Abstract
Simple rehabilitative strategies are proposed to help patients with the chronic fatigue syndrome. A model is outlined of an acute illness giving way to a chronic fatigue state in which symptoms are perpetuated by a cycle of inactivity, deterioration in exercise tolerance and further symptoms. This is compounded by the depressive illness that is often part of the syndrome. The result is a self-perpetuating cycle of exercise avoidance. Effective treatment depends upon an understanding of the interaction between physical and psychological factors. Cognitive behavioural therapy is suggested. Cognitive therapy helps the patient understand how genuine symptoms arise from the frequent combination of physical inactivity and depression, rather than continuing infection, while a behavioural approach enables the treatment of avoidance behaviour and a gradual return to normal physical activity.
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Selected References
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- Archer M. I. The post-viral syndrome: a review. J R Coll Gen Pract. 1987 May;37(298):212–214. [PMC free article] [PubMed] [Google Scholar]
- Baekeland F. Exercise deprivation. Sleep and psychological reactions. Arch Gen Psychiatry. 1970 Apr;22(4):365–369. doi: 10.1001/archpsyc.1970.01740280077014. [DOI] [PubMed] [Google Scholar]
- Bell E. J., McCartney R. A., Riding M. H. Coxsackie B viruses and myalgic encephalomyelitis. J R Soc Med. 1988 Jun;81(6):329–331. doi: 10.1177/014107688808100609. [DOI] [PMC free article] [PubMed] [Google Scholar]
- David A. S., Wessely S., Pelosi A. J. Postviral fatigue syndrome: time for a new approach. Br Med J (Clin Res Ed) 1988 Mar 5;296(6623):696–699. doi: 10.1136/bmj.296.6623.696. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dorian B., Garfinkel P. E. Stress, immunity and illness--a review. Psychol Med. 1987 May;17(2):393–407. doi: 10.1017/s0033291700024958. [DOI] [PubMed] [Google Scholar]
- Edwards R. H. Muscle fatigue and pain. Acta Med Scand Suppl. 1986;711:179–188. doi: 10.1111/j.0954-6820.1986.tb08948.x. [DOI] [PubMed] [Google Scholar]
- Fegan K. G., Behan P. O., Bell E. J. Myalgic encephalomyelitis--report of an epidemic. J R Coll Gen Pract. 1983 Jun;33(251):335–337. [PMC free article] [PubMed] [Google Scholar]
- Greenleaf J. E., Kozlowski S. Physiological consequences of reduced physical activity during bed rest. Exerc Sport Sci Rev. 1982;10:84–119. [PubMed] [Google Scholar]
- Holmes G. P., Kaplan J. E., Gantz N. M., Komaroff A. L., Schonberger L. B., Straus S. E., Jones J. F., Dubois R. E., Cunningham-Rundles C., Pahwa S. Chronic fatigue syndrome: a working case definition. Ann Intern Med. 1988 Mar;108(3):387–389. doi: 10.7326/0003-4819-108-3-387. [DOI] [PubMed] [Google Scholar]
- IMBODEN J. B., CANTER A., CLUFF L. E. Convalescence from influenza. A study of the psychological and clinical determinants. Arch Intern Med. 1961 Sep;108:393–399. doi: 10.1001/archinte.1961.03620090065008. [DOI] [PubMed] [Google Scholar]
- Lethem J., Slade P. D., Troup J. D., Bentley G. Outline of a Fear-Avoidance Model of exaggerated pain perception--I. Behav Res Ther. 1983;21(4):401–408. doi: 10.1016/0005-7967(83)90009-8. [DOI] [PubMed] [Google Scholar]
- Lloyd A. R., Hales J. P., Gandevia S. C. Muscle strength, endurance and recovery in the post-infection fatigue syndrome. J Neurol Neurosurg Psychiatry. 1988 Oct;51(10):1316–1322. doi: 10.1136/jnnp.51.10.1316. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lloyd A. R., Wakefield D., Boughton C., Dwyer J. What is myalgic encephalomyelitis? Lancet. 1988 Jun 4;1(8597):1286–1287. doi: 10.1016/s0140-6736(88)92107-1. [DOI] [PubMed] [Google Scholar]
- Manu P., Matthews D. A., Lane T. J. The mental health of patients with a chief complaint of chronic fatigue. A prospective evaluation and follow-up. Arch Intern Med. 1988 Oct;148(10):2213–2217. [PubMed] [Google Scholar]
- Mechanic D. The concept of illness behaviour: culture, situation and personal predisposition. Psychol Med. 1986 Feb;16(1):1–7. doi: 10.1017/s0033291700002476. [DOI] [PubMed] [Google Scholar]
- Philips H. C. Avoidance behaviour and its role in sustaining chronic pain. Behav Res Ther. 1987;25(4):273–279. doi: 10.1016/0005-7967(87)90005-2. [DOI] [PubMed] [Google Scholar]
- Stephens T. Physical activity and mental health in the United States and Canada: evidence from four population surveys. Prev Med. 1988 Jan;17(1):35–47. doi: 10.1016/0091-7435(88)90070-9. [DOI] [PubMed] [Google Scholar]
- Szabadi E. Physical exercise and mental health. Br Med J (Clin Res Ed) 1988 Mar 5;296(6623):659–660. doi: 10.1136/bmj.296.6623.659-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Taerk G. S., Toner B. B., Salit I. E., Garfinkel P. E., Ozersky S. Depression in patients with neuromyasthenia (benign myalgic encephalomyelitis). Int J Psychiatry Med. 1987;17(1):49–56. doi: 10.2190/8r67-n9er-xr74-9ra7. [DOI] [PubMed] [Google Scholar]
- Taylor D. C. The components of sickness: diseases, illnesses, and predicaments. Lancet. 1979 Nov 10;2(8150):1008–1010. doi: 10.1016/s0140-6736(79)92573-x. [DOI] [PubMed] [Google Scholar]
- Williams P. Deciding how to treat - the relevance of psychiatric diagnosis. Psychol Med. 1979 Feb;9(1):179–186. doi: 10.1017/s0033291700021681. [DOI] [PubMed] [Google Scholar]
- Yousef G. E., Bell E. J., Mann G. F., Murugesan V., Smith D. G., McCartney R. A., Mowbray J. F. Chronic enterovirus infection in patients with postviral fatigue syndrome. Lancet. 1988 Jan 23;1(8578):146–150. doi: 10.1016/s0140-6736(88)92722-5. [DOI] [PubMed] [Google Scholar]