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Traumatic brain injury (TBI) is a complex condition associated with a range of persistent symptoms including headaches, cognitive dysfunction, mental fatigue, insomnia, and mood disorders. Conventional treatments for TBI-related symptoms can be insufficient, leading to interest in complementary and integrative medicine (CIM) approaches. This comprehensive article examines the existing literature on CIM modalities, including mind-body interventions, acupuncture/acupressure, herbal remedies, nutritional supplements, biofeedback, yoga, and tai chi in the context of managing secondary complications following TBI. The article highlights potential benefits and limitations of CIM modalities, while acknowledging the need for further research to better establish efficacy and safety in this specific population., Competing Interests: Disclosure There are no commercial or financial conflicts of interest from any of the authors., (Published by Elsevier Inc.)

Individuals suffering from long-COVID can present with "brain fog", which is characterized by a range of cognitive impairments, such as confusion, short-term memory loss, and difficulty concentrating. To date, several potential interventions for brain fog have been considered. Notably, no systematic review has comprehensively discussed the impact of each intervention type on brain fog symptoms. We included studies on adult (aged > 18 years) individuals with proven long- COVID brain-fog symptoms from PubMed, MEDLINE, Central, Scopus, and Embase. A search limit was set for articles published between 01/2020 and 31/12/2023. We excluded studies lacking an objective assessment of brain fog symptoms and patients with preexisting neurological diseases that affected cognition before COVID-19 infection. This review provided relevant information from 17 studies. The rehabilitation studies utilized diverse approaches, leading to a range of outcomes in terms of the effectiveness of the interventions. Six studies described noninvasive brain stimulation, and all showed improvement in cognitive ability. Three studies described hyperbaric oxygen therapy, all of which showed improvements in cognitive assessment tests and brain perfusion. Two studies showed that the use of Palmitoylethanolamide and Luteolin (PEA-LUT) improved cognitive impairment. Noninvasive brain stimulation and hyperbaric oxygen therapy showed promising results in the treatment of brain fog symptoms caused by long-COVID, with improved perfusion and cortical excitability. Furthermore, both rehabilitation strategies and PEA-LUT administration have been associated with improvements in symptoms of brain fog. Future studies should explore combinations of interventions and include longer follow-up periods to assess the long-term effects of these treatments., (© 2024. The Author(s).)

Background: Mental fatigue and mental recovery have gained scientific attention in relation to sporting performance, yet best practice assessment and management methods are lacking. A greater understanding of current knowledge and practices in high-performance sport are necessary., Objective: To understand the contemporary knowledge, beliefs, monitoring processes, management strategies, perceived responsibility, sources of evidence, and challenges, when assessing the mental fatigue and mental recovery of athletes in high-performance sport., Methods: A mixed-methods survey approach obtained information from 156 multi-disciplinary high-performance sport practitioners. Descriptive outputs were reported and potential differences between key concepts were detected using Wilcoxon-signed rank analysis. Thematic analysis interpreted open-text responses., Results: Only 11.5% and 5.1% of respondents indicated they were "very" knowledgeable about mental fatigue and mental recovery, respectively. Knowledge (p < 0.001) and confidence in application (p = 0.001) were significantly greater for mental fatigue than mental recovery. Nearly all respondents perceived mental fatigue and mental recovery impacted training and competition performance, with a greater negative impact during competition (p < 0.001). A limited number of respondents reported deliberate assessment (31.1%) or management (51.2%) of mental fatigue and mental recovery. A combination of sources of evidence were used to inform practice, with common challenges to implementation including staff knowledge, athlete-buy in, time-availability, and a lack of evidence. Practitioners reported that assessing and managing mental fatigue and mental recovery was multi-disciplinary in nature., Conclusion: Practitioners reported that mental fatigue and mental recovery did impact performance, yet this was not reflected in the implementation of evidence-based assessment and management practices in high-performance sport., (© 2023 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.)

