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Both aerobic exercise and cognitive-behavioral therapy reduce chronic fatigue in FSHD

Objective: To investigate the effect of aerobic exercise training (AET) and cognitive-behavioral therapy (CBT) on chronic fatigue in patients with facioscapulohumeral muscular dystrophy (FSHD). Methods: We performed a multicenter, assessor-blinded, randomized clinical trial (RCT). Fifty-seven patients with FSHD type 1 with severe chronic fatigue were randomly allocated to AET, CBT, or usual care (UC). Outcomes were assessed before treatment, following 16 weeks of intervention, and after a 12-week follow-up. A linear mixed model for repeated measurements was used to study the estimated group differences. Results: Following treatment, both the AET (28 participants) and CBT (25 participants) intervention groups had less fatigue relative to the UC group (24 participants), with a difference of −9.1 for AET (95% confidence interval [CI] −12.4 to −5.8) and −13.3 for CBT (95% CI −16.5 to −10.2). These beneficial effects lasted through follow-up, with a difference of −8.2 for AET (95% CI −12.4 to −5.8) and −10.2 for CBT (95% CI −14.0 to −6.3). The patients who received CBT had an increase in registered and experienced physical activity, sleep quality, and social participation. The patients who received AET had an increase in registered physical activity only. The increase in registered physical activity in both groups and the improvement in social participation following CBT were still present at follow-up. Conclusions: This RCT shows that AET and CBT can ameliorate chronic fatigue in patients with FSHD. Classification of evidence: This study provides Class III evidence that, in patients with FSHD type 1 and severe chronic fatigue, AET or CBT reduces the severity of chronic fatigue.