Open Access Highly Accessed Study protocol

Effects of aerobic exercise therapy and cognitive behavioural therapy on functioning and quality of life in amyotrophic lateral sclerosis: protocol of the FACTS-2-ALS trial

Annerieke C van Groenestijn1, Ingrid GL van de Port1*, Carin D Schröder1, Marcel WM Post12, Hepke F Grupstra4, Esther T Kruitwagen1, Harmen van der Linde5, Reinout O van Vliet3, Margreet GH van de Weerd1, Leonard H van den Berg1 and Eline Lindeman1

Author Affiliations

1 Rudolf Magnus Institute of Neuroscience and Centre of Excellence for Rehabilitation Medicine, University Medical Centre Utrecht and Rehabilitation Centre De Hoogstraat, the Netherlands

2 Swiss Paraplegic Research, Nottwil, Switzerland

3 Het Roessingh Rehabilitation Centre, Enschede, The Netherlands

4 Department of Rehabilitation Medicine, Academic Medical Centre, Amsterdam, the Netherlands

5 Radboud University Medical Centre, Nijmegen, the Netherlands

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BMC Neurology 2011, 11:70  doi:10.1186/1471-2377-11-70

Published: 14 June 2011



Amyotrophic lateral sclerosis (ALS) is a fatal progressive neurodegenerative disorder affecting motor neurons in the spinal cord, brainstem and motor cortex, leading to muscle weakness. Muscle weakness may result in the avoidance of physical activity, which exacerbates disuse weakness and cardiovascular deconditioning. The impact of the grave prognosis may result in depressive symptoms and hopelessness. Since there is no cure for ALS, optimal treatment is based on symptom management and preservation of quality of life (QoL), provided in a multidisciplinary setting. Two distinctly different therapeutic interventions may be effective to improve or preserve daily functioning and QoL at the highest achievable level: aerobic exercise therapy (AET) to maintain or enhance functional capacity and cognitive behavioural therapy (CBT) to improve coping style and cognitions in patients with ALS. However, evidence to support either approach is still insufficient, and the underlying mechanisms of the approaches remain poorly understood. The primary aim of the FACTS-2-ALS trial is to study the effects of AET and CBT, in addition to usual care, compared to usual care alone, on functioning and QoL in patients with ALS.

Methods / Design

A multicentre, single-blinded, randomized controlled trial with a postponed information model will be conducted. A sample of 120 patients with ALS (1 month post diagnosis) will be recruited from 3 university hospitals and 1 rehabilitation centre. Patients will be randomized to one of three groups i.e. (1) AET + usual care, (2) CBT + usual care, (3) Usual care. AET consists of a 16-week aerobic exercise programme, on 3 days a week. CBT consists of individual psychological support of patients in 5 to 10 sessions over a 16-week period. QoL, functioning and secondary outcome measures will be assessed at baseline, immediately post intervention and at 3- and 6-months follow-up.


The FACTS-2-ALS study is the first theory-based randomized controlled trial to evaluate the effects, and the maintenance of effects, of AET and CBT on functioning and QoL in patients with ALS. The results of this study are expected to generate new evidence for the effect of multidisciplinary care of persons with ALS.

Trial registration

Dutch Trial Register NTR1616.