Chalder Fatigue Scale Research Articles

Risk factors of fatigue among community-dwelling older adults in Bahir Dar, Northwest Ethiopia: a community-based cross-sectional study.

Fatigue is defined as subjective fatigue and a decline in physical and mental activity that does not improve with rest. Fatigue among older adults could lead to future comorbidity, mortality, decreased social interaction, greater strain on families, decreased productivity, and a higher need for hospitalization and rehabilitation. However, no studies have been conducted in Africa, particularly in Ethiopia. Therefore, this study aimed to evaluate the prevalence and factors of fatigue among older adults. A community-based cross-sectional study of 605 older adults was carried out using a single-stage cluster sampling technique. The Chalder Fatigue Scale (CFS) was used to assess fatigue, and data were collected through an interview. The collected data were coded, cleaned, and entered into EpiData version 4.6 and exported to SPSS Version 25 for analysis. Bivariate and multivariate logistic regression analyses were performed. Variables in the final multivariate logistic regression model with a 95% confidence interval (CI) and a p-value of 0.05 were considered statistically significant. The prevalence of fatigue among older adults was 37.9% (95% CI, 34-41.90). Significant risk factors included older age [adjusted odds ratio (AOR) = 6.13, CI = 3.25-11.58], the presence of two or more comorbidities (AOR = 5.68, CI = 2.97-10.83), physical inactivity (AOR = 3.33, CI = 1.56-7.12), poor social support (AOR = 2.83, CI = 1.61-4.96), insomnia (AOR = 5.48, CI = 3.38-8.88), and depression (AOR = 2.65, CI = 1.60-4.36). The prevalence of fatigue among older adults was noticeable, and it was summarized as a public health issue among older adults in the study area. Our study findings revealed that older age, the presence of comorbidities, physical inactivity, poor social support, insomnia, and depression were all risk factors for fatigue among community-dwelling older adults.

Lower DTI-ALPS index in patients with major depressive disorder: Correlation with fatigue

Background and purposeDiffusion tensor imaging along perivascular spaces (DTI-ALPS) is an index that may provide insights into intracranial waste clearance processes. Glymphatic system dysfunction has been suggested to play a role in the development of major depressive disorder (MDD). Additionally, fatigue—a common precursor of MDD—is also closely connected to the waste clearance function of the central nervous system (CNS), further underscoring the significance of efficient waste removal in MDD. However, evidence linking altered DTI-ALPS index to MDD remains limited. This study aims to investigate the changes in the DTI-ALPS index in patients with MDD and explore the potential interplay between DTI-ALPS index alterations, fatigue, and the presence of MDD. Material and methodsA total of 46 patients with MDD and 55 healthy controls (HC) were included in the study. All participants underwent diffusion tensor imaging using the same 3-T MRI (3-Tesla Magnetic Resonance Imaging) scanner. The DTI-ALPS index was assessed, and the Chalder Fatigue Scale (CFS) was used to evaluate fatigue levels in both groups, and the 17-item Hamilton Depression Rating Scale (HAMD-17) was used to evaluate the severity of depression in the patients. We compared the DTI-ALPS index and clinical characteristics between the MDD and HC group, and explored the relationship among the DTI-ALPS index, CFS scores, and the presence of MDD through mediation analysis. ResultsThe DTI-ALPS index in the right hemisphere (DTI-ALPS-R) is significantly lower in patients with MDD (t = 2.41, P = 0.02). The MDD patients exhibited significantly higher scores on the CFS scales compared with HCs (t = 13.12, P <.001). Mediation analysis showed that the CFS score plays a significant mediating role between DTI-ALPS-R and the presence of MDD, acting as a full mediator (indirect effect β = −0.230, 95 % CI: [-0.388, −0.059]). ConclusionOur study found that patients with MDD have a reduced DTI-ALPS index. This reduction appears to contribute to the development of MDD by facilitating the accumulation of fatigue symptoms. These findings may provide a new perspective on the pathogenesis of MDD, suggest a potential new biomarker for MDD, and offer new insights for its treatment.

Vitamin and mineral supplements: Are they associated with fatigue?

