Effect of aerobic exercise training and cognitive behavioural therapy on reduction of chronic fatigue in patients with facioscapulohumeral dystrophy: protocol of the FACTS-2-FSHD trial

<p>Abstract</p> <p>Background</p> <p>In facioscapulohumeral dystrophy (FSHD) muscle function is impaired and declines over time. Currently there is no effective treatment available to slow down this decline. We have previously reported that loss of muscle strength contributes to chronic fatigue through a decreased level of physical activity, while fatigue and physical inactivity both determine loss of societal participation. To decrease chronic fatigue, two distinctly different therapeutic approaches can be proposed: aerobic exercise training (AET) to improve physical capacity and cognitive behavioural therapy (CBT) to stimulate an active life-style yet avoiding excessive physical strain. The primary aim of the FACTS-2-FSHD (acronym for Fitness And Cognitive behavioural TherapieS/for Fatigue and ACTivitieS in FSHD) trial is to study the effect of AET and CBT on the reduction of chronic fatigue as assessed with the Checklist Individual Strength subscale fatigue (CIS-fatigue) in patients with FSHD. Additionally, possible working mechanisms and the effects on various secondary outcome measures at all levels of the International Classification of Functioning, Disability and Health (ICF) are evaluated.</p> <p>Methods/Design</p> <p>A multi-centre, assessor-blinded, randomized controlled trial is conducted. A sample of 75 FSHD patients with severe chronic fatigue (CIS-fatigue ≥ 35) will be recruited and randomized to one of three groups: (1) AET + usual care, (2) CBT + usual care or (3) usual care alone, which consists of no therapy at all or occasional (conventional) physical therapy. After an intervention period of 16 weeks and a follow-up of 3 months, the third (control) group will as yet be randomized to either AET or CBT (approximately 7 months after inclusion). Outcomes will be assessed at baseline, immediately post intervention and at 3 and 6 months follow up.</p> <p>Discussion</p> <p>The FACTS-2-FSHD study is the first theory-based randomized clinical trial which evaluates the effect and the maintenance of effects of AET and CBT on the reduction of chronic fatigue in patients with FSHD. The interventions are based on a theoretical model of chronic fatigue in patients with FSHD. The study will provide a unique set of data with which the relationships between outcome measures at all levels of the ICF could be assessed.</p> <p>Trial registration</p> <p>Dutch Trial Register, NTR1447.</p

Facets for the single node fixed-charge network set with a node set-up variable

We consider a variant of the well-known Single Node Fixed-Charge Network (SNFCN) set where a set-up variable is associated with the node, indicating whether the node is open or not. This set arises as a relaxation of several practical mixed integer problems. We relate the polyhedral structure of this variant with the polyhedral structure of the SNFCN set. We show that in the presence of the node setup variable new facet-defining inequalities appear and establish the relation between the new family of inequalities with the flow cover inequalities. For the constant capacitated case we provide a full polyhedral description of the convex hull of the given set

Polyhedral Methods for the QAP

For many combinatorial optimization problems investigations of associated polyhedra have led to enormous successes with respect to both theoretical insights into the structures of the problems as well as to their algorithmic solvability. Among these problems are quite prominent NP-hard ones, like, e.g., the traveling salesman problem, the stable set problem, or the maximum cut problem. In this chapter we overview the polyhedral work that has been done on the quadratic assignment problem (QAP). Our treatment includes a brief introduction to the methods of polyhedral combinatorics in general, descriptions of the most important polyhedral results that are known about the QAP, explanations of the techniques that are used to prove such results, and a discussion of the practical results obtained by cutting plane algorithms that exploit the polyhedral knowledge. We close by some remarks on the perspectives of this kind of approach to the QAP