Nondrug therapy provides modest short-term improvement in fatigue in older adults

Reference

Ho LYW, Ng SSM. Non-pharmacological interventions for fatigue in older adults: a systematic review and meta-analysis. Age Ageing 2020;49(3):341-351.

Synopsis

These authors searched multiple databases, clinical trial registries, and other sources to identify randomized trials of nonpharmacologic therapies to improve fatigue in community-dwelling adults older than 60 years. They did not include studies published before 2008 since they believe that fatigue is an "evolutionary concept" that changes based on "the social context in which a person lives in [sic]." The included studies had to assess fatigue with a valid scale. Two authors independently assessed the eligibility of studies for selection, as well as the risk of bias of each included trial. When possible, they contacted the authors of the original trials for unreported data. Ultimately, they included 7 randomized trials and 1 study with a factorial design. The 8 studies included 1093 participants whose mean ages ranged from 63.3 years to 75.3 years of age. Only 2 of the studies recruited persons with stable health; 3 studies recruited persons with sleep disorders and 3 studies recruited persons with arthritis or osteoarthritis. Six of the studies reported fatigue as a secondary outcome. One study assessed Tai Chi, 1 assessed cognitive behavioral therapy, 1 assessed both Tai Chi and cognitive behavioral therapy, and 1 study each assessed either mindfulness meditation, a behavioral lifestyle program, muscle relaxation, pets, or yoga. Only one of the studies had an overall low risk of bias. One of the studies did not report fatigue scores. That left 7 trials with 1033 participants for meta-analysis. Several interventions provided modest improvements in fatigue immediately after the intervention (standard mean difference [SMD] -0.40; 95% CI -0.62 to -0.18), but these data were moderately heterogeneous: mindfulness meditation, muscle relaxation, yoga, Tai Chi, and cognitive behavioral therapy. Lifestyle program and pet insects (seriously) did not improve fatigue. Although 5 studies evaluated longer term effects of the interventions, these showed no statistically significant improvements in fatigue scores. The authors performed a few subgroup analyses and found no significant difference between physical and cognitive/mental interventions, nor differences for persons with arthritis or stable health status. Only persons with sleep disorders showed significant improvements (SMD -0.63; -1.06 to -0.20).