Review Effectiveness of physical activity interventions on reducing perceived fatigue among adults with chronic conditions: .. review.., 2023, Barakou et a

Posts moved from: Independent advisory group for the full update of the Cochrane review on exercise therapy and ME/CFS (2020), led by Hilda Bastian
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This is a first. Nature just published a review of exercise interventions in chronic conditions, from a group in Newcastle, looks like. They reference the Cochrane review on GET as an example showing limited or no benefit in CFS.



https://www.nature.com/articles/s41598-023-41075-8

 

Perhaps that's the reason why the authors didn't include any trials on exercise for CFS or ME/CFS in their review -- despite promoting a 'transdiagnostic approach to fatigue'?

So that they still can assess the most included studies on other chronic illness (applying the same questionable methodology) as having a low risk of bias and conclude "Physical activity interventions moderately reduced fatigue among adults with chronic conditions"?

Apologies, off-topic & not able to properly comment at the moment, but that review by the Newcastle team I think deserved to be on the short list of an award for the most muddled reasoning on that topic -- even if they seem to draw the right conclusions about the outdated but still not withdrawn Cochrane review.

Edited / clarity.

 

Bias shown in only the second paragraph.

"While some recommendations suggest that PA might reduce fatigue symptoms32,33,34,35, other studies indicate limited or no effects of exercise therapy on fatigue among adults with chronic fatigue syndrome36 and Parkinson’s disease37. Nevertheless, PA offers benefits for overall functioning, health, well-being, and quality of life and is associated with a reduced risk of premature mortality"

Ref 36 is to the Cochrane review. I suppose the positive interpretation is that at least they looked beyond the headlines to see what it actually showed; the negative interpretation is that they didn't understand the abstract...

 

And this report has managed to highlight the real issue at hand that has been undermining evverything for so long:

an ambiguous definition of fatigue that means it doesn't require methodology that removes/isolates the psychological concept of 'fatigue' from the physical understanding of physical fatigue.

e.g. being tired and demotivated as someone who has got into bad habits of sitting too much getting 'motivated to move' or 'feeling better for a walk' vs having anemia or the exhaustion after MS fatiguability are very different things that are being looked at. They should not be being thrown into the same reviews or discussed in comparable contexts.

I'm shocked that this many years into 'fatigue research' the norm doesn't require that methods try and separate the purely biomedical/physical limits and impact of e.g. the anemia or MS fatiguability post an activity when they might be trying to measure other components/concepts that they want to place under this broader 'fatigue' area and 'feeling'. It's quite likely someone can feel invigorated temporarily from having done exercise with an illness and including that sense of mastery/satisfaction whilst the actual fatigue and fatiguability means they are making their underlying exhaustion and its cause worse and they are left unable to lift their arms or walk for hours and days. Just from an old-school when psychology was about focusing on methodology in order to get to the bottom of honing and isolating different concepts days I can't believe this isn't the norm in expectation when discussing methodology.

I'm further beyond shocked we still have Knoop type studies where they think kidding someone they've done more than they have reduces fatigue is studying the same actual 'thing' as long-term follow up of getting someone with MS fatiguability to do a physical activity programme. As these would be literal opposites of each other and separate things they are measuring.

To then have 'reviews' that aren't required to be precise in these things, and to acknowledge that some dodgy biased studies might claim effects based on short-term survey answers being 'more positive' in the 'feeling-sense' to certain questions (although I question this as all use coercion techniques as their treatment) are to be described as if they are the same thing or even in the same bracket as whether any treatment makes someone more 'well' and 'capable' and their body 'threshold to exhaustion' and 'after-effects of exertion' are measured long-term: ie the real 'does it work' measures.

It really is like watching a mass delusion emperor's new clothes sometimes. And I just wonder how noone has insisted on the nomenclature and breaking down these component types and parts of what might be slung under that term 'fatigue' to even sure it is like-with-like and not apples-and-oranges, or more precisely pretending you are studying oranges when you've actually used methodology that's looking at apples in all these reviews.

 

The framing and how they define fatigue are just weird. Medicine really does not understand what the word means to patients, use it willy-nilly to mean almost anything and everything. They use it and can parrot some other MDs words about it, but they have zero understanding of what it actually means, can't seem to differentiate severe crippling fatigue from illness from a hard day's work or even feeling moody. Or anything else, really. It's just a generic buzzword devoid of any actual meaning.

All studies are biased. They're all over the place for various conditions that just aren't the same. There shouldn't be any conclusions from this, it's disastrously random and chaotic. Still, they recommend it, placing some causality out of purely associative, and highly biased, suggestions and assertions that use heavily tortured data to fit a conclusion that was the obvious starting point. Just like this review, literally the second sentence of the abstract is an affirmation that it must. In most cases it makes far more sense for any limited causality to work the other way around, but it's still always argued in the one direction of causality that is preferred.

Everything wrong with medicine, and how evidence-based medicine is simply unfit for purpose. What is even the point of continuing to fund hundreds more identical reviews and studies that are always biased, never have any firm findings, and just keep looping back on the same failure? With a conclusion to always keep doing more of the same, without any valid basis for it. This nonsense needs to end with extreme prejudice, it was an error, it is now a massive failure.

Also, they included 38 articles. There have been hundreds of systematic reviews, trials and studies of various kinds. Probably well over a thousand. This basically filters out well over 95% of them. How? How is any field of study completely unconcerned with such massive redundant waste?

No one seems to care that most of them are so useless they're not even worth considering. Because there will be more, the conclusion is always to do more. Always the same way. All so bad that most of them can't even be included in evidence reviews. This is insane! And again with the admission of no follow-up data. Which is always used to absurdly argue for ways to make it last, but they never even check and we all know why.

Millions of people have been subjected to this already. It's been going on for decades. There are way more centers dedicated to doing this than studies they could include in this. And no one cares! It just keeps plowing through with nothing ever to show for it than demands for more. Always more. Always for them, never delivering a damn thing.