Background: There is evidence that mindfulness-based interventions (MBI) can help one to recover from mental fatigue (MF). Although the strength model of self-control explains the processes underlying MF and the model of mindfulness and de-automatization explains how mindfulness training promotes adaptive self-regulation leading to the recovery of MF, a systematic overview detailing the effects of MBI on the recovery of MF is still lacking. Thus, this systematic review aims to discuss the influences of MBI on the recovery of MF. Methods: We used five databases, namely, PubMed, Web of Science, EBSCOhost, Scopus, and China National Knowledge Infrastructure (CNKI) for articles published up to 24 September 2021, using a combination of keywords related to MBI and MF. Results: Eight articles fulfilled all the eligibility criteria and were included in this review. The MBI directly attenuated MF and positively affected the recovery of psychology (attention, aggression and mind-wandering) and sports performance (handgrip, plank exercise and basketball free throw) under MF. However, the interaction did not reach statistical significance for the plank exercise. Therefore, the experience and duration of mindfulness are necessary factors for the success of MBI. Conclusions: mindfulness appears to be most related to a reduction in MF. Future research should focus on improving the methodological rigor of MBI to confirm these results and on identifying facets of mindfulness that are most effective for attenuating MF.

Mental fatigue or brain fatigue is a pathological and disabling symptom with diminished mental energy. It can be a long-lasting consequence after trauma or disease affecting the brain. The person can do most things in the moment and can be perceived as completely healthy, but the mental energy is insufficient over time and affects the ability to work and participate in social activities. After a conversation, for example, the person can be completely drained of energy and the recovery time is disproportionally long. Here we describe the phenomenon of mental fatigue, provide an explanatory model for how the condition can arise, point out diagnostic methods and possible treatments, which are currently in the research stage but may be implemented in healthcare within the foreseeable future.

Volleyball is a team sport with high physical and perceptual-cognitive demand, hence, increasing the perception of physical and mental fatigue during a competition. To alleviate fatigue (physical and mental), mindfulness and music have been proposed. The aim of this study was to analyze the effect of mindfulness-based mental versus music training on mental fatigue, physical fatigue, and recovery in elite competitive female volleyball athletes using a randomized two-controlled study with follow-up. Participants were 30 elite female Brazilian volleyball athletes. Athletes were randomly assigned to the following groups: 1) mindfulness-based mental training group (MBMT); 2) music-based training group (MBT); or 3) control group (CG). Three variables were evaluated as follows: 1) recovery based on total quality recovery; 2) mental fatigue visual analog scale; and 3) physical fatigue visual analog scale. Regarding recovery, there was no difference between the MBMT, MBT, and CG groups (p > 0.05). A difference in mental fatigue was noted between MBT and CG at follow-up [F(2,26) = 5.71, p = 0.009; large]. Regarding physical fatigue, there was no difference between the MBMT, MBT, and CG groups (p > 0.05). The mindfulness intervention effectively attenuated the mental fatigue caused by competition in volleyball athletes. These results will assist coaches and staff in providing fatigue management and reinforce the applicability of mental training in sports., (© Journal of Sports Science and Medicine.)

Recovery from work is generally thought to occur outside of the workplace. However, employees may also have the opportunity to recover within the work day via microbreaks during demanding work tasks. Two major strategies for mitigating fatigue include psychological detachment (i.e., mentally disengaging) and replenishing motivational incentives via positive affect. This study examined whether 40-s "microbreaks" improve work recovery and to what extent different microbreak content (mastery vs. relaxation activities) boost performance. Using an experimental study, we randomly assigned individuals to receive a relaxation microbreak ( n  =   59), a mastery microbreak ( n  =   68), or no break ( n  =   72) in the middle of a monotonous work task and assessed work performance. Microbreaks improved task performance and within-task recovery, but only for psychological detachment (not positive affect). Mastery breaks also resulted in more psychological detachment than relaxation breaks, but this increased detachment did not explain performance differences between break types. These results build on existing recovery theories by further demonstrating within-task recovery and provide practical implications for organizations to consider the importance of microbreaks.

Mental fatigue is growingly considered to be associated with functional brain dysconnectivity. Although conventional wisdom suggests that rest break is an effective countermeasure, the underlying neural mechanisms and how they modulate fatigue-related brain dysconnectivity is largely unknown. Here, we introduce an empirical method to examine the reorganization of dynamic functional connectivity (FC) in a two-session experiment where one session including a mid-task break (Rest) compared to a successive task design in the other session (No-rest). Temporal brain networks were estimated from 20 participants and the spatiotemporal architecture was examined using our newly developed temporal efficiency analysis framework. We showed that taking a mid-task break leads to a restorative effect towards the end of experiment instead of immediate post-rest behaviour benefits. More importantly, we revealed a potential neural basis of our behaviour observation: the reduced spatiotemporal global integrity of temporal brain network in No-rest session was significantly improved with the break opportunity in the last task block of Rest session. Overall, we provided novel evidence to support beneficial effect of rest breaks in both behaviour performance and brain function. Moreover, these findings extended prior static FC studies of mental fatigue and highlight that altered dynamic FC may underlie cognitive fatigue.

