A Systematic Review of Biological Mechanisms of Fatigue in Chronic Illness

Biological Research for Nursing

Volumn 20, Issue 4, 2018, Pages 410-421

  Matura, Lea Ann ^a   Malone, Susan ^a   Jaime Lara, Rosario ^a   Riegel, Barbara ^a  

^a UNIVERSITY OF PENNSYLVANIA   (United States)

Author keywords

autonomic nervous system; chronic kidney disease; chronic obstructive pulmonary disease; fatigue; heart failure; hypothalamic pituitary adrenal axis; inflammation; multiple sclerosis; rheumatoid arthritis

Indexed keywords

ADULT; AGED; AUTONOMIC NERVOUS SYSTEM; CHRONIC DISEASE; CHRONIC KIDNEY FAILURE; CHRONIC OBSTRUCTIVE LUNG DISEASE; FATIGUE; FEMALE; HEART FAILURE; HUMAN; HYPOPHYSIS ADRENAL SYSTEM; HYPOTHALAMUS HYPOPHYSIS SYSTEM; INFLAMMATION; MALE; MIDDLE AGED; MULTIPLE SCLEROSIS; PATHOPHYSIOLOGY; RHEUMATOID ARTHRITIS; VERY ELDERLY;

ADULT; AGED; AGED, 80 AND OVER; ARTHRITIS, RHEUMATOID; AUTONOMIC NERVOUS SYSTEM; CHRONIC DISEASE; FATIGUE; FEMALE; HEART FAILURE; HUMANS; HYPOTHALAMO-HYPOPHYSEAL SYSTEM; INFLAMMATION; MALE; MIDDLE AGED; MULTIPLE SCLEROSIS; PITUITARY-ADRENAL SYSTEM; PULMONARY DISEASE, CHRONIC OBSTRUCTIVE; RENAL INSUFFICIENCY, CHRONIC;

EID: 85044052828     PISSN: 10998004     EISSN: 15524175     Source Type: Journal    
DOI: 10.1177/1099800418764326     Document Type: Article

References (97)

