BACKGROUND: The management of persistent, unexplained physical symptoms is challenging and often unsatisfactory for patients and doctors. Aerobic exercise training has benefited patients referred to secondary care with symptoms of chronic fatigue and fibromyalgia. It is not known if this approach is either possible or beneficial for patients with the broader range of persistent, unexplained symptoms found in primary care. OBJECTIVES: To examine the feasibility and effects of aerobic exercise training in primary care patients with unexplained physical symptoms persisting more than 12 months. METHODS: Randomized comparison (n = 228) of aerobic exercise with stretching as control among patients recruited from primary care. Training comprised 20, one-hour, sessions led by NHS physiotherapists. Adherence to training was recorded along with two groups of outcome measures: (i) documented symptoms and health care use, monitored from six months before to six months after training; and (ii) self-reported measures including emotional state and perceived disability, assessed before, during and six months after training. RESULTS:Exercise training proved feasible: more than 70% of referred patients attended for assessment and were randomized to aerobic or control exercise; 78% of eligible patients attended the first session; and median attendance was 11 sessions for both programmes. Primary care consultations and prescriptions were significantly reduced in the 6 months after training; extent of reduction was related to attendance at training sessions, irrespective of type. Whilst self-reported measures improved similarly during both training programmes, improvements were unrelated to level of attendance. CONCLUSION: For primary care patients with persistent, unexplained physical symptoms willing to be involved inexercise training, aerobic exercise offers no benefits over non-aerobic exercise. Whilst the observed reduction in primary health care use following exercise training is potentially of practical importance in a group of patients characterized by high consultation rates, improvement in patients' subjective state was not clearly attributable to exercise training.
RCT Entities:
BACKGROUND: The management of persistent, unexplained physical symptoms is challenging and often unsatisfactory for patients and doctors. Aerobic exercise training has benefited patients referred to secondary care with symptoms of chronic fatigue and fibromyalgia. It is not known if this approach is either possible or beneficial for patients with the broader range of persistent, unexplained symptoms found in primary care. OBJECTIVES: To examine the feasibility and effects of aerobic exercise training in primary care patients with unexplained physical symptoms persisting more than 12 months. METHODS: Randomized comparison (n = 228) of aerobic exercise with stretching as control among patients recruited from primary care. Training comprised 20, one-hour, sessions led by NHS physiotherapists. Adherence to training was recorded along with two groups of outcome measures: (i) documented symptoms and health care use, monitored from six months before to six months after training; and (ii) self-reported measures including emotional state and perceived disability, assessed before, during and six months after training. RESULTS: Exercise training proved feasible: more than 70% of referred patients attended for assessment and were randomized to aerobic or control exercise; 78% of eligible patients attended the first session; and median attendance was 11 sessions for both programmes. Primary care consultations and prescriptions were significantly reduced in the 6 months after training; extent of reduction was related to attendance at training sessions, irrespective of type. Whilst self-reported measures improved similarly during both training programmes, improvements were unrelated to level of attendance. CONCLUSION: For primary care patients with persistent, unexplained physical symptoms willing to be involved in exercise training, aerobic exercise offers no benefits over non-aerobic exercise. Whilst the observed reduction in primary health care use following exercise training is potentially of practical importance in a group of patients characterized by high consultation rates, improvement in patients' subjective state was not clearly attributable to exercise training.
Authors: T A Saifee; P Kassavetis; I Pareés; M Kojovic; L Fisher; L Morton; J Foong; G Price; E M Joyce; M J Edwards Journal: J Neurol Date: 2012-05-15 Impact factor: 4.849
Authors: Charlotte Paterson; Rod S Taylor; Peter Griffiths; Nicky Britten; Sue Rugg; Jackie Bridges; Bruce McCallum; Gerad Kite Journal: Br J Gen Pract Date: 2011-06 Impact factor: 5.386
Authors: Joanna Leaviss; Sarah Davis; Shijie Ren; Jean Hamilton; Alison Scope; Andrew Booth; Anthea Sutton; Glenys Parry; Marta Buszewicz; Rona Moss-Morris; Peter White Journal: Health Technol Assess Date: 2020-09 Impact factor: 4.014
Authors: Soo Y Kim; Angela J Busch; Tom J Overend; Candice L Schachter; Ina van der Spuy; Catherine Boden; Suelen M Góes; Heather Ja Foulds; Julia Bidonde Journal: Cochrane Database Syst Rev Date: 2019-09-02
Authors: Julia Bidonde; Angela J Busch; Candice L Schachter; Sandra C Webber; Kristin E Musselman; Tom J Overend; Suelen M Góes; Vanina Dal Bello-Haas; Catherine Boden Journal: Cochrane Database Syst Rev Date: 2019-05-24
Authors: A J Wearden; L Riste; C Dowrick; C Chew-Graham; R P Bentall; R K Morriss; S Peters; G Dunn; G Richardson; K Lovell; P Powell Journal: BMC Med Date: 2006-04-07 Impact factor: 8.775
Authors: Julia Bidonde; Angela J Busch; Candice L Schachter; Tom J Overend; Soo Y Kim; Suelen M Góes; Catherine Boden; Heather Ja Foulds Journal: Cochrane Database Syst Rev Date: 2017-06-21