Fatigue: energy conservation

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Epub: Garcia et al. Energy conservation for fatigue management in multiple sclerosis: a pilot randomized controlled trial. Clin Rehabil. 2012 Jul 2.

Objective: To develop and test the feasibility of an energy conservation programme to manage fatigue in MS


Design: A pilot randomized controlled trial.

Setting: Community.

Subjects: MSers reporting fatigue.

Interventions: An energy conservation programme was compared to a peer support group. Both interventions were delivered in group format with 2-hour sessions once a week for five weeks. MSers’ views about the interventions were sought in discussion groups one week post intervention.

Main measures: The primary feasibility outcomes were recruitment and adherence. Other outcome measures were the Fatigue Impact Scale, Fatigue Severity Scale, MS-Impact Scale-29, MS Self-efficacy Scale, Beck’s Depression Scale-Fast Screen and Epworth Sleepiness Scale. Outcomes were administered at baseline, post intervention, 6-week and 3-month follow-up.Results: Almost 30% of the people approached to take part in the study did not commit to participation because of transport/time issues. 23 MSers took part in the study. 3 MSers dropped out, one reporting adverse effects. A power calculation indicated that a sample of 56 (28 per group) would be required for a main randomized controlled trial. MSers valued peer support and those in the energy conservation group described the programme as useful, but reported difficulties completing some practice activities.

Conclusion: An energy conservation programme in the community is feasible and welcomed by MSers. However, future research needs to consider longer follow-ups and practical issues to improve recruitment rate by accommodating to patients’ needs.
“This study is clearly under-powered and therefore the results are not meaningful. The strategy underpinning an energy conservation programme is appealing and makes common sense. We always tell MSers to think of their daily supply of energy as being a finite resource and to therefore plan their activities around this. If they do a lot in the morning to then take it easier the rest of the day and vice versa. If you find taking a bath exhausting then shift the bath to just before you go to bed at night. All common sense?”