Introduction: Given the increasing prevalence of complications caused by the polycystic ovarian syndrome (PCOS) such as medical and psychological problems and also the chronicity of this disease, patients with the PCOS tend to experience lower quality of life and greater psychological fatigue similar to other patients with chronic diseases. This study was conducted to determine the effects of cognitive-behavioral therapy (CBT) on the quality of life and psychological fatigue in women with the PCOS. Methods: This randomized controlled clinical trial study, conducted from 2016 to 2017, enrolled 74 women aged between 18 and 35 years from the Iranian city of Saqqez. The participants were assigned to a CBT group and a control group via block randomization. The intervention group received 8 weekly CBT sessions between 45 and 60 minutes each. The Polycystic Ovary Syndrome Health-Related Quality of Life Questionnaire (PCOSQ) and the Fatigue Impact Scale (FIS) were completed by the patients before and after the intervention. Results: No significant differences were observed between the two groups before the intervention in terms of sociodemographic characteristics and the mean scores of quality of life and psychological fatigue. After the intervention, the mean (standard deviation [SD]) of the quality of life score was 60.2 (13.3) in the intervention group and 24.4 (15) in the control group, with the mean score of quality of life being significantly higher in the intervention group than in the control group (adjusted mean difference = 33.1). The mean (SD) score of psychological fatigue was 28.2 (13.9) in the intervention group and 78.2 (37.1) in the control group, with the mean score of psychological fatigue being significantly lower in the intervention group than in the control group (-54.8). Conclusions: The results showed that CBT was able to reduce fatigue and improve quality of life in our sample of women with the PCOS and ultimately boost their health.

Attention Restoration Theory is applied to explore the causes and consequences of mental fatigue in clergy and suggest practical interventions to restore cognitive wellbeing. Previous research has investigated the physical and emotional health and wellbeing of clergy, but has largely neglected clergy cognitive wellbeing. Due to the demanding nature of their work, clergy are particularly susceptible to mental fatigue and depletion of their capacity to maintain attention. Symptoms include inability to focus attention, inhibit distractions, make decisions or solve problems. Mental fatigue can be overcome, and cognitive capacity restored, by spending time in restorative environments that allow directed attention to rest.

Objective: To verify whether the mechanical massage using massage chairs and binaural beats (brain massage) affect the mental fatigue recovery and cognitive enhancements., Methods: 25 healthy adults used massage chairs that could provide mechanical massage and binaural beats (brain massage) for 20 min. Mental fatigue and cognitive function were assessed before and after receiving brain massage using electroencephalogram (EEG) and 5 prolonged cognitive tests., Results: When a person received a brain massage on the massage chair, the decrease in mental fatigue was statistically significant compared to taking a rest or receiving a mechanical massage only on the massage chair. In addition, sustained attention, verbal short-term and long-term memory and non-verbal long-term memory were statistically significantly increased after using brain massage., Conclusion: Brain massage (mechanical massage and binaural beats) are effective in reducing mental fatigue and improving the cognitive function., (Copyright © 2018. Published by Elsevier Ltd.)

Fatigue is one of the most common and debilitating symptoms affecting patients with multiple sclerosis (MS). Sustained cognitive effort induces cognitive fatigue, operationalized as subjective exhaustion and fatigue-related objective alertness decrements with time-on-task. During prolonged cognitive testing, MS patients show increased simple reaction times (RT) accompanied by lower amplitudes and prolonged latencies of the P300 event-related potential. Previous studies suggested a major role of structural and functional abnormalities in the frontal cortex including a frontal hypo-activation in fatigue pathogenesis. In the present study we investigated the neuromodulatory effect of transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (DLPFC) on objective measures of fatigue-related decrements in cognitive performance in MS patients. P300 during an auditory oddball task and simple reaction times in an alertness test were recorded at baseline, during and after stimulation. Compared to sham, anodal tDCS caused an increase in P300 amplitude that persisted after the end of stimulation and eliminated the fatigue-related increase in RT over the course of a testing session. Our findings demonstrate that anodal tDCS over the left DLPFC can counteract performance decrements associated with fatigue thereby leading to an improvement in the patient's ability to cope with sustained cognitive demands. This provides causal evidence for the functional relevance of the left DLPFC in fatigue pathophysiology. The results indicate that tDCS-induced modulations of frontal activity can be an effective therapeutic option for the treatment of fatigue-related declines in cognitive performance in MS patients.

