Hypothalamic-pituitary-adrenal (HPA) Axis and Chronic Fatigue Syndrome in Older Adults – The Rehabilitation Perspectives: Hypothalamic-pituitary-adrenal (HPA) Axis

Chronic fatigue syndrome (CFS) is a long-term and debilitating condition that regards as a neurological disease. Its symptoms include profound physical and mental fatigue (characteristically made worse by exertion), muscle and joint pain, disturbed sleep and both concentration and memory problems. CFS as a kind of human stress-related disorders that are characterized by alterations in Hypothalamic-pituitary-adrenal (HPA) Axis activity. Investigation of abnormal activity of the HPA axis in various neurological and neuropsychiatric disorders can date back at least 60 years (1) and its relation to CFS had been reported in early 1990s (2). Literature review shown much has been written on the individuals with CFS, this chapter further disseminated updated evidence for disruption of HPA function in CFS, with the explanation on the relationship between cytokines and HPA activities. Moreover, very limited literature had addressed the importance of rehabilitation to them (3). This chapter address this gap by sharing a pilot rehabilitation outcome on a single-blinded randomized control trial with a parallel group experimental design in the application of activity scheduling (AS) program of occupational therapy for a group of community dwelling older adults with CFS. There was a significant effect of AS on the physical functioning of participants as measured by Functional Independence Measures (FIM), as the primary outcome measure, in experimental group, with Wilk’s λ = .72, F (2,57) = 18.75, p <.001. Moreover, in secondary outcome measures, significant decrease in the impact of caring role as reflected by their perceived burden as measured by the Chinese Zarit Burden Interview (CZBI) in caring for experimental group, with Wilk’s λ = .72, F (2,97) = 18.75, p <.001. Furthermore, to study the effect of time on caring activities for those recruited couples in AS group. There was significant effect of AS on caring activities with Wilk’s λ = .71, F (2,97) = 12.47, p <.001. With proper coaching and regular facilitation regarding AS, activities participation in older adults with CFS can be greatly enhanced. Behavioral intervention, such as AS, can supplement therapeutic treatment or may lead to decline in CFS symptoms.