Cognition-targeted Exercise May Boost CBT’s Easing of Fatigue

Margarida Maia, PhD avatar

by Margarida Maia, PhD |

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Cognition-targeting exercise, when combined with cognitive behavioral therapy (CBT) — a type of talk therapy — may further ease fatigue and other symptoms in people with multiple sclerosis (MS), a study found.

The study, “The added value of cognition-targeted exercise versus symptom-targeted exercise for multiple sclerosis fatigue: A randomized controlled pilot trial,” was published in PLOS One by a team of researchers in Egypt.

Fatigue is a common symptom of MS that interferes with the ability to perform everyday activities, which may have a toll on quality of life and mental health. It is frequently reported as one of the most burdensome symptoms to patients.

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Management Programs May Help Keep Fatigue Stable Over Long-term

An effective way to ease fatigue is CBT, a type of talk therapy that helps people behave differently and better cope with their condition by changing the way they think and feel about certain issues. Another way appears to be regular exercise. However, it is not clear what type of exercise is best to ease fatigue.

To know more, the researchers designed two exercise programs to use in combination with CBT and then watched for changes in fatigue and other symptoms.

The study (NCT04699370) included 60 people with MS with a fatigue score of four or greater on the Modified Fatigue Impact Scale (MFIS), who were randomly assigned to receive either cognition-targeting exercises, which focused on how each movement was done rather than whether it relieved fatigue, or a standardized physical therapy protocol focused on relieving symptoms.

In the cognition-targeted exercises, a therapist listened actively to each person’s way of perceiving disease and treatment outcome. “Perceptions about each exercise and anticipated consequences of the exercises were discussed,” the researchers wrote, adding that “progression to the next level was preceded by mentally visualizing the task.”

The physical therapy protocol consisted of eight 30-minute, individually tailored sessions of general aerobic, strength, and flexibility exercises over a period of four weeks (about one month).

All patients in both groups also received eight 50-minute, weekly sessions of CBT. These sessions aimed at tackling all factors (behavioral, cognitive, and affective) that could contribute to fatigue.

When the treatment began, the two groups were fairly similar in regards to their age, sex, weight, disability status, education level, employment, and treatments.

Results showed that people who engaged in cognition-targeted exercise, in combination with CBT, saw their fatigue reduced at one month, and the effect was maintained at three months. Moreover, their ability to work and engage in social activities was improved and their perception of anxiety and stress was reduced.

For people assigned to the standardized physical therapy protocol, the effects were not as obvious and long-lasting.

“The results of this study are an important addition to the validation of [cognitive behavior therapy] treatment approaches and interventions that rely upon physical exercise and activity programs in some way to reduce fatigue in people with Multiple Sclerosis,” the researchers concluded.

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