Fatigue in neurological disorders: a review of self-regulation and mindfulness-based interventions

Background: Fatigue is prevalent in neurological disorders and is associated with increased disability and mortality rates. Currently, clinical assessment and management of fatigue is difficult as underlying mechanisms remain poorly understood. Purpose: This narrative review integrates models of pathological fatigue with the concepts of self-regulation and mindfulness. Findings from clinical trials testing the efficacy of mindfulness-based interventions (MBI) for fatigue in neurological disorders are also reviewed. Methods: A search of Medline and PsycINFO databases was conducted using “fatigue,” “neurological disorders,” “exercise,” “self-regulation,” and “mindfulness” search terms to identify articles published from 1980 to the present. Only articles reporting on fatigue relevant clinical outcomes were included in the review of trials testing MBI. Results: Recent definitions and models of pathological fatigue suggest that neurological disorders might instigate maladaptive changes in self-regulation leading to difficulties in sustaining movement and disproportionate levels of perceived effort. MBI might be effective in the management of fatigue since mindfulness training is thought to promote self-regulation by developing attention control and cognitive and emotional flexibility. Findings from a small number of clinical trials provide limited support for the efficacy of mindfulness-based interventions for fatigue in neurological disorders. Conclusion: Given the prevalence and debilitating effect of fatigue in neurological conditions, further research is needed to investigate the potential role of maladaptive self-regulation in the aetiology of this condition. Further research is also needed to test the efficacy of MBI including large randomised controlled trials with active control conditions and which directly assess changes in mindfulness along with fatigue.