Posted on: Saturday, January 3, 2004
PRESCRIPTIONS
Exercise, therapy can fight fatigue
By Landis Lum
I'm so tired all the time. My doctor diagnosed chronic fatigue syndrome. Is there any hope? What about vitamins?
What do you exactly mean by "tired?" If you mean sleepy and you also snore at night, ask your doctor about a sleep study, because you might have sleep apnea, where you stop breathing. This can lead to car crashes, strokes and heart problems.
Fatigue is very often caused by unrecognized depression. But if you've seen your doctor and tests showed nothing else, then what?
If you see ads claiming that something improves energy, find out whether the research behind the claims is legit. The power of suggestion with taking energy pills is so strong you'll actually feel less tired even if the pill contained nothing but water.
Therefore, make sure studies were done that used placebo group — people who thought they were taking the real pills, but were actually given fakes — to guard against the power of suggestion.
One such study was done by a Dr. Brouwers in October 2002 in chronic fatigue patients. He gave half of them multivitamins, minerals and (co)enzymes, and the other half fake pills. There was no improvement in fatigue in those taking the vitamins and coenzymes.
The book "Clinical Evidence" is evidence based. It uses high quality studies with placebo groups. Likewise, it found little benefit in chronic fatigue syndrome with antidepressant and steroid drugs, evening primrose oil, immunotherapy, nicotinamide adenine dinucleotide or prolonged rest.
It found two things that helped: gradual aerobic exercise and Cognitive Behavior Therapy, or CBT. What is CBT? As described in the British Medical Journal in 1996, Michael Sharpe and his colleagues encouraged patients to question a simple disease explanation of their illness and to consider the role of psychological and social factors.
They were invited to evaluate the effect of gradual and consistent increases in activity and to try strategies other than avoiding doing things. They learned strategies to reduce excessive perfectionism and self criticism and to try an active problem solving approach to personal and work-related difficulties.
The results? Seventy-three percent of those who had such therapy realized satisfactory improvement compared with the 27 percent who did not do CBT.
If you can't find a therapist who does CBT, then exercise! In fact, do both! Start slow, walking 10 minutes five to seven days a week, and gradually increase to 20 to 30 minutes.
Slowly increase your pace — get to a brisk walk if possible. If you have increased fatigue at any time, continue at the same pace for an extra week and increase when your fatigue improves.
You also could jog, swim or cycle — with more intense exertion. Twenty minutes, three days a week may suffice.
It may take six weeks before you see improvement, so don't give up — and if it rains, drive to the malls and walk!
Dr. Landis Lum is a family-practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i's John A. Burns School of Medicine. Send your questions to Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; or write islandlife@honoluluadvertiser.com. This column is not intended to provide medical advice.