“What is disappointing is the admission that this study is under-powered. Why did they do the study then? Did ethics give them the go ahead knowing that the study was underpowered? Some consider it unethical to do studies that are underpowered; they consume unnecessary resources and time.”
The number of other posts on this blog pertaining to fatigue is very large and testament to how important this symptom and problem is for MSers:
21 Jul 2012
Methods: In this cross-sectional study, the authors evaluated 49 children with demyelinating disorders (multiple sclerosis and acute disseminated encephalomyelitis) and 92 healthy controls for depression and/or fatigue using 
08 Jul 2012
Fatigue in MS is associated with excessive daytime sleepiness and autonomic dysfunction. Recently it has been reported that the wakefulness-promoting drug modafinil may relieve fatigue in MS patients and ameliorate the 
27 Jun 2012
Objective: To investigate whether analysis of ocular motor movements can provide diagnostic information in MSers with fatigue, 37 MSers (21 female, age 44 ± 9 years) and 20 age- and gender-matched healthy controls were 
27 Jun 2012
The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety (cut-point >7) and depression (>7) and the Fatigue Severity Scale (FSS) to measure fatigue (≥5). Results: At cohort entry, prevalence of 
25 Jun 2012
1 comment: Anonymous said… I’m not sure if this has been flagged up here but a small trial has shown modafinil reduces progression, even in PPMS. There should be more work on this IMHO 
08 May 2012
So far the influence of natalizumab on cognitive functions and fatigue in MS remains uncertain. The aim of this prospective, open-label, observational study was to evaluate the possible effects of natalizumab on cognition and 
12 Aug 2012
Re: “Should I ignore fatigue and will myself to carry on (after spasms subside) or is overdoing it risky?” I tell my MSers not to overdo things and work within self-defined limits. Treat you energy levels as you would a battery and 
27 Mar 2012
OBJECTIVES: To determine whether there is a relationship between self-reported fatigue and the energy cost of walking (ECw), and how self-reported fatigue and ECw relate to physical functioning in patients with multiple 
14 Mar 2012
OBJECTIVES: Fatigue is one of the most common and troubling symptoms of multiple sclerosis (MS), and heat is often reported as a trigger. Although it is assumed that this heat sensitivity is specific for MS, the evidence for 
24 Feb 2012
Objective: The objective of this study was to analyse the central motor conduction changes (speed and size of the electrical impulse) in relation to muscle contraction force (power) during muscle fatigue and recovery in MS’ers 
22 Feb 2012
BACKGROUND: Fatigue is one of the commonest complaints in MS and is frequently reported as the most debilitating by MS’ers. Cognitive fatigue (CF) can be defined as decreased performance with sustained cognitive effort 
22 Jan 2012
BACKGROUND: Fatigue and unintentional weight loss are two of the commonest symptoms experienced by people with advanced progressive illness. Appropriate interventions may bring considerable improvements in 
18 Jan 2012
You Said.DRUGS…. “Perhaps the mousedoctor might like to acquaint himself/herself with the benefits of exercise in respect of fatigue, just because you can’t ‘prescribe it’ does not mean that you should have some idea as to 
08 Mar 2012
Methods: Cervical cord functional magnetic resonance imaging (fMRI) during a tactile (light touch) stimulation of the right hand, and structural brain and cord MRI were acquired from 20 controls, 15 MS’ers without fatigue (NF) 
17 Jan 2012
We are aware that there is a real unmet need for the treatment of fatigue. However understanding this and doing research on this subject is difficult and is near impossible in our furry friends. However the best thing to sort out 
17 Aug 2012
Sleep apnoea is a common cause of fatigue and of marital difficulties (snoring), two problems that affect MSers. CPAP (continuous positive airway pressure) machines can be the solution for sleep apnoea and have a 
28 May 2012
Effect of wearing a dorsiflexion assist orthosis on mobility, perceived fatigue and exertion during the six-minute walk test in people with multiple sclerosis: a randomised cross-over protocol. BMC Neurol. 2012 May 25;12(1):27.
25 Nov 2011
The objective of the study was to treat fatigue in MS’ers by a neurocognitive rehabilitation program aimed at improving motor planning by using motor imagery (MI). 20 MS’ers complaining of fatigue were treated for 5 weeks 
06 Oct 2011
Effect of time of day on walking capacity and self-reported fatigue in persons with multiple sclerosis: a multi-center trial. Mult Scler. 2011 Oct 3. Background: Many MS’ers report increased fatigue in the afternoon and evening 
18 Jun 2011
I agree with your other poster – being fatigued dwindles in importance in comparison with not being able to walk/balance. However if it is a symptom that can be ‘helped’ then attention should be paid to it as it could help many 
19 Aug 2011
Fatigue and its relationships with cognitive functioning and depression in paediatric multiple sclerosis. Mult Scler. 2011 Aug 15. Background: There is limited information on fatigue and its clinical and psychosocial correlates in 
28 Jul 2011
The main consequence to slowed conduction is fatigue. The commonest example is exercise-induced fatigue. For example you may find that as you walk or exercise it becomes more difficult; your leg begins to drag, your 
04 Aug 2011
This study examined the safety and efficacy of an escalating dose (100 mg, 200 mg, 400 mg/day) of American ginseng over 6 weeks in 56 MSers with fatigue. There were no serious adverse events but fatigue on ginsengwas 
17 Aug 2012
It includes recently accepted factors such as use of antidepressants, use of anticonvulsants, history of falling, and history of fatigue. And if you want to keep your risk at the lowest you can help your bone health with a good 
11 Apr 2011
“I think the problem with in the field of fatigue is that we still don’t know how to measure fatigue or even characterise it; for example mental/cognitive vs. physical (exercised-induced or temperature-sensitivity) or fatigue related 
01 Jun 2012
MAIN OUTCOME MEASURES: At the baseline, 4 weeks and 8 weeks fatigue and health-related quality of life were assessed by blind assessor using the Modified Fatigue Impact Scale and the Multiple Sclerosis Quality of 
19 May 2011
Rietberg MB, et al. Mult Scler. 2011 May 17. [Epub ahead of print] In this study no association could be found between the severity of MS-related fatigue and physical activity. “We are desperately in need of a better fatigue 
20 Jan 2011
This paper reviews sleep disturbances in MS and it association with fatigue. In people with significant fatigue sleep hygiene should be on top of the management plan; without a good night’s sleep how can you expect to feel 
31 Jul 2012
Methods: Questionnaires concerning demographics, disease characteristics, physical functioning, daily hassles, fatigue, depression and anxiety were completed by 718 MSers. Three MSers younger than 18 were excluded, 
25 Apr 2012
A pilot randomised controlled trial of an Internet-based cognitive behavioural therapy self-management programme (MS Invigor8) for multiple sclerosis fatigue.Behav Res Ther. Epub. The majority of people affected by Multiple 
07 Apr 2012
OBJECTIVE: The authors examined for associations between C(w), spatiotemporal gait parameters, daily activity, and perceived fatigue in persons with mild MS. METHODS: 44 participants completed 4 trials of walking on a 
29 Jul 2012
“I also believe that cognitive impairment is the main driver of early social disability in MS; loss of employment, breakdowns in relationships, depression and fatigue. Unfortunately, we don’t have the tools to investigate and 

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Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

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