Subjective Ratings Of Fatigue Research Articles

Acute effects of an alcoholic drink on food intake: Aperitif versus co-ingestion

To compare the effects on appetite and energy intake (EI) within a meal and across 4 days of drinking wine either before (aperitif) or with (co-ingestion) a meal, 11 men attended the laboratory on three occasions. On each occasion participants were given breakfast in the laboratory then 3 h later returned for a two course (garlic bread, pizza) lunch, then recorded food intake for the remainder of the day and the next 3 days. In the control condition, participants ate lunch ad libitum; in the aperitif condition 375 ml of red wine was consumed 20 min before lunch; and in the co-ingestion condition 125 ml of red wine was consumed with the starter and 250 ml of red wine was consumed with the main course. Subjective ratings of appetite and mood were administered before and after the meal. EI at lunch was greater when wine was consumed ( p < 0.01) (aperitif: 6436 ± 435 kJ; co-ingestion: 6254 ± 417 kJ) compared to control (5125 ± 262 kJ). In particular, intake of the starter was enhanced by wine consumption. Having wine as an aperitif significantly influenced subjective ratings of light headedness and fatigue. These results suggest that the effects of wine on appetite are immediate, and stimulate food intake early in the meal. Total EI during the test days was significantly higher than during subsequent days revealing a tendency to overeat in the laboratory, exacerbated by drinking wine before or with lunch. However, lean healthy men adjusted total EI on the days following the laboratory in all conditions.

Central motor drive and perception of effort during fatigue in multiple sclerosis

To determine if task performance and fatiguability during repeated low-level contractions of an intrinsic hand muscle differ in a group of MS subjects compared with a control group, and what central changes accompany the development of fatigue and the period of recovery, whether these measures are related to subjective ratings of fatigue or perception of effort. Force of index finger abduction, rating of perceived effort, and motor evoked potential amplitude and silent period duration were measured during and after a 20-min. intermittent submaximal (40%) contraction of the first dorsal interosseous muscle in 23 clinically definite MS subjects with mild-moderate symptoms, and 15 controls. Rating of perceived effort increased at a greater rate in the MS group than in control subjects during exercise, and this was associated with larger increases in both MEP amplitude and silent period duration. Submaximal fatiguing exercise is associated with an enhanced central motor drive and increased perception of effort in MS. MS subjects can increase central drive during fatiguing exercise to a greater degree than controls, but this is associated with greater perceived exertion. These factors may underlie the more general complaint of fatigue experienced by people with MS.

Oxygenation, EMG and position sense during computer mouse work. Impact of active versus passive pauses

We investigated the effects of active versus passive pauses implemented during computer mouse work on muscle oxygenation and EMG of the forearm extensor carpi radialis muscle, and on wrist position sense. Fifteen healthy female subjects (age: 19-24 years) performed a 60-min mouse-operated computer task, divided into three 20 min periods, on two occasions separated by 3-6 days. On one occasion a passive pause (subjects resting) was implemented at the end of each 20-min period, and on another occasion an active pause (subjects performed a number of high intensity extensions of the forearm) was implemented. Also at the end of each 20-min period, test contractions were conducted and subjective ratings of fatigue and stress were obtained. Another parameter of interest was total haemoglobin calculated as the summation of oxy-and deoxy-haemoglobin, since it reflects blood volume changes. The most interesting findings were an overall increasing trend in total haemoglobin throughout the mouse work (P<0.001), and that this trend was greater for the active pause as compared to the passive pause (P<0.01). These data were accompanied by an overall increase in oxygen saturation (P<0.001), with a tendency, albeit not significant, toward a higher increase for the active pause (P=0.13). EMG amplitude and median frequency tended to decrease (P=0.08 and 0.05, respectively) during the mouse work but was not different between pause types. Borg ratings of forearm fatigue showed an overall increase during the activity (P<0.001), but the perceptions of stress did not change. Position sense did not change due to the mouse work for either pause type. While increasing trends were found for both pause types, the present study lends support to the hypothesis of an enhancement in oxygenation and blood volume for computer mouse work implemented with active pauses. However, a presumption of an association between this enhancement and attenuated fatigue during the mouse work was not supported.