Background and aimsVitamin/mineral supplements (VMS) and vitamin/mineral and/or dietary supplements (VMDS) are commonly consumed, based on the belief of their invigorating properties. Still, the association of VMS/VMDS with fatigue in the general population remains sparse and conclusions are mixed. This study aimed to understand the association between VMS/VMDS and fatigue. MethodsTwo cross-sectional studies (2014-2017 and 2018-2021) conducted on a population-based cohort. Participants were divided into VMS/VMDS users and non-users. Fatigue levels were assessed using the Fatigue Severity Scale (FSS) and the 14-item version of the Chalder Fatigue Scale (CFS). ResultsOverall, 2084 (50.8% female, 61.7±9.8 years) and 1728 (49.6% female, 64.1±9.3 years) were included in the first and second surveys, respectively. In the first survey, after multivariable analysis, no association was found between VMS use and FSS: adjusted mean±sem 3.04±0.13 vs. 2.82±0.03 for users and non-users, respectively, p=0.083, while users scored higher in the CFS: 6.17±0.22 vs. 5.72±0.06 for users and non-users, respectively, p=0.048. In the second survey, no association was found between VMS use and FSS (2.83±0.19 vs. 2.84±0.03, p=0.952) and CFS (5.38±0.33 vs. 5.61±0.06, p=0.504). In the first survey, VMDS users scored higher in both FSS (3.03±0.06 vs. 2.76±0.04, p<0.001) and CFS (6.19±0.11 vs. 5.58±0.06, p<0.001) while no differences were found in the second survey in both FSS (2.93±0.07 vs. 2.81±0.04, p=0.161) and CFS (5.78±0.12 vs. 5.54±0.07, p=0.088) ConclusionIn this population-based cross-sectional study, the authors found no consistent association between VMS consumption and fatigue. Participants taking VMDS tended to present with higher fatigue scores.

Insomnia, cardiorespiratory function and quality of life in individuals with post-COVID-19 fatigue

ObjectiveThis study aimed to compare the prevalence of insomnia, lung function, inspiratory muscle function, functional capacity, and quality of life in individuals with and without post-COVID-19 fatigue. MethodsThirty-four post-COVID-19 individuals participated in the study, 20 with fatigue (32 ± 12 years old, 15% male) and 14 without fatigue (31 ± 12 years old, 42.9% male). The Chalder Fatigue Scale (CFS) was employed to categorize the volunteers into two groups: those with fatigue (score ≥ 4) and those without fatigue (score < 4). The Insomnia Severity Index (ISI) and the Epworth Sleepiness Scale (ESS) were used to assess insomnia and excessive daytime sleepiness, respectively. Pulmonary function was evaluated by spirometry, inspiratory muscle strength was assessed by the maximum inspiratory pressure (MIP), and inspiratory endurance was evaluated by maintaining an inspiratory load of 60% of MIP until fatigue. The six-minute walk test (6MWT) was used to evaluated functional capacity, while the WHOQOL-BREF questionnaire assessed quality of life. ResultsIndividuals with post-COVID-19 fatigue demonstrated a higher prevalence of insomnia (80% vs. 49%) and excessive daytime sleepiness (45% vs. 7%), as well as lower MIP, shorter distance covered in the 6MWT, and lower FEV1/FVC (forced expired volume in the first second divided by forced vital capacity), and FEV1/FVC% of predicted. Additionally, they exhibited poorer quality of life in the physical and environmental domains. CFS demonstrated a direct correlation with ISI (r = 0.436, p = 0.01) and ESS (r = 0.593, p = 0.001), as well as an inverse correlation with the distance covered in the 6MWT (r = -0.398, p = 0.022) and FEV1 (r = -0.412, p = 0.01). ISI was an independent predictor of CFS, with 62% of CFS variance explained by ISI variance. ConclusionIndividuals with symptoms of post-COVID-19 fatigue may have a higher prevalence of insomnia, reduced inspiratory muscle strength, functional capacity, and Tiffeneau index, along with impaired quality of life. ISI is an independent predictor of post-COVID-19 fatigue.

Prevalence of Vitamin D Deficiency in Patients with Fatigue and Neuropsychiatric Symptoms of Long COVID and its Correlation with Symptom Severity