1. Alexander S., Minton O., Andrews P., Stone P., (2009). A comparison of the characteristics of disease-free breast cancer survivors with or without cancer-related fatigue syndrome. European Journal of Cancer, 45, 384–392.
2. Almeida C., Choy E. H., Hewlett S., Kirwan J. R., Cramp F., Chalder T., …Christensen R., (2016). Biologic interventions for fatigue in rheumatoid arthritis. Cochrane Database of Systemic Reviews, 6, Cd008334. doi:10.1002/14651858.CD008334.pub2
3. Al-Shair K., Kolsum U., Dockry R., Morris J., Singh D., Vestbo J., (2011). Biomarkers of systemic inflammation and depression and fatigue in moderate clinically stable COPD. Respiratory Research, 12, 3.
4. Baghai-Ravary R., Quint J. K., Goldring J. J. P., Hurst J. R., Donaldson G. C., Wedzicha J. A., (2009). Determinants and impact of fatigue in patients with chronic obstructive pulmonary disease. Respiratory Medicine, 103, 216–223.
5. Baltzan M. A., Scott A. S., Wolkove N., Bailes S., Bernard S., Bourbeau J., Maltais F., (2011). Fatigue in COPD: Prevalence and effect on outcomes in pulmonary rehabilitation. Chronic Respiratory Disease, 8, 119–128.
6. Bergman M. J., Shahouri S. H., Shaver T. S., Anderson J. D., Weidensaul D. N., Busch R. E., …Wolfe F., (2009). Is fatigue an inflammatory variable in rheumatoid arthritis (RA)? Analyses of fatigue in RA, osteoarthritis, and fibromyalgia. Journal of Rheumatology, 36, 2788–2794.
7. Bossola M., Di Stasio E., Giungi S., Rosa F., Tazza L., (2015). Fatigue is associated with serum interleukin-6 levels and symptoms of depression in patients on chronic hemodialysis. Journal of Pain and Symptom Management, 49, 578–585.
8. Bossola M., Vulpio C., Tazza L., (2011). Fatigue in chronic dialysis patients. Seminars in Dialysis, 24, 550–555.
9. Bower J. E., (2007). Cancer-related fatigue: Links with inflammation in cancer patients and survivors. Brain, Behavior, and Immunity, 21, 863–871.
10. Bower J. E., (2014). Cancer-related fatigue: Mechanisms, risk factors, and treatments. Nature Reviews. Clinical Oncology, 11, 597–609.
11. Bower J. E., Ganz P. A., Desmond K. A., Bernaards C., Rowland J. H., Meyerowitz B. E., Belin T. R., (2006). Fatigue in long-term breast carcinoma survivors. Cancer, 106, 751–758.
12. Bower J. E., Ganz P. A., Dickerson S. S., Petersen L., Aziz N., Fahey J. L., (2005). Diurnal cortisol rhythm and fatigue in breast cancer survivors. Psychoneuroendocrinology, 30, 92–100.
13. Bower J. E., Ganz P. A., Irwin M. R., Kwan L., Breen E. C., Cole S. W., (2011). Inflammation and behavioral symptoms after breast cancer treatment: Do fatigue, depression, and sleep disturbance share a common underlying mechanism? Journal of Clinical Oncology, 29, 3517–3522.
14. Bower J. E., Ganz P. A., Tao M. L., Hu W., Belin T. R., Sepah S., …Aziz N., (2009). Inflammatory biomarkers and fatigue during radiation therapy for breast and prostate cancer. Clinical Cancer Research, 15, 5534–5540.
15. Bunevicius A., Gintauskiene V., Podlipskyte A., Zaliunas R., Brozaitiene J., Prange A. J., JrBunevicius R., (2012). Fatigue in patients with coronary artery disease: Association with thyroid axis hormones and cortisol. Psychosomatic Medicine, 74, 848–853.
16. Cadden M., Arnett P., (2015). Factors associated with employment status in individuals with multiple sclerosis. International Journal of MS Care, 17, 284–291.
17. Caplin B., Kumar S., Davenport A., (2011). Patients’ perspective of haemodialysis-associated symptoms. Nephrology Dialysis Transplantation, 26, 2656–2663.
18. Cella D., Yount S., Rothrock N., Gershon R., Cook K., Reeve B., …Rose M., (2007). The Patient-Reported Outcomes Measurement Information System (PROMIS): Progress of an NIH roadmap cooperative group during its first two years. Medical Care, 45, S3–S11. doi:10.1097/01.mlr.0000258615.42478.55
19. Chauffier K., Salliot C., Berenbaum F., Sellam J., (2012). Effect of biotherapies on fatigue in rheumatoid arthritis: A systematic review of the literature and meta-analysis. Rheumatology (Oxford), 51, 60–68.
20. Coats A. J. S., (1998). Optimizing exercise training for subgroups of patients with chronic heart failure. European Heart Journal, 19, O29–O34.