Background: Prolonged exposure to stress can lead to substantial suffering, impairment and societal costs. However, access to psychological treatment is limited. Internet-based cognitive behavioral therapy (ICBT) can be effective in reducing symptoms of stress, but little is known of its effects in clinical samples. The aim of this study was to investigate the efficacy of ICBT for patients suffering from chronic stress, operationalized as adjustment disorder (AD) and exhaustion disorder (ED)., Methods: A total of 100 adults diagnosed with AD or ED were randomly assigned to a 12-week ICBT (n = 50) or waitlist control condition (n = 50). Primary outcome was the level of perceived stress (PSS). Secondary outcomes included several mental health symptom domains as well as functional impairment and work ability. All outcomes were assessed at baseline, after treatment and at the 6-month follow-up. The study was preregistered at Clinicaltrials.gov: NCT02540317., Results: Compared to the control condition, patients in the ICBT group made large and significant improvements on the PSS (d = 1.09) and moderate to large improvements in secondary symptom domains. Effects were maintained at the 6-month follow-up. There was no significant between-group effect on functional impairment or work ability., Conclusions: A relatively short ICBT is indicated to be effective in reducing stress-related symptoms in a clinical sample of patients with AD and ED, and has the potential to substantially increase treatment accessibility. Results must be replicated, and further research is needed to understand the relationship between symptom reduction, functional impairment and work ability., (© 2018 S. Karger AG, Basel.)

Mental fatigue is a frequently occurring symptom after mild, moderate or severe traumatic brain injury (TBI). Such mental fatigue may become a long-lasting problem, irrespective of severity and even after recovery from other neurological or psychiatric symptoms. Two characteristics of this mental fatigue are that patients easily become exhausted and there is generally a long recovery time. There is a need to increase knowledge and awareness of mental fatigue as it interferes considerably with work, studies, and social activities. Assessment is difficult and few treatment studies have been carried out. For the purposes of assessment, the development of the Mental Fatigue Scale is described here, and we also summarise the few treatment studies found for fatigue after TBI. Symptom alleviation is reported through Mindfulness-Based Stress Reduction (MBSR), light therapy and for the psychostimulant methylphenidate and the dopamine stabiliser (-)-OSU6162. However, more knowledge of the origin of mental fatigue and its underlying mechanisms is needed for development of more efficient therapeutic methods. Prospective randomised trials focusing on long-term outcomes are warranted and should include both pharmacological and non-pharmacological treatments.

Background: Mental fatigue caused by continuous cognitive tasks represents one of the most worrying modern health problems. Event Related Potential (ERP) P300 is thought to be associated with cognitive function., Objective: This study aimed at characterizing the neural activity correlated with the attentional processes and exploring a novelty method which combine the magnetic stimulation and acupoint to relieve mental fatigue caused by continuous cognitive tasks., Methods: P300 (P3a and P3b) were extracted at three points: when subjects felt relaxed, at the point of mental fatigue, and after the subjects were stimulated at acupoints. The amplitudes and latencies of P3a and P3b were analyzed statistically., Results: Among the four features (P3a amplitude, P3a latency, P3b amplitude, and P3b latency), only P3b amplitude was found to have a significant difference between the resting state and the mental fatigue state. And P3b amplitude significantly increased after magnetic stimulation at the acupoints., Conclusions: Subjects experiencing mental fatigue demonstrated a significant decrease in P3b amplitude in the parietal region, suggesting attenuation of resource allocation for selective attention. P3b amplitude significantly increased after magnetic stimulation at acupoints indicating that this strategy can be used to improve selective attention and relieve mental fatigue.