Background: Despite the potential role of vitamin D in the acute phase of COVID-19, studies on its prevalence and association with long COVID severity are limited, leaving the relationship between vitamin D levels and long COVID symptoms unclear. Aim: The objective of this study was to investigate the prevalence of vitamin D deficiency in patients with fatigue or neuropsychiatric symptoms of long COVID and its correlation with the severity of symptoms. Methods: A cross-sectional, single-center study was conducted at Thammasat University Hospital, Thailand. The study recruited participants between the ages of 18 and 60 years who had received a diagnosis of COVID-19 and had at least one long COVID symptom, including fatigue or neuropsychiatric symptoms. Vitamin D level was collected, and clinical severity was assessed using the Chalder Fatigue Scale [CFQ-11], Depression, Anxiety and Stress Scale-21 Items [DASS-21], Pittsburgh Sleep Quality Index [PSQI], Addenbrooke's Cognitive Examination III [ACE], and Trail Making Test A &amp; B [TMT-A and TMT-B]. Results: A total of 82 patients were recruited; most were female [78%], with a mean age of 34.2 years. Most participants had a vitamin D deficiency [&lt;20 ng/mL, 73.2%], accounting for 23.2% vitamin D insufficiency [20-30 ng/mL], and 3.6% had an adequate vitamin D level. Only gender was associated with vitamin D levels. Multivariable analysis demonstrated that the vitamin D level was not correlated with all clinical outcomes, including total CFQ, total DASS, DASS depression, DASS anxiety, total PSQI, total ACE score, and total TMT scores. Conclusion: The prevalence of vitamin D insufficiency and deficiency was high in patients with long COVID, with female gender serving as predictors of lower vitamin D levels. However, no associations were found between vitamin D level and fatigue syndrome, depression, anxiety, sleep problems, or cognitive function.

Fatigue Assessment in Patients with Hereditary Hemochromatosis: First Use of the Popular Diagnostic Tools.

Background: Hereditary hemochromatosis (HH) is a genetic condition with fatigue as an essential but not precisely assessed symptom. While some well-specified scales for fatigue assessment in some pathologies exist, data on their usefulness in HH need to be collected. This research aimed to evaluate fatigue in HH using the Fatigue Assessment Scale (FAS), Fatigue Severity Scale (FSS), and Chalder Fatigue Scale (CFQ). Methodology: Seventy-nine HH patients underwent a questionnaire containing items about detailed medical history and the FAS, FSS, and CFQ scales. Twenty-five sex- and age-matched healthy persons constituted the control group (controls); additionally, thirty blood donors (donors) were compared. Results: The fatigue indices were significantly worse in the HH patients than in the controls and donors (HH vs. controls p-value: FAS = 0.003, FSS < 0.001, and CFQ = 0.003; HH vs. donors p-value: FAS = 0.025, FSS < 0.001, and CFQ = 0.041). There were no differences between the severity of fatigue and the specific genotype or the age of the patients. The HH women presented more severe fatigue than the men. High internal consistency and reliability for each scale were revealed: the Cronbach alpha values were as follows: FAS 0.92, FSS 0.95, and CFQ 0.93. Additionally, the construct validity and factorial validity of the implemented scales were confirmed. Conclusions: The HH patients exhibited significantly worse fatigue across all the scales. The FAS, FSS, and CFQ are simple and reliable diagnostic tools for assessing and quantifying fatigue for clinical and research purposes.

Effect of Cereal Consumption (Frugra®) on Autonomic Nervous System Function in Healthcare Workers Who Skip Breakfast.

In this study, we aimed to clarify the effects of breakfast intervention on autonomic nerve function in healthcare workers who skip breakfast. This cross-sectional, interventional study was conducted between January 2020 and December 2021. All participants were full-time healthcare workers who completed a self-administered questionnaire on fatigue and subjective symptoms and underwent noninvasive autonomic nerve function tests. "Skippers" were defined as individuals who ate breakfast <4 times per week, and "eaters" were those who ate breakfast >4 times per week. We introduced a cereal, Frugra (Calbee, Inc.), to skippers who opted for the breakfast intervention. Subsequently, they completed the questionnaire again and repeated the autonomic nerve function tests. Among 196 participants (age [mean±SD]: 29.8±7.8 y; 177 women and 19 men), 120 were categorized as skippers and 76 as eaters. In the skipper group, more participants were nurses, lived alone, and worked the night shift than in the eater group. The Chalder Fatigue Scale (CFS) score in the skipper group was higher than that in the eater group, although not significantly. Regarding autonomic nerve function, no significant differences were observed between the groups. In 50 skippers who opted for the breakfast intervention, the CFS score significantly decreased after 4 wk. Log low frequency and log coefficient of component variance total power significantly increased, whereas log high frequency increased, but not significantly, after the intervention. In conclusion, for healthcare workers who were breakfast skippers, the consumption of breakfast cereal reduced their fatigue level and improved their autonomic nervous system activity.

Evaluation of the post-COVID multidisciplinary outpatient clinic at the Pulmonary Division of the Cantonal Hospital Winterthur from the patient's perspective: a mixed-methods study.