Vigilance and fatigue following traumatic brain injury

Research findings have suggested that individuals with traumatic brain injury (TBI) show greater psychophysiological and subjective costs associated with performing vigilance tasks, but have not examined relationships with fatigue. The present study aimed to investigate vigilance and its relationship with subjective and objective fatigue measures. Forty-six TBI participants and 46 controls completed a 45-minute vigilance task. They also completed a subjective fatigue scale (the VAS-F) and a selective attention task before and after the vigilance task, and had their blood pressure (BP) monitored. TBI participants performed at a lower level on the vigilance task, but performed at a similar level across the duration of the task. Higher subjective fatigue ratings on the VAS-F were associated with more misses on the vigilance task for TBI participants. TBI participants showed greater increases in diastolic BP, and these were associated with greater increases in subjective fatigue ratings on the VAS-F. A subgroup of TBI participants showed a decline in performance on the vigilance task and also showed disproportionate increases in subjective fatigue. Findings provide support for the coping hypothesis, suggesting that TBI individuals expend greater psychophysiological costs in order to maintain stable performance over time, and that these costs are also associated with subjective increases in fatigue.

Effects of Visual Occlusion and Fatigue on Motor Performance in Water

The purpose of this study was to test the effects of visual occlusion and fatigue on the motor performance of vertical skills in synchronized swimming. Experienced synchronized swimmers (n = 12) were randomly assigned to either an exercise or nonexercise (control) activity group. Subjective ratings of fatigue were obtained from the swimmers who then each performed four vertical skills under alternating conditions of vision and visual occlusion before and after either a swimming (designed to induce fatigue) or nonphysical activity. A main effect of activity (p < .03) was found for two measures of performance accuracy (lateral and anterior total distance traveled) but not for lateral and anterior maximum deviation from vertical, indicating that fatigue played a role in executing the skills. The data also indicate that the maintenance of a stationary position is a skill of greater difficulty than maintaining a true vertical. In contrast with previous research findings on synchronized swimmers, a significant effect of vision in all conditions was found, with performance decrements in the conditions of visual occlusion showing that vision provided important sensory input for the swimmers.

Effects of mental fatigue on attention: An ERP study

The effects of mental fatigue on attention were assessed. Subjects performed a visual attention task for 3 h without rest. Subjective levels of fatigue, performance measures and EEG were recorded. Subjective fatigue ratings, as well as theta and lower-alpha EEG band power increased, suggesting that the 3 h of task performance resulted in an increase in fatigue. Reaction times, misses and false alarms increased with time on task, indicating decreased performance efficiency in fatigued subjects. Subjects were unable to inhibit automatic shifting of attention to irrelevant stimuli, reflected by a larger negativity in the N1 latency range for irrelevant, compared to relevant stimuli. This difference in negativity was unaffected by time on task. However, N1 and N2b amplitude did change with time on task: N1 amplitude decreased, and the difference in N2b amplitude between relevant and irrelevant stimuli (larger N2b amplitude evoked by relevant stimuli) decreased with time on task. The results indicate a dissociation in the effects of mental fatigue on goal-directed (top–down) and stimulus-driven (bottom–up) attention: mental fatigue results in a reduction in goal-directed attention, leaving subjects performing in a more stimulus-driven fashion.

Effects of time pressure and precision demands during computer mouse work on muscle oxygenation and position sense

The present study investigated the effects of time pressure and precision demands during computer mouse work on muscle oxygenation and position sense in the upper extremity. Twenty-four healthy subjects (12 males and 12 females) performed a 45-min standardized mouse-operated computer task on two occasions. The task consisted of painting rectangles that were presented on the screen. On one occasion, time pressure and precision demands were imposed (more demanding task, MDT), whereas, on the other occasion, no such restraints were added (less demanding task, LDT). The order of the two task versions was randomized. Tissue oxygen saturation in the trapezius and extensor carpi radialis muscles was recorded throughout, and the position-matching ability of the wrist was measured before and after the tasks. In addition, measurements of autonomic nervous system reactivity and subjective ratings of tenseness and physical fatigue were obtained. Performance was measured in terms of the number of rectangles that were painted during the task. During MDT, oxygen saturation in extensor carpi radialis decreased (P < 0.05) compared to LDT. These data were paralleled by increased electrodermal activity (P < 0.05), skin blood flow (P < 0.05), ratings of tenseness and fatigue (P < 0.01), and increased performance (P < 0.01) during MDT. Females exhibited lower oxygen saturation than males, during rest as well as during the computer tasks (P < 0.01). Wrist repositioning error increased following LDT as compared to MDT (P < 0.05). In conclusion, computer mouse work under time pressure and precision demands caused a decrease in forearm muscle oxygenation, but did not affect wrist position sense accuracy. We attribute our changes in oxygenation more to increased oxygen consumption as a result of enhanced performance, than to vasoconstriction.