Cancer-related fatigue has a multidimensional nature and complaints typically increase during adjuvant treatment for breast cancer. Physical exercise might prevent or reduce cancer-related fatigue. So far, no meta-analysis has investigated the effects of physical exercise on different dimensions of fatigue. The aim of the present meta-analysis was to investigate the effects of physical exercise during adjuvant breast cancer treatment on physical and psychosocial dimensions of fatigue. We performed a systematic literature search in PubMed, Embase and the Cochrane Library in June 2015. Randomised controlled trials reporting the effects of physical exercise during adjuvant breast cancer treatment on different dimensions of fatigue were included. Pooled effects of 6 exercise programmes (including 784 patients) showed significant beneficial exercise effects on general fatigue (ES: -0.22, 95% CI -0.38; -0.05) and physical fatigue (ES: -0.35, 95% CI -0.49; -0.21). Effects on fatigue subscales 'reduced activity' (ES: -0.22, 95% CI -0.38; -0.05) and 'reduced motivation' (ES: -0.18, 95% CI -0.35; -0.01) were also in favour of physical exercise. No effects were found on cognitive and affective fatigue. Including only the supervised exercise programmes (n=4 studies), slightly larger pooled effect estimates were found on general fatigue (ES: -0.25, 95% CI -0.47; -0.04) and physical fatigue (-0.39, 95% CI -0.56; -0.23). In conclusion, physical exercise during adjuvant breast cancer treatment has beneficial effects on general fatigue, physical fatigue, 'reduced activity' and 'reduced motivation', but did not show effects on cognitive and affective fatigue. Largest effect sizes are found for physical fatigue, suggesting that this is the fatigue dimension most sensitive to physical exercise., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Background: There is a lack of research regarding the long-lasting effects of a more physically active lifestyle in patients with mental disorders. In the present study, clinical data were analysed to examine if initially physically inactive patients, clinically diagnosed with stress-related exhaustion, taking part in 12-month multimodal treatment (MMT), differ at the 18-month follow-up regarding mental health, depending on whether they did or did not comply with the physical activity (PA) recommendations resembling those of the American College of Sports Medicine., Methods: The study population consisted of 69 patients (65% women) who were referred to a stress clinic due to stress-related exhaustion. All patients received MMT. A major goal was to increase patients' PA levels. The patients received general comprehensive instructions including personal advice regarding the positive effects of PA on mental health and could self-select for an 18-week coached exercise program. Changes in mental health symptoms over an 18-month period were compared between non-compliers (n = 26), mild compliers (n = 22) and strong compliers (n = 21) with the PA recommendations included in the MMT., Results: Non-compliers, mild and strong compliers did not differ regarding burnout, depression and anxiety at baseline. Although substantial improvements occurred in all groups, mild and strong compliers reported significantly lower burnout and depression levels at the 18-month follow-up than the non-complying group (p < .05). The general pattern of findings was corroborated, if standard cut-off criteria for clinical burnout were used., Conclusions: Compliance with PA recommendations is associated with decreased levels of burnout and depression in patients with stress-related exhaustion. Thus, the promotion of a more active lifestyle among patients with stress-related exhaustion should be implemented as a part of MMT, to achieve a more sustainable decrease of symptoms of burnout and depression., Trial Registration: This is not a clinical trial.

Tertiary prevention refers to care aimed at reducing morbidity and disability in people diagnosed with, and being treated for, disease. This article focuses on psychological aspects of tertiary prevention during the active phase of cancer treatment. Research in this area gained momentum in the 1970s, a time that coincides with changing public attitudes about discussing cancer and the origins of health psychology and behavioral medicine as fields of study. Over the past 40 years, much has been learned about the psychological impact of cancer and the beneficial effects of psychological interventions on patients' mental and physical well-being. The amount of research in this area necessitates a selective, rather than comprehensive, review approach. The focus here is on issues that affect a large proportion of people with cancer and for which research has generated an in-depth understanding. Accordingly, the article summarizes findings regarding the prevalence, etiology, and contributing factors, and the clinical management of, two of the most common psychological reactions to cancer diagnosis and treatment (i.e., depression and anxiety) and two of the most common physical symptoms related to cancer and its treatment (i.e., fatigue and pain). The review also summarizes emerging lines of research on psychological reactions to recurrent and second cancers, and on cancer diagnosis and treatment as a "teachable moment" for promoting health behavior change. Finally, important future directions are identified, including the need to adopt a team science approach to tertiary care and to better translate findings from intervention research into clinical practice., (PsycINFO Database Record (c) 2015 APA, all rights reserved.)