This prospective study, conducted with patients from the multidisciplinary post-COVID outpatient clinic at the Pulmonary Division of the Cantonal Hospital Winterthur, aimed to investigate changes in patients' main symptoms, elements that aided in coping with the condition and satisfaction with the consulting and therapeutic interventions. After obtaining ethical approval, fifty patients were consecutively included in this longitudinal study, which incorporated three survey times post-consultation: t1 (0-7 days), t2 (4-8 weeks) and t3 (4-6 months). The survey comprised standardised questionnaires, including the Hospital Anxiety and Depression Scale, the Post-COVID-19 Functional Status scale and the Chalder Fatigue scale, along with study-specific questions regarding symptoms and reasons for consulting the post-COVID outpatient clinic. Additionally, ten patients were invited to participate in qualitative individual interviews at t2 and t3. The study was conducted between November 2021 and February 2023. The median age of the 50 participants was 47 years (IQR: 36-55), with 66% (33/50) being female. Most participants (66% or 33/50) reported no pre-existing conditions prior to COVID-19 infection, and only six patients required hospitalisation during the acute phase of their infection. Visits to the multidisciplinary post-COVID clinic occurred approximately eight months post-infection, with referrals primarily made by primary care physicians (82% or 41/50). The majority of patients experienced persistent tiredness, exhaustion and fatigue (94% or 47/50), along with reduced physical performance (82% or 41/50), while pain or breathing difficulties were less frequently mentioned. At t1, around half of the patients were fully or partially unable to work, a proportion that reduced to around a third by t3. Symptoms generally decreased over time, with significant improvements observed between t2 and t3. However, subjectively perceived cognitive limitations worsened or were reported more frequently over time. Most patients (96% or 48/50) felt well cared for throughout their consultations. In qualitative interviews, patients highlighted the medical staff's attentiveness and the time dedicated to consultations, which made them feel that their complaints were taken seriously and that they received appropriate information. The results confirmed that the multidisciplinary post-COVID outpatient clinic met most respondents' expectations. Patients found that the attentive interprofessional coaching was most helpful in coping with their illness. However, participants also noted long waiting times and expressed a desire for earlier admission to the clinic.

Effect of auriculotherapy on persistent fatigue in recovered patients from the acute phase of COVID-19: a double-blind randomized clinical trial

ABSTRACT Background: Fatigue is a common problem following the acute phase of COVID-19. Potential interventions to reduce fatigue and improve quality of life are appropriate. Objective: The study aimed to investigate the effect of auriculotherapy on persistent fatigue in recovered patients from acute phase COVID-19. Methods: This double-blind clinical trial was conducted in 2022 in Kashan, Iran on 52 recovered patients reporting persistent fatigue following acute phase COVID-19. A convenience sample was selected and randomly assigned to sham and intervention groups. The intervention group received four weeks of auriculotherapy with Vaccaria seeds attached to six fatigue-related auriculotherapy points on both ears. In the sham group, adhesive tapes were attached to the same points. Fatigue was assessed by the Chalder Fatigue Scale before (T0), after (T1), and four weeks after (T2) the intervention. Both per-protocol and intention-to-treat analyses were used. Results: The two groups differed on financial status and hospitalization history (p < 0.05). The time-group interaction effect was significant for fatigue after adjusting for confounders (p < 0.0001). Fatigue scores of the intervention group were significantly lower than the sham group at T1 and T2 (p < 0.0001). In addition, fatigue scores in the intervention group decreased significantly over time, while in the sham group, fatigue first decreased briefly and then increased (p < 0.05). Conclusion: This initial trial suggested that auriculotherapy may reduce intensity of fatigue and therefore could potentially be integrated into rehabilitation programs for patients with prolonged COVID-19. Trial registration: Iranian Registry of Clinical Trials identifier: IRCT20100211003329N9.

Effect of high plant protein/peptide nutrition supplementation on knee osteoarthritis in older adults with sarcopenia: A randomized, double-blind, placebo-controlled trial

