IntroductionFatigue is one of the most common and disabling symptoms in end-stage kidney disease, particularly among in-centre haemodialysis patients. This two-arm parallel group feasibility randomised controlled trial will determine whether a fully powered efficacy trial is achievable by examining the feasibility of recruitment, acceptability and potential benefits of a cognitive-behavioural therapy (CBT)-based intervention for fatigue among in-centre haemodialysis patients.MethodsWe aim to recruit 40 adult patients undergoing in-centre haemodialysis at secondary care outpatient dialysis units, who meet clinical levels of fatigue. Patients will be randomised individually (using a 1:1 ratio) to either a 4–6 weeks’ CBT-based intervention (intervention arm) or to a waiting-list control (control arm). The primary feasibility outcomes include descriptive data on numbers within each recruiting centre meeting eligibility criteria, rates of recruitment, numbers retained postrandomisation and treatment adherence. To assess the potential benefits of the cognitive-behavioural therapy for renal fatigue intervention, secondary self-report outcomes include measures of fatigue severity (Chalder Fatigue Questionnaire), fatigue-related functional impairment (Work and Social Adjustment Scale), sleep quality (Pittsburgh Sleep Quality Index), depression (Patient Health Questionnaire-9) and anxiety (Generalised Anxiety Disorder-7). Changes in fatigue perceptions (Brief Illness Perception Questionnaire), cognitive and behavioural responses to fatigue (Cognitive and Behavioural Responses to Symptoms Questionnaire), sleep hygiene behaviours (Sleep Hygiene Index) and physical activity (International Physical Activity Questionnaire–short form) will also be explored. These self-report measures will be collected at baseline and 3 months postrandomisation. Nested qualitative interviews will be conducted postintervention to explore the acceptability of the intervention and identify any areas in need of improvement. The statistician and assessor will be blinded to treatment allocation.Ethics and disseminationA National Health Service (NHS) Research Ethics Committee approved the study. Any amendments to the protocol will be submitted to the NHS Committee and study sponsor.Trial registration numberISRCTN91238019;Pre-results.

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Research has suggested that chewing gum relieves perceptions of stress in stressed and nonstressed individuals, but is most beneficial for those experiencing a greater amount of negative work characteristics. To determine if this was true in a student sample, the present study assigned 36 students to four one-day intervention conditions in which participants either chewed or refrained from gum and experienced a high or low workload. The results showed that an individual's perceptions of stress and mental fatigue decreased as a result of chewing gum. Depression and cognitive failures decreased as a result of experiencing a high workload. Perceptions of physical fatigue decreased when chewing gum under a high workload. The findings suggested that gum may be an effective way to reduce certain stress characteristics, and also reassuring students that a high workload is not necessarily detrimental to their wellbeing.

Pregnancy is a time when women may be particularly motivated to make healthy lifestyle changes, which is encouraging when maternal obesity remains such an important modifiable risk factor. However, offering the right ‘recipe’ of support can be challenging for midwives. They report lacking time and confidence for ongoing discussions about diet and physical activity in consultations, and a lack of local evidence-based supportive services to which they can refer interested women. This article reports the efforts of a team of midwives, health psychologists, dieticians and physiotherapists to use theory and evidence to develop and pilot a community-based programme to address this issue. Bump Start aims to encourage healthy lifestyle changes in overweight antenatal women in a health board in Scotland. It presents initial findings from the first pilot, highlighting particular factors that went well and challenges that presented themselves along the way, in the hope of sharing learning with other teams.

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