Stress-related exhaustion has been linked to a pattern of selective cognitive impairments, mainly affecting executive functioning, attention and episodic memory. Little is known about potential treatments of these cognitive deficits. The purpose of this study was to evaluate the effects of a process-based cognitive training intervention, designed to target the specific cognitive impairments associated with stress-related exhaustion. To this end, patients diagnosed with exhaustion disorder (ED) were randomized to either a multimodal stress rehabilitation program with the addition of a process-based cognitive training intervention (training group, n = 27) or a treatment-as-usual control condition, consisting of multimodal stress rehabilitation with no additional training (control group, n = 32). Treatment effects were evaluated through an extensive cognitive test battery, assessing both near and far transfer effects, as well as self-report forms regarding subjective cognitive complaints and burnout levels. Results showed pronounced training-related improvements on the criterion updating task (p < 0.001). Further, evidence was found of selective near transfer effects to updating (p = 0.01) and episodic memory (p = 0.04). Also, the trained group reported less subjective memory complaints (p = 0.02) and levels of burnout decreased for both groups, but more so for the trained group (p = 0.04), following the intervention. These findings suggest that process-based cognitive training may be a viable method to address the cognitive impairments associated with ED.

Since the onset of the Iraq war and Afghanistan conflicts, military healthcare teams have had increasing exposure to the traumatic effects of caring for wounded warriors, leading to a phenomenon termed compassion fatigue. The purpose of this integrative review was to develop a proposed definition for compassion fatigue in support of these teams. There is no current standardized formal definition, and this lack of clarity can inhibit intervention. Seven main themes evolved from the literature review and were integrated with the core elements of the Bandura Social Cognitive Theory Model as the first step in developing a uniformed definition., (© 2013.)

Context: Exposure to a natural environment has been reported to be associated with positive effects on mental well-being. However, no report has examined the effects of a house designed with an open space connected to nature on recovery from fatigue., Objective: The purpose of this study was to examine the effects of such an open space on recovery from mental fatigue., Design: Placebo-controlled, crossover design., Setting: Participants were randomized into open (connected to nature) and closed (not connected to nature) conditions., Participants: Sixteen healthy female volunteers were enrolled., Intervention: After a 30-minute fatigue-inducing mental task, participants moved to an open or closed recovery room for 30 minutes., Main Outcome Measures: As fatigue-evaluating mental tasks, participants performed advanced trail making tests for 20 minutes. They were asked to rate their levels of fatigue, relaxation, comfort, and healing on a visual analogue scale from 0 (minimum) to 100 (maximum) to evaluate their subjective mental. They also underwent accelerated plethysmography., Results: After the recovery session, lower total error counts of a cognitive test, greater levels of subjective relaxation, comfort, and healing, and lower levels of waveform index-1 assessed via accelerated plethysmography were observed in participants exposed to the open condition compared with the closed condition. These results provide evidence that the use of a house designed with an open space connected to nature during the recovery session improved cognitive function and subjective mental states. Hence, open space was effective for helping recovery from mental fatigue., (Copyright © 2013 Elsevier Inc. All rights reserved.)

People tend to recover more quickly from stress and mental fatigue in natural than in urban environments. But natural environments may not always be restorative. Dense wooded areas may evoke fear and stress and require directed attention to avoid getting lost or tripping over. Little is known about the restorative potential of such environments. Two experiments were conducted to examine restoration in natural settings with different levels of accessibility, prospect (clear field of vision) and refuge (places to hide). An on-line survey (n=269) examined perceived restoration of environments presented in a slide show. An experiment examined actual restoration in response to walks in a real outdoor setting (n=17) and in response to videos of the same walks (in a laboratory; n=17). The findings demonstrate that exposure to natural environments with high levels of prospect and low levels of refuge, is indeed restorative. However, exposure to natural environments low in prospect and high in refuge is not, and may even further increase levels of stress and attention fatigue. These findings demonstrate that natural places may not always be restorative places., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background and Purpose: Fatigue is a common, persistent consequence of stroke, and no evidence-based treatments are currently available to alleviate fatigue. A new treatment combining cognitive therapy (CO) with graded activity training (GRAT), called COGRAT, was developed to alleviate fatigue and fatigue-related symptoms. This study compared the effectiveness of the COGRAT intervention with a CO-only intervention after a 3-month qualification period without intervention., Methods: This randomized, controlled, assessor-blind clinical trial was conducted in 8 rehabilitation centers. Eighty-three stroke patients (>4 months after stroke) were randomly assigned to 12 weeks of CO or COGRAT after qualification. Seventy-three patients completed treatment and 68 were available at follow-up. Primary outcomes (Checklist Individual Strength-subscale Fatigue (CIS-f); self-observation list-fatigue (SOL-f)) and secondary outcomes (Hospital Anxiety and Depression Scale, Stroke-Adapted Sickness Impact Profile, SOL-pain, SOL-sleep-D, 6-minute walk test) were collected at baseline (before and after qualification period) and after treatment (immediate and 6-month follow-up)., Results: The qualification period showed stable outcome measures. Both treatments showed significant beneficial effects on fatigue (CIS-f: η(p)(2)=0.48, P<0.001) and other outcomes (except pain and anxiety) with intention-to-treat analyses. Gains for the COGRAT group exceeded those in the CO group on number of individuals showing clinical improvement on the CIS-f (≥8 points: 58% versus 24%) and on physical endurance (η(p)(2)=0.20, P<0.001)., Conclusions: A 12-week cognitive therapy program can alleviate persistent fatigue after stroke. The best results are obtained when cognitive therapy is augmented with graded activity training. Clinical Trial Registration- URL: http://www.trialregister.nl. Unique identifier: NTR2704.

