journals.sagepub.com/home/msj 9% 19% 19% ITT 88% 23% ITT 100% 91% 20% 100% 35% Aims to promote a positive attitude towards active decision-making and the optimum use of the available energy to fit the unique needs of individuals. ECM aims to reduce the impact and severity of fatigue, to increase patients' use of energy-conserving strategies and to improve their confidence in their ability to manage fatigue. Cognitive behavioural model of MS fatigue:disease factors trigger fatigue in MS, and cognitive, emotional, and behavioural factors perpetuate the severity and impact of fatigue. CBT for MS fatigue aims to influence cognitions, behaviours and emotions that perpetuate fatigue. Aerobic exercise may result in improvements through increased fitness, normalisation of hormonal functions, and changes in neuroinflammatory and neuroprotective biomarkers Summary of theory/rationale behind treatment 4× occupational therapists familiar with MS and ECM and qualified in motivational interviewing Training included programme guideline and 1 day ECM refresher course 6 CBT state-certified healthcare psychologists Received 3 day training in this protocol. Supervised every second week by a supervising CBT psychologist Six trained physiotherapists Experienced in treating MS patients. Specific trial intervention training not reported Who delivered treatment (level of training) 12 individually supervised 45-minute outpatient aerobic interval training sessions on Kettler X7 home trainer over 16 weeks Regular prescribed home exercise over 16 weeks on Kettler X7 home trainer provided for duration of study. 12 × 45 minute (face-to-face) individual sessions over 16 weeks Patients given an ECM workbook 12 × 45 minute (face-to-face) individual outpatient sessions over 16 weeks) Therapy tailored to patients' individual needs. Timing and mode of delivery (week × frequency × minutes (mode)) CBT: cognitive behavioural therapy; CON: nurse-led control group; EDSS: Expanded Disability Status Scale; EXP: experimental intervention group; RRMS: Relapse-Remitting Multiple Sclerosis; ITT: intention to treat. Energy conservation management (ECM) Blikman et al.3 14% n = 46 Female: 72% RRMS:74% Age: 48 (9.2) EDSS: 3.0 (2.0-4.0) MS length 12.0 (2.0-19.0) 14% n = 44 Female: 68% RRMS 73% Age 47 (11.5) EDSS: 3 (2.8-3.6) MS length 7.5 (3-14) n = 43 Female: 74% RRMS: 73% Age: 43 (9.8) EDSS: 2.5 (2.0-3.5) MS length: 7.0 (2.0-10.0) n = 42 Female: 81% RRMS: 76% Age: 48 (11.0) EDSS: 2.5 (2-4) MS length 6.5 (3.7-17.4) 98% 26% Aerobic exercise Hein et al.2 11% ITT 100% 14% n = 47 Female: 83% RRMS: 75% Age: 46 (11.6) EDSS: 2.5 (2.3-3.0) MS length: 5.2 (2.1-11.5) n = 44 Female: 71% RRMS: 73% Age: 51 (8.3) EDSS: 3 (2.8-3.6) MS length: 8.2 (2.9-14.2) Cognitive behavioural therapy (CBT) Van de Akker et al.1 22% Experimental Control Experimental Control Control Experimental Lost to 52-week follow-up (%) (dropout + non-response) Percent analysed in ITT Lost to end-oftreatment follow-up (%) (dropout + nonresponse) N Demographic and disease factors Female (%) RRMS (%) Age (years, M (SD)) EDDS level of disability (median (range)) Time since diagnosis (median years (range)) Study reference Table 1. Summary comparison of the three TREFAMS-ACE randomised controlled trials. R Moss-Morris and S Norton 1437https://journals.sagepub.com/home/msj