercise guidance can be effectively administered remotely.
  • Fatigue is a common problem for people with many chronic health conditions, including inflammatory arthritis.
  • Participating in cognitive behavioral therapy or a personalized exercise program may help.

An estimated 80 percent of people with inflammatory rheumatic diseases are plagued by fatigue. Fatigue is much more than just being tired. It’s an often-debilitating symptom that can interfere with your job, relationships, and activities of daily living — and harm your overall quality of life. Perhaps the worst part: There aren’t any quick and easy ways to treat it.  

Experts often advise people who are bothered by fatigue to get more physical activity, as well as take steps to manage their stress and reframe negative thoughts about their condition (which may entail working with a mental health provider). Unfortunately, things like time, money, and lack of know-how can get in the way.  

With these concerns in mind, a group of researchers from England and Scotland set out to determine whether two non-drug interventions — talk therapy and exercise — could have a significant impact on people with inflammatory rheumatic diseases. What’s more, they wanted to find out whether these interventions could be administered remotely via telephone.  

In the study, which was published in The Lancet, researchers took a group of 367 inflammatory rheumatic disease patients with persistent fatigue and randomly assigned them to one of three groups: cognitive behavioral therapy, personalized exercise program, or usual care. (The “usual care” group received a Versus Arthritis booklet about fatigue, as did those in the therapy and exercise groups). 

People in the therapy and exercise groups had up to seven private telephone sessions with a provider who worked with them for up to 45 minutes at a time. Those in the therapy group focused on targeting “unhelpful beliefs and behaviors and aimed to replace them with more adaptive ones.” Participants in the exercise group received individually-tailored advice about routines and activities.  

Participants in the two intervention groups had these phone sessions over the course of 14 weeks; they also had a “booster” session at week 22.  

After 56 weeks, all participants were assessed using the Chalder Fatigue Scale and the Fatigue Severity Scale. According to the findings, people in the therapy and exercise groups had significant improvements in fatigue.  

“Telephone-delivered [cognitive behavioral therapy] and [personalized exercise training] produced and maintained statistically and clinically significant reductions in the severity and impact of fatigue in a variety of inflammatory rheumatic diseases,” the authors wrote. “These interventions should be considered as a key component of inflammatory rheumatic disease management in routine clinical practice.” 

They explained that both interventions were safe, effective, and worked better than the usual care (just getting a booklet about fatigue). Also promising: The benefits were maintained for at least six months after treatment completion, and patients also reported improved mental-health related quality of life and sleep. Those in the exercise group had lowered levels of work disability and depression, too. 

The fact that these interventions were administered remotely is also noteworthy, especially in light of the COVID pandemic. It suggests that patients and providers can successfully interact despite lack of in-person contact, which means that patients with contagion concerns, transportation issues, or just a busy schedule can more easily get the help they need. 

What This Means for You

Don’t ignore fatigue; ask your doctor to assess your medications as well as your lifestyle habits. Your doctor, physical therapist, or occupational therapist can work with you to start or change your current exercise routine with an eye on upping your energy level. You may also consider talk therapy to help you manage stress and reframe your thinking in a way that translates to less fatigue.  

Want to Get More Involved with Patient Advocacy? 

The 50-State Network is the grassroots advocacy arm of CreakyJoints and the Global Healthy Living Foundation, comprised of patients with chronic illness who are trained as health care activists to proactively connect with local, state, and federal health policy stakeholders to share their perspectives and influence change. If you want to effect change and make health care more affordable and accessible to patients with chronic illness, learn more here.  

Thombs, Brett D, et al. “Addressing Fatigue in Inflammatory Rheumatic Diseases.” The Lancet Rheumatology. June 2022. doi: https://doi.org/10.1016/S2665-9913(22)00182-5. 

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