Background & AimsSkeletal muscle is an important contributor to joint health. Previous studies have shown that age-related muscle mass and strength loss are closely associated with the development of knee osteoarthritis. The objective of this study is to investigate whether a high plant protein/peptide nutrition supplementation can alleviate knee osteoarthritis by improving muscle mass and strength. MethodsThis randomized, double-blind, placebo-controlled trial that included participants aged 50–70 years diagnosed with knee osteoarthritis and sarcopenia was conducted in China from February 2022 to September 2022 (ChiCTR2200056415). Participants were randomized to receive a 12-week high plant protein/peptide nutrition supplementation or a placebo twice daily, with one serving each after breakfast and lunch, respectively. The primary outcome analyzed using intention-to-treat analysis was difference in Short Physical Performance Battery (SPPB) from baseline to week 12 between the two groups. The secondary outcomes included changes in muscle mass, strength, symptom and imaging of knee osteoarthritis, body composition, biochemical parameters, and health quality scores. ResultsAfter 12 weeks, a total of 124 participants (38.7% male) completed the trial and were included in the final analysis. Over the 12-week follow-up, the experimental group showed a significant improvement in the SPPB total score (1.03, 95% CI, 0.69 to 1.38, P < 0.0001) compared with the placebo group. Grip strength (2.83 kg, 95% CI, 2.13–3.53, P < 0.0001) and skeletal muscle mass index (0.66 kg/m2, 95% CI, 0.45–0.86, P < 0.0001) were also significantly increased in the experimental group compared with the placebo group. The mean change in Western Ontario and McMaster Universities Osteoarthritis Index total score was −3.95 points (95% CI, −5.02 to −2.89, P < 0.0001) in the experimental group and 0.23 points (95% CI, −0.17 to 0.63, P = 0.253) in the placebo group. Additionally, within the experimental group, nine participants experienced an improvement in osteophyte magnetic resonance imaging results, while no improvement was observed in the placebo group. The experimental group also exhibited significant improvements in health quality compared with the placebo group as assessed by Short Form 36, the World Health Organization Quality of Life Brief Scale, and the Chalder Fatigue Scale. No serious adverse event was reported during the trial. ConclusionOral supplementation with high levels of plant protein/peptides can alleviate symptoms of osteoarthritis in elderly individuals with minor and mild knee osteoarthritis and sarcopenia. The improvement may be attributed to the enhancement of muscle mass, strength, and physical performance.

Acupuncture for fatigue in breast cancer survivors: a study protocol for a pragmatic, mixed method, randomised controlled trial

IntroductionFatigue is a common symptom observed in post-cancer treatment, yet its underlying mechanisms remain poorly understood. Acupuncture has been employed to alleviate cancer-related fatigue (CRF); however, its effectiveness in addressing...

Effects of an 8-week high-dose vitamin D supplementation on fatigue and neuropsychiatric manifestations in post-COVID syndrome: A randomized controlled trial.

This study evaluated the effectiveness of high-dose vitamin D supplementation in alleviating fatigue and neuropsychiatric symptoms in post-COVID syndrome. In an 8-week, double-blind, randomized, placebo-controlled trial, 80 patients with post-COVID fatigue or neuropsychiatric symptoms were enrolled. Participants were randomly assigned to receive either 60,000 IU of vitamin D weekly (n = 40) or a placebo (n = 40) for 8 weeks. Clinical outcomes were assessed using the 11-item Chalder Fatigue Scale (CFQ-11); 21-item Depression, Anxiety, and Stress Scale (DASS-21); Pittsburgh Sleep Quality Index (PSQI); Addenbrooke's Cognitive Examination III (ACE); and Trail Making Test A and B (TMT-A and TMT-B). Baseline and 8-week measurements of inflammatory markers, including interleukin 6 (IL-6) and C-reactive protein (CRP), were also collected. Significant improvements were found in the vitamin D group for CFQ (coefficient -3.5, P = 0.024), DASS-anxiety (-2.0, P = 0.011), and ACE (2.1, P = 0.012). No significant differences were observed in PSQI, DASS-depression, TMT, IL-6, or CRP levels. The incidence of adverse events was comparable between groups, with no serious adverse events reported. High-dose vitamin D supplementation may benefit patients with post-COVID syndrome by reducing fatigue, alleviating anxiety, and improving cognitive symptoms, with minimal side effects.

A Comparative Study to Assess Post-COVID Fatigue and its Functional Limitations

Objectives: This work aimed to study the difference in the level of fatigue perception between cases and controls, who did not have COVID-19. This study sought to establish the impact of severity of infection with fatigue scores on the quality of life. Methods: This observational case-control study, recruiting 165 participants, both males and females, from Fazaia Ruth Pfau Medical College, Karachi, Pakistan, started from August 2022 to October 2023 after obtaining their consent. A total of 65 COVID-positive with 21.5% hospitalized and 78.5% non-hospitalized subjects were included. Post-COVID fatigue among the participants was compared using the validated Fatigue Severity Scale (FSS), Chalder Fatigue Scale (CFQ-11), and WHOQOL scale. Results: Participants in all groups reported fatigue on the Fatigue Severity Scale with Covid-positive (38.25 ±12.15) and Covid-negative (33.75±11.28) rate, with a significant p-value (0.031). According to CFQ, no significant difference (p=0.91) was found between fatigue scores of Covid positive and negative. However, a significant (p=0. 016) difference was observed between Covid-positive hospitalized (4.37±0.33) and non-hospitalized (1.98 ±0.22) subjects. QOL scores in different domains, including QOL General Health (7.18±1.54), physical (20.38±3.51), psychological (46.33±7.05), and social (9.98±1.94), were all significant (p=0.00) when compared between Covid positives and negatives. Conclusion: The study revealed that post-covid survivors experienced fatigue, which imposed limitations on different aspects of life, which was different from the fatigue of non-affected individuals.

