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Patient perceptions on energizers and drainers in RA fatigue: Implications for clincial practice

Cliss, Alena C.; Ambler, Nicholas; Knops, Beverly; Swinkels, Annette; Hammond, Alison; Kitchen, Karen; Pollock, Jon I.; Pope, Denise; Hewlett, Sarah


Alena C. Cliss

Nicholas Ambler

Beverly Knops

Annette Swinkels

Karen Kitchen

Jon I. Pollock

Denise Pope

Sarah Hewlett


Background: Fatigue is a significant symptom of RA, yet patients have reported feeling unsupported by clinicians, and self-management has variable success. This study aimed to explore the patients’ perception of what contributes to, or resolves fatigue.

Methods: Patients with RA who scored >6 on a fatigue VAS (0-10, 10 high) were recruited into an RCT of Cognitive Behavioural Therapy vs information only for RA fatigue management. Patients receiving group-based CBT were invited to generate ‘‘things that give you energy’’ and ‘‘things that drain your energy’’. Each group then discussed the items, classing them as energizers, drainers or both. Data were analysed thematically to identify common issues.

Results: 27 patients (24 F, 3M) participated, with a mean age of 60.5 yrs (SD. 11.7, range 29-77). Mean fatigue VAS was 8 (SD 1, range 6-9). Patients generated a total of 521 items. Two main themes emerged: psychosocial items (58.7%) and physiological items (41.3%), each containing both energizers and drainers. Psychosocial factors comprised Cognitive Issues (eg acceptance, stress), Situations Involving High Emotion (eg family, sex, Christmas, socializing), Cerebral Activities (eg sudoku, finances, reading) and Creative Activities (eg music, painting, singing). Physiological factors comprised Biological Issues (eg medication, eating), Structured Physical Activity (eg walking, swimming, rest) and Unstructured Physical Activity (eg gardening, housework). Patients generated 205 perceived energizing activities and 316 drainers. Energizers were more frequently psychosocial than physiological (62.0% vs. 38.0%) with socialising, music and rest the most frequently raised. Drainers were marginally more physiological than psychosocial (52.2% vs. 47.8%), with housework, shopping and family most frequently generated. Many activities had dual effects. 61.5% of energizers were also categorised by patients as drainers (eg talking) and 58.8% of drainers were also classified by patients as energizers (eg shopping).

Conclusions: Patients with RA fatigue can identify what drains and what restores their energy. They might benefit from goal setting psychosocial issues to restore energy (eg increase socialising) whilst working on physical goals to reduce energy depletion (eg decrease housework). However, patients may need support to recognise that energising activities may also deplete their reserves, and that activities that drain can also have value in making them feel good. These patient perceptions might help clinicians direct individual self-management strategies.


Cliss, A. C., Ambler, N., Knops, B., Swinkels, A., Hammond, A., Kitchen, K., …Hewlett, S. (2008). Patient perceptions on energizers and drainers in RA fatigue: Implications for clincial practice. Rheumatology,

Journal Article Type Conference Paper
Publication Date 2008
Deposit Date Oct 24, 2023
Journal Rheumatology
Print ISSN 1462-0324
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Publisher URL