Background: Bathing in hot water is very common in Japan; people bathe in order to clean their bodies and to recover from physical and mental fatigue. However, there have been few reports examining the effects of bathing on recovery from mental fatigue. The purpose of this study was to examine the effects of mild-stream bathing on recovery from mental fatigue., Material/methods: During mild-stream bathing, a mild stream continuously passes from the sole to the calf, thigh, waist and back, thus providing a massage function. In a double-blinded, placebo-controlled, crossover experiment, 14 male healthy volunteers were randomized into normal bathing and mild-stream bathing experiments. After a fatigue-inducing mental task for 4 hours, subjects took a normal or mild-stream bath., Results: Heart rate was higher, muscle stiffness in the waist was lower and plasma cortisol levels tended to be lower after mild-stream bathing when compared to normal bathing. In addition, after mild-stream bathing, mental task performance, as assessed by reaction times on an advanced trail making test, was better than that after normal bathing., Conclusions: The present results suggest that improved working memory processing, diminished waist muscle tone, and attenuated mental stress are induced by mild-stream bathing. Therefore, mild-stream bathing appears to be more effective for alleviating mental fatigue than normal bathing.

Introduction: Fatigue and poor physical function are well-known symptoms in cancer patients. Allogeneic stem cell transplantation is an established treatment for certain cancer diagnoses, especially leukaemia. The aim of this study was to investigate physical function and fatigue in relation to allogeneic stem cell transplantation., Materials and Methods: 21 patients awaiting allogeneic stem cell transplantation were included in a descriptive follow-up design. Fatigue and physical function was assessed by a standardized test programme consisting of a stair test, a test of maximum oxygen uptake and questionnaires on physical activity and fatigue prior to transplantation as well as 3 and 6 months after transplantation., Results: 10 men and 11 women were included. The mean age was 39 years (19-60). Prior to transplantation patients had a low maximum oxygen uptake and reported more fatigue than the Danish general population. Physical fatigue rather than mental fatigue was pronounced both before and after transplantation. No significant changes in the parameters were found from before transplant to 6 months after transplant., Conclusion: The results indicate that prior to transplantation patients have poor physical function and increased physical fatigue. The symptoms seem to persist 6 months after transplantation. This could indicate a need for an extensive rehabilitation programme following transplantation.

Background: Mental health care is now a major occupational health issue in Japan. Although realizing effective use of external employee assistance programmes (EAPs) has been identified as crucial for mental health care, few scientific papers describe or analyse the characteristics of EAPs in Japan., Aims: This study sought to clarify the characteristics of an external EAP in Japan., Methods: The characteristics of an external EAP were clarified in terms of programme description and utilization. A total of 10,260 counselling sessions from 1996 to 2000 were used for utilization analysis., Results: The EAP studied had contracts with 133 organizations, half of which were health insurance societies. The EAP provided employees and family members with free, confidential counselling. Annual mean utilization rate per 1000 individuals increased from 1.3 in 1996 to 2.7 in 2000. Less than one-third of counselling sessions were for work-related mental health issues, and male users (30%) consulted significantly more often than female users (14%) for such problems. Among men, career development issues were most common, while job dissatisfaction was highest among women. Absenteeism, depression and fatigue were the most frequently observed problems in both sexes., Conclusions: EAP use in Japan is rising. The majority of its use is for non-work-related health issues. Male users were more likely to consult for work-related mental health problems.