The relationship between the level of postural stress, Musculoskeletal Disorders, and chronic fatigue: A case study in the dairy industry.

Dairy industry workers face numerous ergonomic risk factors in their workplace, including improper posture, manual material handling, and musculoskeletal disorders (MSDs). Fewstudies have been conducted on the correlation of postural stress, MSDs, and chronic fatigue among workers in the dairy industry. This study aimed to investigate the relationship between the level of postural stress, MSDs, and chronic fatigue in a dairy company. In this cross-sectional study, 260 male workers were included in the research based on specific inclusion criteria. The Cornell Musculoskeletal Discomfort Questionnaire, Chalder Fatigue Scale, and a researcher-made demographic questionnaire were used to collect data. The posture of workers was evaluated using RULA and REBA software, and the evaluation of the manual lifting of loads was assessed using the WISHA lifting calculator. Finally, the collected data were entered into the SPSS software version 26.0 and analyzed. The findings revealed a significant statistical relationship between the level of postural stress and chronic fatigue and a significant positive correlation between MSDs and chronic fatigue. Furthermore, a statistically significant relationship was observed between MSDs, chronic fatigue, and ergonomics training experience. The results obtained in this study support the notion that high levels of postural stress and MSDs can produce an increase in chronic fatigue among workers, and lack of ergonomics training for workers can increase both MSDs and chronic fatigue. Therefore, it is necessary to carry out intervention measures in the field of ergonomics management in similar industries through the implementation of ergonomic intervention programs with a focus on proactive and preventive measures and the use of participatory ergonomic programs and educational demands assessment.

Associations of physical activity levels with fatigue in people with inflammatory rheumatic diseases in the LIFT trial.

The overall aim of the current study was to quantify physical activity levels in inflammatory rheumatic diseases (IRDs) and to explore their role in fatigue. We conducted a secondary analysis of data from the Lessening the Impact of Fatigue in IRDs (LIFT) trial of the personalized exercise program (PEP) intervention for fatigue. Participants with IRDs were recruited from 2017 to 2019 and the current analysis used fatigue, measured by the Chalder Fatigue Scale (CFS) and the Fatigue Severity Scale (FSS), and accelerometer measured physical activity data collected at baseline and at the 6-month follow-up. Physical activity levels were quantified and associations with fatigue and effects of PEP investigated. Of the 337 included participants, 195 (68.4%) did not meet the current recommendations for moderate-vigorous physical activity (MVPA). In baseline cross-sectional analysis, many dimensions of physical activity were associated with fatigue. After mutual adjustment, overall physical activity (vector magnitude) was associated with CFS [-0.88 (95% CI -0.12, -1.64)] and distribution of time spent at different activity intensities was associated with FSS [-1.16 (95% CI -2.01, -0.31)]. Relative to usual care, PEP resulted in an increase in upright time, with trends for increases in step count and overall physical activity. People who increased overall physical activity (vector magnitude) more had greater improvements in CFS and FSS, while those who increased step count and MVPA more had greater improvements in FSS. Increasing physical activity is important for fatigue management in people with IRDs and further work is needed to optimize PEPs to target the symptoms and impact of fatigue. ClinicalTrials.gov (http://clinicaltrials.gov), NCT03248518.

Fatigue during the COVID-19 pandemic – prevalence and predictors: findings from a prospective cohort study

The COVID-19 pandemic and consequent lockdowns had a substantial impact on mental health. Distress and fatigue are highly correlated. However, little is known about the determinants of fatigue in the general population during the pandemic. This study aimed to examine the prevalence and predictors of fatigue during the COVID-19 pandemic in the UK population. Online surveys were completed by a UK community cohort in April 2020 (wave 1), July-September 2020 (wave 2) and November-December 2020 (wave 3). In total, 3097 participants completed the wave 1 survey, and 1385 and 1087 participants (85.4% women) completed wave 2 and 3 surveys respectively. Fatigue was assessed using the Chalder Fatigue Scale at waves 2 and 3. Hair samples were provided by 827 participants (90.6% women) at wave 1 and wave 2, which were analyzed to indicate HairE (stress hormone). The mean total fatigue score during wave 2 was 14.7 (SD = 4.7), significantly higher than pre-pandemic levels observed in the community (mean difference 0.50, p = .003). At wave 2, 614 (44.3%) participants met the case definition for fatigue, only 15.6% of whom indicated that fatigue lasted for more than 6 months (suggesting it had started prior to the pandemic). Predictors of fatigue at wave 3 included being in a risk group, depression and belief in having COVID-19, which explained 23.8% of the variability in fatigue scores. Depression at wave 1 was the only significant predictor of remaining a fatigue case at wave 3. Fatigue was highly prevalent in the UK community during the COVID-19 pandemic and limited people’s daily function. Depression and sociodemographic variables were significant predictors of fatigue.

