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Fatigue After Aneurysmal Subarachnoid Hemorrhage Is Highly Prevalent in the First-Year Postonset and Related to Low Physical Fitness

A Longitudinal Study

Harmsen, Wouter J., PhD; Ribbers, Gerard M., MD, PhD; Heijenbrok-Kal, Majanka H., PhD; Khajeh, Ladbon, MD; Sneekes, Emiel M., MSc; van Kooten, Fop, MD, PhD; Neggers, Sebastian J.C.M.M., MD, PhD; van den Berg-Emons, Rita J., PhD

American Journal of Physical Medicine & Rehabilitation: January 2019 - Volume 98 - Issue 1 - p 7–13
doi: 10.1097/PHM.0000000000000976
Original Research Articles CME Article . 2019 Series . Number 1

Objective The aim of the study was to investigate whether low physical fitness and inactive and sedentary lifestyles play a role in the severity of fatigue in patients with aneurysmal subarachnoid hemorrhage (a-SAH).

Design This is a prospective 1-yr follow-up study, including a total of 52 patients with a-SAH. Outcome measures included the Fatigue Severity Scale score, peak oxygen uptake (VO2peak), isokinetic knee muscle strength (peak torque), physical activity (% 24-hr period), and sedentary behavior (% waking hours) and were evaluated at 6 and 12 mos after onset.

Results Fatigue was highly prevalent in the first year and reported by 48% of the patients at 6 mos and by 52% at 12 mos after a-SAH. Fatigue was associated with the knee extension (P < 0.001) and flexion strength (P < 0.001). A nonsignificant trend for a relationship was found between fatigue and the aerobic capacity (P = 0.079). No relationships were found between fatigue and physical activity or sedentary behavior. Fatigue could not be predicted by disease-related characteristics.

Conclusions Half of the patients were fatigued in the first year after a-SAH. Interventions are necessary to reduce fatigue and should consider exercise training as a potential contributor to a multimodal treatment, preventing debilitating conditions after a-SAH.

To Claim CME Credits Complete the self-assessment activity and evaluation online at

CME Objectives Upon completion of this article, the reader should be able to: (1) Recognize the association between fatigue and physical fitness in patients after aneurysmal subarachnoid hemorrhage; (2) Determine the severity of fatigue complaints in patient after aneurysmal subarachnoid hemorrhage; and (3) Discuss the role of physical deconditioning in the management of fatigue in patients after aneurysmal subarachnoid hemorrhage.

Level Advanced

Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

From the Rijndam Rehabilitation Institute, Rotterdam, the Netherlands (WJH, GMR, MHH-K, EMS, RJvdB-E); and Departments of Rehabilitation Medicine (WJH, GMR, MHH-K, EMS, RJvdB-E), Neurology (LK, FvK), and Endocrinology (SJCMMN), Erasmus MC University Medical Center, Rotterdam, the Netherlands.

All correspondence should be addressed to: Wouter J. Harmsen, PhD, Department of Rehabilitation Medicine, Erasmus Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.

The study was supported by the Dutch Brain Foundation (Grant Number 15F07.06).

The abstract of the study was presented at the International Brain Injury Association on April 1, 2017, in New Orleans, Louisiana.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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