Physical, Psychosocial Interventions Lessen Fatigue in Rheumatic Diseases

Mature woman with painful hand.
Researchers evaluated whether cognitive behavioral approaches and personalized exercise programs could alleviate fatigue severity and pain associated with inflammatory rheumatic diseases.

Among patients with a variety of inflammatory rheumatic diseases, the use of telephone-derived cognitive behavioral approaches (CBAs) and personalized exercise programs (PEPs) induced and maintained statistically, clinically significant reductions in the impact and severity of pain. Results of the study were published in The Lancet Rheumatology

The researchers hypothesized that remotely delivered CBA and PEP interventions might effectively alleviate the severity of pain and its impact on quality of life among individuals with inflammatory rheumatic disorders. The study was designed to evaluate usual care alongside telephone-delivered CBAs or PEPs compared with usual care alone in UK hospitals. 

All patients who had a history of any stable inflammatory rheumatic disease with clinically significant, persistent fatigue were eligible to participate in the study. A web-based randomization system was used to assign treatment allocation among the participants. Trained health care professionals in rheumatology delivered CBA and PEP sessions over a period of 6 months. The coprimary study outcomes were fatigue severity. The Chalder Fatigue Scale (0=low to 33=high; Likert scale) measured fatigue severity, and the Fatigue Severity Scale (1=low to 9=high scale) assessed fatigue impact.

Between September 4, 2017, and September 30, 2019, a total of 367 participants (274 women; 92 men) were randomly assigned and treated in 1 of 3 groups: (1) PEP (n=124; 1 participant withdrew); (2) CBA (n=121); or (3) usual care alone (n=122). The mean age of the participants was 57.5±12.7 years.

Analyses for the Chalder Fatigue Scale comprised 101 individuals in the PEP group, 107 in the CBA group, and 107 in the usual-care group. For the Fatigue Severity Scale, the analyses included 101 participants in the PEP group, 106 in the CBA group, and 107 in the usual-care group.

Results of the study showed that at 56 weeks, PEP and CBA significantly improved the severity of fatigue (Chalder Fatigue Scale for PEP: adjusted mean difference, -3.03; 97.5% CI, -5.05 to -1.02; P =.0007 and Chalder Fatigue Scale for CBA: adjusted mean difference, -2.36; 97.5% CI, -4.28 to -0.44; P =.0058) compared with usual care alone.

At 56 weeks, PEP and CBA were also associated with significant improvements in the impact of fatigue (Fatigue Severity Scale for PEP: adjusted mean difference, -0.64; 97.5% CI, -0.95 to -0.33; P <.0001 and Fatigue Severity Scale for CBA: adjusted mean difference,-0.58; 97.5% CI, -0.87 to -0.28; P < .0001) compared with usual care alone.

Limitations of the study included the fact that full masking was not possible because of the need to engage people in behavioral change. The comparator was treatment as usual (ie, usual care) because the aim of the study was to evaluate whether the PEP and CBA interventions improved upon current practice. The researchers were also not able to full evaluate whether intervention participants adapted or implemented what was being prescribed.

The study authors concluded that in a wide range of patients with rheumatic inflammatory disorders whose disease is otherwise stable, telephone-delivered CBA and PEP were associated with clinically and statistically significant decreases in fatigue severity and impact.


Bachmair E-M, Martin K, Aucott L, et al; LIFT study group. Remotely delivered cognitive behavioural and personalised exercise interventions for fatigue severity and impact in inflammatory rheumatic diseases (LIFT): a multicenter, randomised, controlled, open-label, parallel-group trial. Lancet Rheumatol. Published online June 27, 2022. doi: 10.1016/S2665-9913(22)00156-4