. 2013 Nov 29;15(6):221. doi: 10.1186/ar4395

Table 4.

Non-pharmacological strategies

Intervention	Design and sample	Scales used	Effect on fatigue
Conventional therapies
Cognitive behavioral therapy	One RCT comparing multidisciplinary treatment to treatment augmented with CBT (n = 83) of women with FM [71]	FIQ fatigue	Cannot draw conclusion
Exercise - aerobic exercise	1 single-arm study of women with FM, CFS, and CFIDS (n = 7) [72]	VAS fatigue	Cannot draw conclusion in single arm study, 2 meta-analyses found improvement, MCID cannot be determined
Exercise - aerobic exercise	2 meta-analyses of 28 RCTs (n = 2,494) [73] and 34 RCTs (n = 2,276) [74]	VAS fatigue
Exercise - strength training	1 RCT (n = 26) of postmenopausal women with FM [75]	VAS fatigue	Clinically meaningful improvement in 2 RCTs, cannot draw conclusion in 1 RCT
	1 double-arm study of aerobic versus strength training (n = 30) of women with FM [76]
	1 RCT (n = 21) of premenopausal women with FM [77]
Multicomponent/multidisciplinary treatment^a	2 single-arm studies (n = 305) of patients with FM [78,79], 4 RCTs (n = 513) of patients with FM [80-83], 1 RCT (n = 855) in patients with FM, OA, and RA [84]	FIQ fatigue	Clinically meaningful improvement in 4 RCTs, no clinically meaningful improvement in 3 RCTs
Multicomponent/multidisciplinary treatment^a	1 meta-analysis of 9 RCTs (n = 1119) [85]	VAS fatigue	Meta-analysis found no evidence for efficacy in long-term follow-up
Complementary and alternative medicine
Acupuncture	1 meta-analysis of 7 RCTs (median treatment time 9 sessions, n = 385) [86]		No improvement
Meditative movement therapies	1 meta-analysis of 7 RCTs (n = 362) [87]		Improvement overall, in subgroup analysis, only yoga improved fatigue

^aMultidisciplinary treatments varied between studies but typically included education, exercise, psychotherapy (that is, cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and so on), and occupational and physical therapies. CF, chronic fatigue; CFIDS, chronic fatigue and immune dysfunction syndrome; FIQ, Fibromyalgia Impact Questionnaire; FM, fibromyalgia; MCID, minimal clinically important difference; OA, osteoarthritis; RA, rheumatoid arthritis; RCT, randomized controlled trial; VAS, Visual Analogue Scale.