Background: Patients with chronic fatigue syndrome (CFS) show evidence of circadian rhythm disturbances. We aimed to determine whether CFS symptoms were alleviated by melatonin and bright-light phototherapy, which have been shown to improve circadian rhythm disorders and fatigue in jet-lag and shift workers., Design: Thirty patients with unexplained fatigue for > 6 months were initially assessed using placebo and then received melatonin (5 mg in the evening) and phototherapy (2500 Lux for 1 h in the morning), each for 12 weeks in random order separated by a washout period. Principal symptoms of CFS were measured by visual analogue scales, the Shortform (SF-36) Health Survey, Mental Fatigue Inventory and Hospital Anxiety and Depression Scale. We also determined the circadian rhythm of body temperature, timing of the onset of melatonin secretion, and the relationship between these., Results: Neither intervention showed any significant effect on any of the principal symptoms or on general measures of physical or mental health. Compared with placebo, neither body temperature rhythm nor onset of melatonin secretion was significantly altered by either treatment, except for a slight advance of temperature phase (0.8 h; P = 0.04) with phototherapy., Conclusion: Melatonin and bright-light phototherapy appear ineffective in CFS. Both treatments are being prescribed for CFS sufferers by medical and alternative practitioners. Their unregulated use should be prohibited unless, or until, clear benefits are convincingly demonstrated.

Folk wisdom suggests that chicken extract is useful for recovery from physical and mental fatigue. To explore this question, the physiological effect of Brand's Essence of Chicken (BEC), a popular chicken extract used as a traditional remedy, was assessed during recovering from mental stress. We quantitated the blood levels of stress-related substances, and examined the task performance and subjects' mood states during mental workloads. Subjects were 20, healthy male students who have never tasted BEC. They took two bottles of BEC or a placebo (70 ml/bottle) daily in the morning for 7 days. On the final experimental day, two mental workload tests were performed: (A) a mental arithmetic test (MAT; 1600 trials of two or three figure-addition or subtraction for 40 min). (B) a short-term memory test (SMT; 20 trials of memorizing 9 digit numbers). Blood was collected before and after each workload task. After the mental workload, the recovery of mean cortisol level of subjects who consumed BEC was significantly faster than that for those consuming the placebo. The task performance of subjects performing the MAT and SMT was also improved with BEC consumption compared with placebo. According to the profile of mood state questionnaire, subjects felt more active and less fatigued during the workload when they took BEC regularly. We conclude that the extract of chicken has the potential to metabolize stress-related substance in blood and to promote recovery from mental fatigue.

The method of regulative music therapy (RMT) by C. Schwabe is presented-its mechanisms, the caring out procedure, usability and application domains. RMT can help to cope with mental and physical overstrain, resulting in variety of disorders regarding sleep and cardiovascular system; stomach and muscle pains, irritability and lack of balance, anxiety. RMT is based on the learning of specific perception form-efficient observation on: one's own personality, body, functions, thoughts, emotions, and not reasoning. In this way the pathogenic attention narrowing is overwhelmed and the behavior changes which reflect on the general well-being and self-tolerance. The music in RMT has a starting function. RMT is used not only in the case of neurosis therapy, it is successfully applied in the preventive medicine as a training method to cope with over-tension and as means to prevent emotional alienation in every day life.

Cross-training is a widely used approach for structuring a training programme to improve competitive performance in a specific sport by training in a variety of sports. Despite numerous anecdotal reports claiming benefits for cross-training, very few scientific studies have investigated this particular type of training. It appears that some transfer of training effects on maximum oxygen uptake (VO2max) exists from one mode to another. The nonspecific training effects seem to be more noticeable when running is performed as a cross-training mode. Swim training, however, may result in minimum transfer of training effects on VO2max. Cross-training effects never exceed those induced by the sport-specific training mode. The principles of specificity of training tend to have greater significance, especially for highly trained athletes. For the general population, cross-training may be highly beneficial in terms of overall fitness. Similarly, cross-training may be an appropriate supplement during rehabilitation periods from physical injury and during periods of overtraining or psychological fatigue.

Optimal levels of the health status of pilots performing an intensive flight program can be maintained by rational work and rest schedules and correction methods. The effectiveness of central electroanalgesia as a correction method was determined. The course of treatment which consisted of 4-5 sessions, each 40-50 min long, produced a beneficial effect on the health status and work capacity of pilots as measured by direct and indirect methods.