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Exercise helps overcome chronic fatigue associated with arthritis and other inflammatory diseases, a study shows. Photo: Shutterstock

Exercise and CBT relieve chronic fatigue from arthritis and other inflammatory diseases, study shows

  • Inflammatory rheumatic diseases including arthritis affect up to 14 million people globally, and many live with chronic fatigue. Drugs are often of no help
  • A study shows patients who had exercise or therapy sessions suffered less fatigue for up to six months, and had better sleep, mental health and quality of life

Millions of people with conditions such as arthritis could combat symptoms of fatigue with exercise and talking therapy, a new study suggests.

People with inflammatory rheumatic diseases – which include rheumatoid arthritis, lupus and axial spondylitis – could benefit from the treatments and they should be used as part of routine care, experts said.

In the UK, about 800,000 people suffer from these conditions and four in five of these (80 per cent) live with fatigue every day, affecting their ability to concentrate, work, and live independently.

Research has previously pointed to around 460 out of every 100,000 people around the world being diagnosed with rheumatoid arthritis. Up to 14 million people around the world have rheumatoid arthritis, according to the WHO.

Chronic pain can be caused by arthritis, and a number of other inflammatory diseases. Photo: Shutterstock
The new study, published in Lancet Rheumatology, examined how to improve fatigue among these patients. Researchers from the universities of Aberdeen and Glasgow in Scotland, funded by charity Versus Arthritis, compared three different types of care, as provided to 368 people with various inflammatory rheumatic diseases.

Participants were either given telephone-delivered physical activity programmes, cognitive behavioural therapy (CBT), or received their usual care.

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Those in the exercise group had five one-on-one 45-minute sessions over 30 weeks, while those who had talk therapy received an average of eight sessions over the same period and the usual care group were given an education booklet on fatigue.

The researchers found that those who had talk therapies or exercise therapy had significantly reduced fatigue levels compared to those receiving usual care.

The benefits continued for six months following completion of the courses of treatment. And people who were offered these interventions also reported improved sleep, mental health and quality of life, compared to those who received usual care.

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Wendy Booth, 57, from Pitmedden in Aberdeenshire, Scotland, had to give up her job as a psychiatric nurse at Royal Cornhill Hospital in Aberdeen as a result of the effects of lupus and Sjogren’s syndrome – an immune system disorder whose common symptoms are dry eyes and a dry mouth.

“The fatigue really affects what you can do. If I do some work in the garden one day, I know I’ll pay for it the next,” she says.

Booth, who received physical activity sessions as part of the study, adds: “The physio called me about once a fortnight and it really encouraged me. I feel like it (the study) helped give me purpose.”

Cognitive behavioural therapy sessions online helped arthritis sufferers overcome chronic fatigue. Photo: Shutterstock

“I joined a gym and I have a good instructor who understands my abilities and gives me modified exercises so I can carry on in the same class along with everyone else.

“Mentally I feel stronger and physically – my motto is ‘I want to keep what I’ve got’ rather than deteriorate.”

Lead investigator Professor Neil Basu, who carried out the majority of the research at the University of Aberdeen, and is now at the University of Glasgow, says: “Our study provides new evidence that some non-pharmacological interventions can be successfully and effectively delivered by non-specialist members of the clinical service.”

Lead investigator Professor Neil Basu. Photo: University of Glasgow

It has been encouraging to see that the interventions have led to improvements for participants even six months after the end of the treatment, Basu adds.

“It’s also great to see that these steps were impactful even when delivered via telephone. Since the onset of the pandemic, healthcare services are being reimagined to incorporate greater remote care; however, the evidence base to support this shift has generally been limited.”
Dr Neha Issar-Brown, director of research and health intelligence at Versus Arthritis, says: “Fatigue and chronic pain go hand in hand as the twin challenges for people living with inflammatory rheumatic diseases such as rheumatoid arthritis and lupus. But fatigue tends not to respond to medicines for these conditions, and often goes unrecognised by clinicians.”
Dr Neha Issar-Brown is director of research and health intelligence at the charity Versus Arthritis. Photo: Versus Arthritis

She stresses the urgent and unmet need for more evidence-based interventions including better access to non-drug treatments – like cognitive behavioural therapies and supported physical activity – so more people with inflammatory rheumatic diseases can retain their independence, stay in work, and enjoy better mental health, which these conditions can cruelly take away.

“The study’s implementation across the health service would give people with inflammatory arthritis and related conditions access to the support they need to manage fatigue while producing long-lasting improvements to their mental health.”

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