Effects of activity pacing in patients with chronic conditions associated with fatigue complaints: a meta-analysis

A meta-analysis was conducted to (1) determine the effect of activity pacing interventions on fatigue, physical functioning and physical activity among patients with chronic conditions associated with fatigue complaints, and to (2) examine potential moderator effects of trial characteristics (components of intervention and amount of patient-provider contact). Six studies were included in the meta-analysis. Relevant content of the studies was extracted and rated on methodological quality. Random-effects modeling was used to pool data across studies. Medium (standardized mean difference =0.50) and marginal (standardized mean difference =0.34) effects were found for fatigue at post-treatment and follow-up respectively. Inconsequential effects were found for physical functioning and activity (standardized mean difference =0.08-0.30) at both assessment points. Subgroup analyses revealed components of intervention and amount of patient-provider contact were not the source of variance. Minimal patient-provider contact had an effect on fatigue comparable in magnitude to more intensive contact. This meta-analysis of activity pacing in patients with fatigue complaints suggests that activity pacing might have sustained beneficial effects on fatigue management, in particular on fatigue reduction. The divergence in effects for all outcomes suggests that alternative ways such as tailoring advice to individual's behavior toward physical activity may be more successful.Implications for rehabilitationIn a relatively small sample this meta-analysis shows fatigue severity improved after activity pacing interventions and provides a basis to integrate activity pacing in activity stimulation programs for persons with chronic conditions.Activity pacing can feasibly be implemented within standard health care to manage fatigue and physical activity behaviors in persons with chronic conditions.