21. Cramp F., Hewlett S., Almeida C., Kirwan J. R., Choy E. H., Chalder T., …Christensen R., (2013). Non-pharmacological interventions for fatigue in rheumatoid arthritis. Cochrane Database of Systematic Reviews, 8, Cd008322. doi:10.1002/14651858.CD008322.pub2
22. Cruz D. N., Mahnensmith R. L., Perazella M. A., (1997). Intradialytic hypotension: Is midodrine beneficial in symptomatic hemodialysis patients? American Journal of Kidney Disease, 30, 772–779.
23. Curran S. L., Andrykowski M. A., Studts J. L., (1995). Short form of the Profile of Mood States (POMS-SF): Psychometric information. Psychological Assessment, 7, 80.
24. Davis M. C., Zautra A. J., Younger J., Motivala S. J., Attrep J., Irwin M. R., (2008). Chronic stress and regulation of cellular markers of inflammation in rheumatoid arthritis: Implications for fatigue. Brain, Behavior, and Immunity, 22, 24–32.
25. Djaldetti R., Ziv I., Achiron A., Melamed E., (1996). Fatigue in multiple sclerosis compared with chronic fatigue syndrome: A quantitative assessment. Neurology, 46, 632–635.
26. Druce K. L., Bhattacharya Y., Jones G. T., Macfarlane G. J., Basu N., (2016). Most patients who reach disease remission following anti-TNF therapy continue to report fatigue: Results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis. Rheumatology (Oxford), 55, 1786–1790.
27. Druce K. L., Jones G. T., Macfarlane G. J., Basu N., (2015a). Determining pathways to improvements in fatigue in rheumatoid arthritis: Results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis. Arthritis and Rheumatology, 67, 2303–2310.
28. Druce K. L., Jones G. T., Macfarlane G. J., Basu N., (2015b). Patients receiving anti-TNF therapies experience clinically important improvements in RA-related fatigue: Results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis. Rheumatology (Oxford), 54, 964–971.
29. Druce K. L., Jones G. T., Macfarlane G. J., Verstappen S. M., Basu N., (2015). The longitudinal course of fatigue in rheumatoid arthritis: Results from the Norfolk Arthritis Register. Journal of Rheumatology, 42, 2059–2065.
30. Fagundes C. P., Murray D. M., Hwang B. S., Gouin J.-P., Thayer J. F., Sollers J. J., …Kiecolt-Glaser J. K., (2011). Sympathetic and parasympathetic activity in cancer-related fatigue: More evidence for a physiological substrate in cancer survivors. Psychoneuroendocrinology, 36, 1137–1147.
31. Falk K., Granger B. B., Swedberg K., Ekman I., (2007). Breaking the vicious circle of fatigue in patients with chronic heart failure. Qualitative Health Research, 17, 1020–1027.
32. Fava G. A., Grandi S., Canestrari R., Molnar G., (1990). Prodromal symptoms in primary major depressive disorder. Journal of Affective Disorders, 19, 149–152.
33. Feldthusen C., Grimby-Ekman A., Forsblad-d’Elia H., Jacobsson L., Mannerkorpi K., (2016). Explanatory factors and predictors of fatigue in persons with rheumatoid arthritis: A longitudinal study. Journal of Rehabilitation Medicine, 48, 469–476.
34. Fink A. M., Gonzalez R. C., Lisowski T., Pini M., Fantuzzi G., Levy W. C., Piano M. R., (2012). Fatigue, inflammation, and projected mortality in heart failure. Journal of Cardiac Failure, 18, 711–716.
35. Fujii H., Koyama H., Fukuda S., Tokai H., Tajima S., Koizumi J., …Nishizawa Y., (2013). Autonomic function is associated with health-related quality of life in patients with end-stage renal disease: A case-control study. Journal of Renal Nutrition, 23, 340–347.
36. Fukuda S., Takashima S., Iwase M., Yamaguchi K., Kuratsune H., Watanabe Y., (2008). Development and validation of a new fatigue scale for fatigued subjects with and without chronic fatigue syndrome. In Watanabe Y., Evengard B., Natelson B. H., Jason L. A., Kuratsune H., (Eds.), Fatigue science for human health (pp. 89–102). New York, NY: Springer.
37. Giovannoni G., Thompson A. J., Miller D. H., Thompson E. J., (2001). Fatigue is not associated with raised inflammatory markers in multiple sclerosis. Neurology, 57, 676–681.
38. 1a on the hypothalamic-pituitary-adrenal axis, leukocyte distribution and mood states in multiple sclerosis patients. European Neurology, 53, 182–187.