Comparing effectiveness of physiotherapy versus drug management on fatigue, physical functioning, and episodic disability for myalgic encephalomyelitis in post-COVID-19 condition: a study protocol of randomized control trial

BackgroundPhysiotherapy interventions effectively improved fatigue and physical functioning in non-COVID patients with myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS). There is a research gap on the effectiveness of physiotherapy interventions versus drug management on ME/CFS in post-COVID-19 conditions (PCC).MethodsWe planned a three-arm prospective randomized control trial on 135 PCC cases with ME/CFS who are diagnosed between 20 November 2023 and 20 May 2024 from a population-based cohort. The study aims to determine the effectiveness of physiotherapy interventions as adapted physical activity and therapeutic exercise (APTE) provided in institution-based care versus telemedicine compared with drug management (DM). Participants will be assigned to three groups with the concealed location process and block randomization with an enrollment ratio of 1:1:1. The post-treatment evaluation will be employed after 2 months of interventions, and follow-up will be taken after 6 months post-intervention. The Chalder fatigue scale will measure the primary outcome of fatigue. SF-36 and the disability-adjusted life years (DALYs) will measure the secondary outcome of physical functioning and episodic disability.DiscussionThis study will address the research gap to determine the appropriate approach of physiotherapy or drug management for ME/CFS in PCC cases. The future direction of the study will contribute to developing evidence-based practice in post-COVID-19 condition rehabilitation.Trial registrationThe trial is registered prospectively from a primary Clinical Trial Registry side of WHO CTRI/2024/01/061987. Registered on 29 January 2024.

SEVERITY OF NEUROLOGICAL LONG-COVID SYMPTOMS CORRELATES WITH INCREASED LEVEL OF AUTOANTIBODIES TARGETING VASOREGULATORY AND AUTONOMIC NERVOUS SYSTEM RECEPTORS

Objective: The Long-COVID syndrome is characterized by a variety of physical, cognitive and psychological symptoms. Worldwide, at least 65 million people are thought to be affected, nevertheless there is still insufficient knowledge about the pathogenesis of long-COVID. Studies on the Long-COVID related myalgicencephalomyelitis/chronic fatigue syndrome (ME/CFS) suggest autoimmune-related changes, for example the formation of autoantibodies against G protein-coupled receptors. Design and method: This monocentric, cross-sectional study included patients who suffered a mild to moderate SARS-CoV-2 infection up to 12 months prior to enrollment with (n = 72) or without (n = 58) Long-COVID diagnosis according to the German S1 guideline or with no known history of SARS-CoV-2 infection (n = 70). Autoantibodies towards the vasoregulation associated Adrenergic Receptor (ADR) B1 and B2 and the CNS and vasoregulation associated muscarinic acetylcholine receptor (CHR) M3 and M4 were measured by ELISA. Neurological disorders and fatigue were quantified by internationally standardized questionnaires including Chalder Fatigue Scale, Short-Form-36 Questionnaire and the CERAD Neurophysiological Assessment Battery. Results: The prevalence and concentrations of evaluated autoantibodies were significantly higher in Long-COVID compared to the 2 other groups (p = 2.1∗10-9) with a significantly higher number of patients with simultaneous detection of more than one autoantibody in Long-COVID group (p = 0.0419). Importantly, the overall inflammatory state was low in all 3 groups. ARB1 and ARB2 correlated negatively CERAD Trail Marking A and B (R &lt;= -0.26, p &lt;= 0.043), while CHRM3 correlated positively with Chadler Fatigue Scale (R = 0.37, p = 0.0087). Conclusions: The present study shows that autoantibodies to GPCR are highly prevalent in patients with Long-COVID. These autoantibodies occur in healthy controls as well, but the prevalence is substantially lower. Concentrations of autoantibodies correlates to intensity of neurological disorders including psychomotor speed, visual search, attention, and fatigue.