Changes in Neuropsychological Test Performance Over the Workday in Multiple Sclerosis

Fatigue, a common symptom of multiple sclerosis (MS), is associated with impairment in performing daily activities, poor quality of life and premature retirement from the workforce. There is little doubt that patients with MS can exhibit marked weakness and other objective signs of physical fatigue, but whether cognitive performance by patients declines more rapidly than that by controls as a function of time engaged in mental activity remains controversial. Krupp and Elkins (2000) reported more rapid deterioration of performance by MS patients on two of five cognitive measures when subjects performed 3 hr of continuously effortful tasks between baseline and posttest. Others, using shorter and less taxing interpolated tasks found similar changes in performance over time for patients and controls. In the present study participants completed a timed walk, fatigue ratings and four cognitive tests that emphasized processing novel information before they went to work and again after completing a normal workday. Patients with MS walked somewhat more slowly and performed more poorly on two of the cognitive tests, but they did not show more decline from baseline to posttest on any of these objective measures of cognitive fatigue. By contrast, subjective ratings of fatigue showed a greater increase over the day for patients than for controls. These results confirm other reports that patients’ subjective ratings of their fatigue are not valid indicators of their actual performance on cognitive tests. Furthermore, laboratory studies that report “objective” cognitive fatigue in MS may utilize conditions that model the cognitive fatigue associated with the jobs patients actually perform rather poorly.

The impact of a nap opportunity during the night shift on the performance and alertness of 12-h shift workers.

The purpose of this workplace evaluation was to assess the effects on performance, alertness and subsequent sleep of strategic napping on 12-h overnight shifts. In a counterbalanced crossover design, 24 male aircraft maintenance engineers working in a forward rotating 12-h shift pattern volunteered to take part in the study for two work weeks. During the experimental week, each subject was given the opportunity to take a 20-min nap at work between 01:00 and 03:00 h on each of their two overnight shifts. On the control week no naps were taken on the night shifts. A computerized neurobehavioural test battery was employed to assess performance and subjective levels of fatigue at the beginning and end of each night shift, and pre- and postnap. Subjects were also asked to rate how near they had come to falling asleep while driving to and from work. The results revealed that taking a single 20-min nap during the first night shift significantly improved speed of response on a vigilance task measured at the end of the shift compared with the control condition. On the second night shift there was no effect of the nap on performance. Taking a short nap during either night shift had no significant effect on subjective ratings of fatigue, the level of sleepiness reported while driving to and from work, or subsequent sleep duration and sleep quality. Overall the results suggest some promise for a short duration nap taken in the workplace to counteract performance deficits associated with the first night shift.

Metabolic and appetite responses to prolonged walking under three isoenergetic diets

The effects of three isoenergetic diets on metabolic and appetite responses to prolonged intermittent walking were investigated. Eight men undertook three 450-min walks at intensities varying between 25-30 and 50-55% of maximal O2 uptake. In a balanced design, the subjects were given breakfast, snacks, and lunch containing total carbohydrate (CHO), protein (P), and fat (F) in the following amounts (g/70 kg body mass): mixed diet, 302 CHO, 50 P, 84 F; high-CHO diet, 438 CHO, 46 P, 35 F; high-fat diet, 63 CHO, 44 P, 196 F. Substrate balance was calculated by indirect calorimetry over the 450-min exercise period. Blood samples were taken before exercise and every 45 min during the exercise period. The high-fat diet resulted in a negative total CHO balance (-140 +/- 1 g) and a lower negative fat balance (-110 +/- 33 g) than the other two diets (P < 0.05). Plasma glucagon, nonesterified fatty acids, glycerol, and 3-hydroxybutyrate were higher with the high-fat diet (P < 0.05 vs. high CHO), whereas plasma insulin was lower after high fat (P < 0.05 vs. mixed and high CHO). Subjective ratings of fatigue and appetite showed no differences between the three trials. Although diet influenced the degree of total CHO and fat oxidation, fat was the main source of energy in all trials.