39. Gold S. M., Krüger S., Ziegler K. J., Krieger T., Schulz K.-H., Otte C., Heesen C., (2011). Endocrine and immune substrates of depressive symptoms and fatigue in multiple sclerosis patients with comorbid major depression. Journal of Neurology, Neurosurgery & Psychiatry, 82, 814–818.
40. Heesen C., Nawrath L., Reich C., Bauer N., Schulz K. H., Gold S. M., (2006). Fatigue in multiple sclerosis: An example of cytokine mediated sickness behaviour? Journal of Neurology, Neurosurgery, and Psychiatry, 77, 34–39.
41. Herrmann-Lingen C., Binder L., Klinge M., Sander J., Schenker W., Beyermann B., …Pieske B., (2003). High plasma levels of N-terminal pro-atrial natriuretic peptide associated with low anxiety in severe heart failure. Psychosomatic Medicine, 65, 517–522.
42. Hewlett S., Cockshott Z., Byron M., Kitchen K., Tipler S., Pope D., Hehir M., (2005). Patients’ perceptions of fatigue in rheumatoid arthritis: Overwhelming, uncontrollable, ignored. Arthritis & Rheumatology, 53, 697–702.
43. Hewlett S., Nicklin J., Treharne G. J. (2008). Fatigue in musculoskeletal conditions (Topical Reviews: Reports on the Rheumatic Diseases, series 6, no. 1). Retrieved from Arthritis Research UK at http://www.arthritisresearchuk.org/health-professionals-and-students/reports/topical-reviews/topical-reviews-autumn-2008.aspx
44. Horigan A. E., (2012). Fatigue in hemodialysis patients: A review of current knowledge. Journal of Pain and Symptom Management, 44, 715–724.
45. Horigan A., Rocchiccioli J., Trimm D., (2012). Dialysis and fatigue: Implications for nurses—A case study analysis. MEDSURG Nursing, 21, 158–163, 175.
46. Iasiukiavichene L., Vasiliauskas D., (2006). Chronic fatigue syndrome in cardiology neurohumoral changes. Kardiologiia, 46, 58–64.
47. Iriarte J., Subirá M. L., de Castro P., (2000). Modalities of fatigue in multiple sclerosis: Correlation with clinical and biological factors. Multiple Sclerosis Journal, 6, 124–130.
48. Jablonski A., (2007). The multidimensional characteristics of symptoms reported by patients on hemodialysis. Nephrology Nursing Journal, 34, 29–37.
49. Jasiukeviciene L., Vasiliauskas D., Kavoliuniene A., Marcinkeviciene J., Grybauskiene R., Grizas V., Tumyniene V., (2008). Evaluation of a chronic fatigue in patients with moderate-to-severe chronic heart failure. Medicina (Kaunas, Lithuania), 44, 366–372.
50. Jorgensen R., (2008). Chronic fatigue: An evolutionary concept analysis. Journal of Advanced Nursing, 63, 199–207.
51. Jump R. L., Fifield J., Tennen H., Reisine S., Giuliano A. J., (2004). History of affective disorder and the experience of fatigue in rheumatoid arthritis. Arthritis & Rheumatology, 51, 239–245.
52. Junghaenel D. U., Christodoulou C., Lai J.-S., Stone A. A., (2011). Demographic correlates of fatigue in the US general population: Results from the patient-reported outcomes measurement information system (PROMIS) initiative. Journal of Psychosomatic Research, 71, 117–123.
53. Kalsbeek A., Van der Spek R., Lei J., Endert E., Buijs R., Fliers E., (2012). Circadian rhythms in the hypothalamo-pituitary-adrenal (HPA) axis. Molecular and Cellular Endocrinology, 349, 20–29.
54. Kapella M. C., Larson J. L., Patel M. K., Covey M. K., Berry J. K., (2006). Subjective fatigue, influencing variables, and consequences in chronic obstructive pulmonary disease. Nursing Research, 55, 10–17.
55. Keselbrener L., Akselrod S., Ahiron A., Eldar M., Barak Y., Rotstein Z., (2000). Is fatigue in patients with multiple sclerosis related to autonomic dysfunction? Clinical Autonomic Research, 10, 169–175.
56. Köhnlein T., Klante T., Elliott M. W., Welte T., (2001). Cardiac insufficiency and disturbed central respiratory regulation: Cheyne-stokes respiration during sleep in advanced left heart insufficiency. Pneumologie, 55, 13–20.
57. Koyama H., Fukuda S., Shoji T., Inaba M., Tsujimoto Y., Tabata T., …Nishizawa Y., (2010). Fatigue is a predictor for cardiovascular outcomes in patients undergoing hemodialysis. Clinical Journal of the American Society of Nephrology, 5, 659–666.
58. Kränkel N., Adams V., Gielen S., Linke A., Erbs S., Schuler G., Hambrecht R., (2003). Differential gene expression in skeletal muscle after induction of heart failure: Impact of cytokines on protein phosphatase 2A expression. Molecular Genetics and Metabolism, 80, 262–271.
