Which therapies work best in reducing fatigue?

Sat 25 September 2021

Fatigue is a common and debilitating symptom in MS. Researcher Dr Reza Safari has scoured the science to look for the best ways to manage it.

Knowing how to manage fatigue is vital for helping people live well with MS. Dr Reza Safari is a researcher at the University of Derby. Reza and fellow researchers at Kings College London and Queen Margaret University recently reviewed lots of existing research into different ways to help people living with MS manage their fatigue. Reza told us what he found.

Why did you decide to look at current fatigue research?

“When people with MS are experiencing fatigue, doctors often give them a drug like aspirin or amantadine (Lysovir). These don’t always do much to reduce fatigue though. 

Some therapies that aren’t drug-based have shown promise. Especially exercise and other ways of changing your behaviour, like cognitive behavioural therapy (CBT). The National Institute for Health and Care Excellence (NICE) even recommend them for fatigue. But we didn’t know which ones are most effective.

I’m interested in how systematically reviewing research can help give clinicians the evidence they need to recommend therapies. And this review used a new approach that let us directly compare therapies that haven’t actually been studied side by side, like running versus CBT. We couldn't do that before!”

So which types of therapy were most effective at reducing fatigue?

“We found over 100 trials had looked at this. And two types of therapy came out top.

We found high quality evidence that CBT reduced fatigue. In particular, CBT focused specifically on fatigue rather than CBT focused on reducing distress. Mostly, this was measured by asking people to report their fatigue levels. And the positive effects could last up to six months. 

Exercises designed to improve balance also showed a large effect on fatigue. For example hippotherapy, where you sit on a walking horse and make small adjustments to your posture. Or a type of physiotherapy called vestibular rehabilitation.

But there wasn’t any data on how long this effect might last. And the evidence wasn’t such high quality. The studies we reviewed were small and the specific types of balance exercise were quite varied. So we need more research to be confident in saying how much of an impact they have.”

What about other forms of exercise?

“Most of the evidence we gathered about other therapies also wasn’t such high quality. Other therapies did show effects on fatigue but by smaller amounts. For example weight training, exercise that gets your heart rate up like running, and behavioural techniques like relaxation. Combining different types of exercise, and combining exercise with therapies to change your behaviour also showed an effect.” 

What do these findings mean for people with MS?

“People with MS sometimes think they should not do much exercise and not exhaust themselves. But actually, being more active and getting involved with some behavioural and psychological therapies (like CBT) could help with fatigue.

There are lots of different types of exercise, so if you struggle with mobility, this needn’t stand in your way. Our results suggest there is a good range of options to choose from, based on your needs and preference.”

What’s next?

“There’s more we need to uncover about how best to treat fatigue. It may be that some fatigue treatments work better depending on what type of MS you have. And we need to understand how well these treatments work for reducing fatigue long term. But it’ll be exciting to see what happens.

My colleagues are now working with the MS Society and others to build effective and readily available behavioural and exercise therapies to help people with MS with their fatigue."

>Watch a video of Reza explaining more about this research

We have developed an online course to help people manage their fatigue. The course is based on a programme developed by researchers at Bournemouth University.

Find out about our online fatigue management course