Ratings of subjective mental fatigue relate to cognitive performance in patients with myasthenia gravis

We examined ratings of fatigue and cognitive performance in myasthenia gravis (MG) patients and healthy subjects. All participants were administered self-report measures of mental and physical fatigue before and after completing a demanding cognitive work battery. Change in fatigue indices was recorded and examined in relation to cognitive function. Results of the study revealed that baseline ratings of fatigue did not relate to cognitive performances for either group. By contrast, increased mental fatigue from the baseline to the post-test assessment correlated with cognitive measures for patients but not control subjects. MG patients reported that physical fatigue also increased following the work battery, but only ratings of mental fatigue correlated with cognitive performances. The results indicate that cognitive impairments may be associated with perceived fatigue in MG.

CHRONOBIOTIC EFFECTS OF THE MELATONIN AGONIST LY 156735 FOLLOWING A SIMULATED 9H TIME SHIFT: RESULTS OF A PLACEBO-CONTROLLED TRIAL

Introduction: The melatonin agonist LY 156735 (LY) is a new investigational drug under development to treat circadian rhythm disorders. The present study assessed the efficacy of LY to alleviate the symptoms of shift lag and to enhance readaptation of desynchronized circadian rhythms to a new time zone.Subjects and methods: Eight healthy male volunteers of age 25–35 yr participated in three identical trials of 13d duration in a temporal isolation unit separated by washout intervals. A high dose (HD) of 5 mg and a low dose (LD) of 0.5 mg of LY and placebo (PL) were administered double-blinded in a three-period cross-over design. Each trial consisted of an adaptation period, a pre-shift period for baseline measurements, a simulated 9h phase-advance shift, and a post-shift period for follow-up. The time shift was performed at 23:00h of day 6 by advancing the laboratory time to 08:00h of day 7. Double-blind study medication was administered at 14:30h on day 6, and at 22:30h on days 7–10. Subjective ratings of jet lag, alertness, tenseness, and daytime fatigue were assessed using visual analog scales (VAS) and standardized questionnaires. The objective markers of readaptation included core body temperature, wrist actigraphy, cortisol and electrolyte excretion, and a battery of computerized performance tests.Results: HD but not LD enhanced the readaptation speed of all physiological rhythms investigated, as demonstrated by a significantly faster movement of acrophases towards the post-shift target time. HD (p=0.05) significantly blunted the post-shift deterioration of performance in those tests that were sensitive to shift lag. Parameters of subjective well-being were not significantly affected by either dose.Conclusion: This pilot study demonstrates the chronobiotic efficacy of LY when taken at a dose of 5 mg/d.

The Effects of Level of Automation on the Out-of-the-Loop Unfamiliarity in a Complex Dynamic Fault-Management Task during Simulated Spaceflight Operations

Out-of-the-loop unfamiliarity (OOTLUF) and information sampling strategies were examined after operator use of intelligent fault management (FM) support in interaction with a generic, autonomous, atmospheric control system. A simulated model-based reasoning agent provided fault diagnosis and recovery at three different levels of automation (LOA). In about 10% of the experimental trials FM support was withdrawn simulating a catastrophic failure. This allowed investigating OOTLUF potentially developed during reliable FM automation and its variation as a function of LOA. Dependent measures were the percentage of time the system was out-of-target, time elapsed until a repair was initiated, alarm reaction time, accuracy of manual tank level recordings, information sampling behavior, and subjective ratings of workload, tension, fatigue, self-confidence and trust in automation. It was found that automated FM support improved overall system performance and reduced subjective operator workload. OOTLUF occurred in terms of longer times until repair initiation only at medium LOA and not as expected at high LOA. A differential effect of LOA on information sampling strategies was observed suggesting that offloading operators from recovery implementation at high LOA during reliable automation enabled engagement in fault assessment activities, thereby maintaining situation awareness. It is concluded that for avoiding OOTLUF in complex, dynamic tasks, involving intelligent FM support, the important factor is not simply the LOA, but the ability of a particular LOA to support the human operator's information sampling and higher-level reasoning activities.