59. Kroencke D. C., Lynch S. G., Denney D. R., (2000). Fatigue in multiple sclerosis: Relationship to depression, disability, and disease pattern. Multiple Sclerosis Journal, 6, 131–136.
60. Krupp L. B., (2003). Fatigue in multiple sclerosis: Definition, pathophysiology and treatment. CNS Drugs, 17, 225–234.
61. Krupp L. B., Christodoulou C., Madigan D., Morgan T., Scherl W., Melville P., McIlree C., (2002). The use of inteferon-beta-1a (Avonex) and modafinil to evaluate and treat cytokine-induced fatigue in multiple sclerosis. Annals of Neurology, 52, s87.
62. Krupp L. B., Elkins L. E., (2000). Fatigue and declines in cognitive functioning in multiple sclerosis. Neurology, 55, 934–939.
63. Krupp L. B., LaRocca N. G., Muir-Nash J., Steinberg A. D., (1989). The Fatigue Severity Scale: Application to patients with multiple sclerosis and systemic lupus erythematosus. Archives of Neurology, 46, 1121–1123.
64. Kumar A., Singh R. B., Saxena M., Niaz M. A., Joshi S. R., Chattopadhyay P., …Fedacko J., (2007). Effect of carni Q-gel (ubiquinol and carnitine) on cytokines in patients with heart failure in the Tishcon study. Acta Cardiologica, 62, 349–354.
65. Lee Y. C., Frits M. L., Iannaccone C. K., Weinblatt M. E., Shadick N. A., Williams D. A., Cui J., (2014). Subgrouping of patients with rheumatoid arthritis based on pain, fatigue, inflammation, and psychosocial factors. Arthritis & Rheumatology, 66, 2006–2014.
66. Lennie T. A., Moser D. K., Biddle M. J., Welsh D., Bruckner G. G., Thomas D. T., …Bailey A. L., (2013). Nutrition intervention to decrease symptoms in patients with advanced heart failure. Research in Nursing and Health, 36, 120–145.
67. Li X., Shaffer M. L., Rodríguez-Colón S. M., He F., Bixler E. O., Vgontzas A. N.,…Liao D., (2011). Systemic inflammation and circadian rhythm of cardiac autonomic modulation. Autonomic Neuroscience, 162, 72–76.
68. Liu L., Mills P. J., Rissling M., Fiorentino L., Natarajan L., Dimsdale J. E., …Ancoli-Israel S., (2012). Fatigue and sleep quality are associated with changes in inflammatory markers in breast cancer patients undergoing chemotherapy. Brain, Behavior, and Immunity, 26, 706–713.
69. Lutgendorf S. K., Weinrib A. Z., Penedo F., Russell D., DeGeest K., Costanzo E. S., …Lucci J. A., III. (2008). Interleukin-6, cortisol, and depressive symptoms in ovarian cancer patients. Journal of Clinical Oncology, 26, 4820–4827.
70. Marzilli M., (2014). Heart failure: A cardiac or a systemic disease? Heart and Metabolism, 64, 8–12.
71. McEwen B. S., Biron C. A., Brunson K. W., Bulloch K., Chambers W. H., Dhabhar F. S., …Spencer R. L., (1997). The role of adrenocorticoids as modulators of immune function in health and disease: Neural, endocrine and immune interactions. Brain Research Reviews, 23, 79–133.
72. McSweeney J. C., Cody M., O’Sullivan P., Elberson K., Moser D. K., Garvin B. J., (2003). Women’s early warning symptoms of acute myocardial infarction. Circulation, 108, 2619–2623.
73. Merkelbach S., Dillmann U., Kölmel C., Holz J., Müller M., (2001). Cardiovascular autonomic dysregulation and fatigue in multiple sclerosis. Multiple Sclerosis Journal, 7, 320–326.
74. Meyers C. A., Albitar M., Estey E., (2005). Cognitive impairment, fatigue, and cytokine levels in patients with acute myelogenous leukemia or myelodysplastic syndrome. Cancer, 104, 788–793.
75. Murtagh F. E., Addington-Hall J., Higginson I. J., (2007). The prevalence of symptoms in end-stage renal disease: A systematic review. Advances in Chronic Kidney Disease, 14, 82–99.
76. Paddison J. S., Effing T. W., Quinn S., Frith P. A., (2013). Fatigue in COPD: Association with functional status and hospitalisations. European Respiratory Journal, 41, 565–570.
77. Paradies G., Paradies V., Ruggiero F. M., Petrosillo G., (2014). Oxidative stress, cardiolipin and mitochondrial dysfunction in nonalcoholic fatty liver disease. World Journal of Gastroenterology: WJG, 20, 14205–14218.
