Table 4.

Effect of non-pharmacological interventions on fatigue in patients with RMDs, as reported in Cochrane reviews

Cochrane review*	Year of publication	RMD	Type of intervention	Reported effect of intervention on fatigue† (reported quality of evidence)
			Physical exercise interventions
Cramp et al	2013	RA	Physical exercise vs usual care (Pool based therapy, yoga, dynamic strength training, stationary cycling, low impact aerobics and Tai Chi)	Small effect (M)
Regnaux et al20	2019	SpA	Exercise programmes vs no intervention	No effect (VL) Reduction in fatigue (one study) (VL)
			Resistance exercise therapy
Busch et al	2013	FM	Resistance training vs usual care or flexibility exercise	Large effects (NR)
		FM	Resistance training vs aerobic training	No effect (NR)
			Whole body vibration (WBV) therapy
Bidonde et al	2017	FM	WBV therapy plus mixed exercise vs placebo plus mixed exercise or other exercise	Reduction that met the threshold for clinical relevance (VL)
			Meditative movement therapies therapy (MMT) (eg, Ai Chi, Tai Chi, Yoga awareness, Bat, Qi-Gong, Water yoga)
Theadom et al	2015	FM	MMT vs usual care	Advantageous (VL)
			Mixed exercise training (two or more components of physical exercise)
Bidonde et al	2019	FM	Mixed exercise training vs no exercise	More improvement postintervention, but at long-term follow-up only one-third studies showed an effect (M)
		FM	Mixed exercise vs self-help programmes, or cognitive-behavioural therapy, or biofeedback, or medication, or aerobic exercise only	No effect (VL)
		FM	Mixed exercise plus education vs education alone	No effect (VL)
		FM	Mixed exercise (aerobic+flexibility) vs mixed exercise (resistance+aerobic+flexibility)	No effect (VL)
		FM	Mixed exercise (callisthenics+aerobic+flexibility) vs mixed exercise (resistance+flexibility+posture exercise)	No effect (VL)
			Aerobics exercise (eg, cycling, walking, regardless of frequency, duration or intensity)
Bidonde et al	2017	FM	Aerobics vs controls (treatment as usual, wait list control, daily activities)	No effect (one study) (VL) Significant effect (two studies) at long-term follow-up (VL)
		FM	Aerobics (Nordic walking) vs aerobics (low-intensity training)	No effect (L)
		FM	Aerobics vs other non-exercise interventions	No effect (L)
Busch et al	2007	FM	Aerobics at American College of Sport Medicine levels	No effect (VL)
			Aquatic exercise therapy
Bidonde et al	2014	FM	Aquatic exercise vs controls (treatment as usual, balneotherapy or education)	No effect (NR)
		FM	Aquatic exercise vs land-based training	No effect (NR)
		FM	Aquatic exercise (Tai Chi) vs aquatic exercise (stretching)	No effect (NR)
		FM	Aquatic exercise in outdoor pool vs aquatic exercise in sea water (effects of salinity of water)	No effect (NR)
			Flexibility exercise therapy
Kim et al	2019	FM	Flexibility exercise vs land-based aerobic exercise, untreated controls, resistance training, Tai Chi or aquatic biodanza	No effect (VL)
			Psychosocial interventions
Cramp et al	2013	RA	Psychosocial interventions vs usual care (including benefit finding, expressive writing, cognitive behavioural therapy, mindfulness, lifestyle management, energy conservation, self-management and group education)	Small effect (L)
			Mind and body therapy
Theadom et al	2015	FM	Psychological therapies vs attention care or usual care	No effect (VL)
		FM	Relaxation-based therapies vs usual care	No effect (VL)
			Complementary interventions and complementary medicine
Cramp et al	2013	RA	Herbal medicine: Andrographis paniculata vs placebo	No effect (L)
		RA	Reflexology: Reflexology vs a non-specific foot massage	Greater mean reduction (L)
			Acupuncture
Deare et al	2013	FM	Real acupuncture vs non-acupuncture treatment	Significant difference (L)
		FM	Real acupuncture vs placebo or sham acupuncture	No effect (M)
		FM	Deep invasive needling with stimulation vs deep invasive needling without stimulation	No effect (NR)
			Transcutaneous electrical nerve stimulation (TENS)
Johnson et al	2017	FM	TENS vs placebo TENS, no treatment or waiting list control	Reduced fatigue with movement, but not at rest (VL)
		FM	TENS added to exercise vs exercise alone (usual care)	Clinically important improvements (VL)
		FM	TENS vs other treatment	Clinically important improvements (VL)
			Lifestyle interventions
Cramp et al	2013	RA	Diet interventions: Mediterranean diet vs Western diet	Improvement in intervention group‡ (L)
		RA	Diet interventions: Omega-3 fatty acid supplementation	Improvements between baseline and follow-up (L)
		RA	Providing health information: Data tracker vs usual care	Small improvements between baseline and follow-up (L)

*Complete references are provided in online supplemental file S14–S17, as well as results of non-Cochrane systematic reviews and narrative reviews.

†Effect always refers to a reduction of fatigue compared to controls, unless otherwise indicated.

‡Between-arm comparisons were not reported.

FM, fibromyalgia; L, low; M, moderate; NR, not reported; RA, rheumatoid arthritis; RMDs, rheumatic and musculoskeletal diseases; SpA, spondyloarthritis; VL, very low.