Efficacy of stimulants for fatigue management: the effects of Provigil® and Dexedrine® on sleep-deprived aviators

Abstract The present report details the results of a quasi-experimental comparison between the alerting effects of modafinil (Provigil ® ) and those of dextroamphetamine (Dexedrine ® ) in sleep-deprived pilots. Data from two separate placebo-controlled studies (one on Dexedrine ® and one on Provigil ® ) were merged and analyzed to determine whether one compound produced greater effects than the other relative to placebo. The results indicated there were differences between the two stimulants on only two of the 14 dependent measures. In one case (a flight performance measure), modafinil was more effective than dextroamphetamine, and in the other case (subjective fatigue ratings), dextroamphetamine was better than modafinil. The remaining measures indicated no statistically-significant differences between the two stimulants. However, in the majority of cases, it was clear that performance, subjective mood ratings, and physiological indices of alertness were substantially better under both drugs than under placebo. Thus, with the exception that modafinil produced more spontaneous reports of side effects than dextroamphetamine, the overall results indicated equivalent efficacy with the two compounds. Limitations of this study were that the two compounds were tested on different samples at different points in time, and there was no systematic measurement of side effects (instead, spontaneous reports were recorded). Future work should validate the present results in a controlled side-by-side comparison of dextroamphetamine and modafinil under conditions similar to the ones reported here.

The influence of flooring on standing comfort and fatigue.

Many occupations require standing for extended periods of time, resulting in complaints of musculoskeletal fatigue and pain. One intervention method to reduce this problem has been to alter the flooring on which workers stand by using "antifatigue" mats. This article reviews the published research on the influence of flooring on people during long-term standing. Most studies have used subjective ratings of fatigue and discomfort experienced while standing in controlled laboratory settings. Some have included objective measures, such as electromyography, leg volume changes, and postural movements. Studies in the literature report mixed and sometimes conflicting results. There are methodological differences across the studies that could have led to many of the conflicting results, with the foremost variable being duration of testing. Generally, softer floors result in reduced discomfort as compared with a hard floor, particularly for the lower extremities and the lower back. Objective measures have been less conclusive, with no consensus about the influence of flooring on any physiological or biomechanical measures. Investigations of the influence of flooring characteristics on discomfort suggest that elasticity, stiffness, and thickness play roles. Further research is needed on underlying physiological causes of standing discomfort and fatigue as well as the influence of flooring properties on subjective and objective measures.

Reliability of EMG spectral parameters in repeated measurements of back muscle fatigue

The change in median frequency of the power spectrum of the electromyographic (EMG) signal may be used as a measure of muscle fatigue. The reliability of the median frequency parameters was investigated for EMG-recording sites at L1 and L5 right and left on the erector spinae. The reliability of subjective fatigue ratings of the back muscles (Borg CR-10 scale) and of maximal trunk extension torque (MVC) was also investigated. Eleven subjects with healthy backs performed a 45-s isometric trunk extension at 80% of MVC twice a day, on three different days. Two-factor analysis of variance was made to obtain the different variances from which the standard error of measurement (SEM) and the intra class correlation coefficient (ICC) were calculated. The SEM within-day was somewhat lower than that between-days. Both were about the same at all four electrode sites. The 95% confidence interval for the studied variables was for the initial median frequency ±10 Hz, for the slope ±0.4–0.5%/s, for the MVC ±36 Nm and for the Borg ratings ±1.6. We conclude that, with the presently used method, changes or differences within these limits should be regarded as normal variability. The slope may be of limited value because of its large variability. Whether the low intra-class correlation coefficient for the EMG parameters in the presently studied test group implies a low potential in discriminating subjects with back pain can not be decisively concluded.

Levels of Sustainable Aerobic Workload in Dialysis Patients

The aerobic performance of a heterogeneous group of 89 ambulatory medically stable patients on chronic hemodialysis was studied to define individual levels of the most acceptable metabolic workload. The patients performed a step test protocol (3 steps) with a cycle ergometer. Each step (25 Watt) lasted 6 min. Heart rate (HR), oxygen consumption (VO2), ventilation (VE), respiratory exchange ratio (RER), blood pressure (BP) and subjective ratings of dyspnea (CRd) and fatigue (CRf) levels were monitored throughout the test. The test was continued to exhaustion or to values of systolic arterial blood pressure (SABP) >240 mmHg, heart rate (HR) > or = 85% max, or ST changes in ECG. In eleven patients (12.5% of the whole group) the test was interrupted within the first two minutes of exercise. In the remaining 78 patients, the maximum workload sustained for at least 3 min (MSW) was 25 Watts for 43 (48.5%), 50 Watts for 27 (30%), and 75 Watts for 8 (9%) patients. Performance was affected in a statistically significant manner by the subjects' anagraphic age, but not by their dialytic age, hemoglobin (Hb) level or weight. Individual levels of tolerable workload were estimated for 60% of the group from the stability of physiological variables during 3 min, and from subjective ratings at a "moderate" level. This level corresponded to an average of 3.5+/-0.9 METs, at 60% of the HRmax, with a mean BP of 167+/-21/98+/-14 mmHg. This could become a safe starting point for a program of physical retraining.