INTRAVENOUS IMMUNOGLOBULINS LEAD TO FUNCTIONAL VASCULAR AMELIORATION IN LONG-COVID

Objective: The Long-COVID syndrome constitutes a major physical and psychological challenge for many patients after the recovery from COVID-19. We have previously shown positive effects of intravenous immunoglobulins (IVIG) on multiple symptoms. The effect of this therapeutical approach on vascular function and different levels of disease burden remains elusive. Design and method: We performed a prospective study, enrolling 21 patients with diagnosed Long-COVID, who received 3 monthly courses of IVIG (0.5 g/kg Privigen, CSL Behring, Austria) alongside supportive therapy (group 1). The control group (group 2; n=29) was addressed by supportive therapy, only. The study population was homogeneous for age, comorbidities and time since SARS-CoV-2 infection. We assessed vascular endothelial function by flow mediated dilation (FMD). Long-COVID associated fatigue intensity, related disability and quality of life were assessed by Short Form Health Survey-36, Chalder and Bell scale. Neuropsychological assessments utilized the German version of the ’Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Assessment Battery’ (CERAD-Plus). Results: The median FMD at baseline in group 1 was 5.0% (interquartile range [IQR] 4.2-6.1%). We saw a substantial amelioration (+27%) of FMD after IVIG, reaching a median of 6.6% (IQR 4.5-9.4%; p=0.039). Baseline FMD in the comparison group was 5.2% (IQR 3.5-7.6%), supportive treatment resulting in unsignificant increase (FMD 6.1% [IQR 4.6-7.7%; p=0.177). Baseline CERAD-Plus scores were comparable between groups (p=0.280). Only treatment with IVIG resulted in a relevant amelioration of neurocognition (p=0.05; group 2 p=0.430). Furthermore, less Fatigue (Chalder Fatigue scale bimodal and Likert p=0.002, each) and disability was seen after 3 months of IVIG (Bell Score, p=0.008), supportive treatment did not ameliorate this burden (Chalder Fatigue Scale bimodal p=0.086 and Likert p=0.952; Bell Score p=0.121). Health related quality of life (SF-36) increased for both groups (group 1 p=0.003, group 2 p=0.017). Conclusions: Using a broad test battery, addressing neuropsychological function, fatigue, related disability and health related quality of life as well as vascular function, we were able to confirm the potential beneficial effect of IVIG in Long-COVID. IVIG might be a candidate approach in this context, that requires further evaluation in randomized controlled trials.

Effects of conventional versus virtual reality-simulated treadmill exercise on fatigue, cognitive function, and participant satisfaction in post-COVID-19 subjects. A randomized trial

Background/ObjectivePost-COVID-19 subjects typically experience symptoms of fatigue, cognitive impairment, and sleep difficulty, which can be relieved by conventional aerobic exercise. Virtual Reality (VR) technology to support conventional exercise has recently gained much attention. Therefore, this study aimed to assess the effects of traditional treadmill exercise compared to virtual reality-simulated treadmill exercise on fatigue, cognitive function, sleep quality, and participant satisfaction with the exercise program in post-COVID-19 subjects. MethodsThis single-centered, randomized, parallel-group intervention study was conducted between December 2021 and March 2022. Sixteen of twenty post-COVID-19 subjects completed this study (n1 = 8, n2 = 8). Inclusion criteria were persistent dyspnea/fatigue, mild cognitive problems, and age from 30–60 years. Exclusion criteria were previous severe COVID-19 infection and ICU admission, concomitant respiratory or cardiovascular disease, and musculoskeletal or neurological disease. Eligible subjects were assigned randomly to two groups: a non-VR group that received traditional treadmill aerobic exercise only and a VR group that received treadmill exercise with non-immersive VR. Both groups received moderate-intensity exercise on a treadmill at [50–60 % (peak HR－resting HR) + resting HR] for 30–45 min, three times per week, and for four weeks. The outcome measures were the Chalder Fatigue Scale, Montreal Cognitive Assessment (MoCA) questionnaire, Pittsburgh Sleep Quality Index (PSQI), and participant satisfaction with the exercise program rated on a 5-point Likert scale. ResultsBoth groups showed significant improvements in the Chalder Fatigue Scale, the MoCA questionnaire, and the PSQI scores after training compared to baseline (p < 0.05), without significant differences between them (p > 0.05). However, participant satisfaction with the exercise program was significantly higher in the VR group than in the non-VR group (p = 0.037). ConclusionA moderate-intensity 4-week treadmill exercise program with and without non-immersive VR may improve fatigue, cognitive function, and sleep quality to the same extent in COVID-19 survivors. However, participant satisfaction with the exercise program could be greater after conventional treadmill training assisted by non-immersive VR than after conventional treadmill training alone in this cohort. Trial registrationPan African Clinical Trials Registry, PACTR202311561948428, retrospectively registered.