78. Perez-Moreno A. C., Jhund P. S., Macdonald M. R., Petrie M. C., Cleland J. G., Bohm M., …McMurray J. J., (2014). Fatigue as a predictor of outcome in patients with heart failure: Analysis of CORONA (Controlled Rosuvastatin Multinational Trial in Heart Failure). JACC. Heart Failure, 2, 187–197.
79. Piepoli M. F., Scott A. C., Capucci A., Coats A. J. S., (2001). Skeletal muscle training in chronic heart failure. Acta Physiologica Scandinavica, 171, 295–303.
80. Pollard L. C., Choy E. H., Gonzalez J., Khoshaba B., Scott D. L., (2006). Fatigue in rheumatoid arthritis reflects pain, not disease activity. Rheumatology (Oxford), 45, 885–889.
81. Pongratz G., Straub R. H., (2014). The sympathetic nervous response in inflammation. Arthritis Research & Therapy, 16, 504. doi:10.1186/s13075-014-0504-2
82. Powell D. J., Moss-Morris R., Liossi C., Schlotz W., (2015). Circadian cortisol and fatigue severity in relapsing-remitting multiple sclerosis. Psychoneuroendocrinology, 56, 120–131.
83. Rai A., Whaley-Connell A., McFarlane S., Sowers J. R., (2006). Hyponatremia, arginine vasopressin dysregulation, and vasopressin receptor antagonism. American Journal of Nephrology, 26, 579–589.
84. Repping-Wuts H., Fransen J., van Achterberg T., Bleijenberg G., van Riel P., (2007). Persistent severe fatigue in patients with rheumatoid arthritis. Journal of Clinical Nursing, 16, 377–383.
85. Ricci J. A., Chee E., Lorandeau A. L., Berger J., (2007). Fatigue in the U.S. workforce: Prevalence and implications for lost productive work time. Journal of Occupational and Environmental Medicine, 49, 1–10.
86. Ryan J. L., Carroll J. K., Ryan E. P., Mustian K. M., Fiscella K., Morrow G. R., (2007). Mechanisms of cancer-related fatigue. Oncologist, 12, 22–34.
87. Saligan L. N., Olson K., Filler K., Larkin D., Cramp F., Sriram Y., …Mustian K., (2015). The biology of cancer-related fatigue: A review of the literature. Supportive Care in Cancer, 23, 2461–2478.
88. Schuetz P., Leuppi J. D., Bingisser R., Bodmer M., Briel M., Drescher T., …Maier S., (2015). Prospective analysis of adrenal function in patients with acute exacerbations of COPD: The Reduction in the Use of Corticosteroids in Exacerbated COPD (REDUCE) trial. European Journal of Endocrinology, 173, 19–27.
89. Smith O. R., Gidron Y., Kupper N., Winter J. B., Denollet J., (2009). Vital exhaustion in chronic heart failure: Symptom profiles and clinical outcome. Journal of Psychosomatic Research, 66, 195–201.
90. Smith O. R., Kupper N., de Jonge P., Denollet J., (2010). Distinct trajectories of fatigue in chronic heart failure and their association with prognosis. European Journal of Heart Failure, 12, 841–848.
91. Treharne G. J., Lyons A. C., Hale E. D., Goodchild C. E., Booth D. A., Kitas G. D., (2008). Predictors of fatigue over 1 year among people with rheumatoid arthritis. Psychology, Health, and Medicine, 13, 494–504.
92. van Hoogmoed D., Fransen J., Bleijenberg G., van Riel P., (2010). Physical and psychosocial correlates of severe fatigue in rheumatoid arthritis. Rheumatology (Oxford), 49, 1294–1302.
93. Wang X. S., Shi Q., Williams L. A., Mao L., Cleeland C. S., Komaki R. R., …Liao Z., (2010). Inflammatory cytokines are associated with the development of symptom burden in patients with NSCLC undergoing concurrent chemoradiation therapy. Brain, Behavior, and Immunity, 24, 968–974.
94. Weinrib A. Z., Sephton S. E., DeGeest K., Penedo F., Bender D., Zimmerman B., …Lutgendorf S. K., (2010). Diurnal cortisol dysregulation, functional disability, and depression in women with ovarian cancer. Cancer, 116, 4410–4419.
95. Weisbord S. D., Fried L. F., Arnold R. M., Fine M. J., Levenson D. J., Peterson R. A., Switzer G. E., (2005). Prevalence, severity, and importance of physical and emotional symptoms in chronic hemodialysis patients. Journal of the American Society of Nephrology, 16, 2487–2494.
96. Witte K. K. A., Clark A. L., (2004). The effect of aspirin on the ventilatory response to exercise in chronic heart failure. European Journal of Heart Failure, 6, 745–748.
97. Woo K., (2000). A pilot study to examine the relationships of dyspnoea, physical activity and fatigue in patients with chronic obstructive pulmonary disease. Journal of Clinical Nursing, 9, 526–533.