Isotonic and isoelectric endurance tests for the upper trapezius muscle.

As an alternative to a conventional endurance electromyogram (EMG) test for assessment of muscle capacity in the upper trapezius muscle (isotonic test, IT), an isoelectric test (IE) has been investigated. Nine subjects performed the two endurance tests. The tests were performed with a straight horizontal arm in the plane of the scapula. In IE, EMG amplitude was fed back to the subject and the subject was instructed to maintain a constant EMG activity equal to the level with the arm unsupported. Subjective ratings of local fatigue were obtained during the experiments. The EMG recordings from both tests were analysed for the root mean square value as well as according to the mean power frequency (MPF) technique. All the subjects endured maximal 15 min IE while in IT the median endurance was 11.9 min. Average subjective ratings of perceived fatigue increased more in IT compared to IE. The average normalised MPF curve from IT increased while that from IE was unaffected. There was a significant difference between the MPF results at 6 and 8 min. It is noteworthy that the MPF was higher in IT in spite of a higher accumulated biomechanical load. It was concluded from these studies that the interpretation of decreased MPF as an indicator of increased local muscle fatigue is doubtful at low contraction levels. It is suggested that an IE is a more appropriate method for the functional evaluation of low threshold motor units of the upper trapezius muscle in research into occupational disorders.

Effects of Low Doses of Melatonin on Late Afternoon Napping and Mood

The effects of low doses of melatonin (0.1, 0.5 and 1 mg) given at 16:00 h on induction and quality of sleep in the late afternoon (17:00-21:00 h), as well as on subjective fatigue and mood ratings before and after sleep were studied. Ten healthy male volunteers (age 26-30 years) were given on a double-blind crossover basis, tablets containing melatonin, or placebo, with one day washout between treatments. Mood and fatigue were assessed before and after bedtime. Sleep quality was objectively monitored using wrist-worn actigraphs and subjectively by using sleep logs. Data were analysed by means of analysis of variance for repeated measures with a factor of group (placebo and the three melatonin doses). The analysis revealed dose-dependent increase by melatonin in subjective evaluation of fatigue and sleepiness, and decrease in alertness, efficiency, vigor and concentration before the nap. Melatonin did not significantly affect actigraph-measured nap sleep latency and efficiency but reduced wake time after sleep onset and delayed sleep offset time compared to placebo, Melatonin did not significantly affect sleep latency and sleep efficiency in the night following the treatment. These data indicate acute effects of low doses of melatonin given at 16:00h on sleepiness and fatigue but not on sleep efficiency or latency in healthy young individuals.

Persistent fatigue in well women.

Fatigue is the subjective report of a sustained sense of exhaustion with reduced motivation and capacity for physical and/or mental activity. Although factors associated with fatigue have been explored in specific patient populations, minimal study has been devoted to exploring both the magnitude of fatigue and associated variables among women generally thought to be well. This cross-sectional, descriptive study examined the relationship of behavioral, socio-demographic, and emotional factors to subjective ratings of fatigue among women in the community who perceived themselves as being fatigued but otherwise healthy. A convenience sample of 155 adult women completed the Piper Fatigue Self-Report Scale (PFS), the Beck Depression Inventory (BDI), and an investigator-designed questionnaire that collected behavioral and socio-demographic data. Correlation and regression analyses were used with fatigue as measured by the PFS as the outcome variable. Statistically significant relationships were noted between PFS and BDI scores as well as PFS and sleep pattern, rest quality, and perceived stress. Construction of a multiple regression model revealed an adjusted R2 of .43 with the BDI score serving as the major predictor variable for fatigue. Persistent fatigue is a consistent element in the lives of many women. As such it can significantly undermine women's quality of life.