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Table 1 4-STEPS sessions content

From: Protocol for the "four steps to control your fatigue (4-STEPS)" randomised controlled trial: a self-regulation based physical activity intervention for patients with unexplained chronic fatigue

4-STEPS sessions Topics
Motivational Interviewing- Session 1 Listen to patient complaints, with emphasis on fatigue.
  Illness perceptions.
  Exploration of patients' present physical activity behavior.
  Current health behaviors and other activities are explored (physical activity, sleep, pain, etc.).
  Discussion of the information on the booklet given previously (specially the relation between CF major symptoms and physical activity behavior and boom-bust pattern).
  Motivation and Confidence Scales: Exploration of the willingness to engage in physical activity (or adjust current physical activity behavior) and the confidence in one's own capability to achieve this behavior with success.
  Discussion of the pros and cons (not-) to change physical activity behavior (Decisional Balance).
  Social support network is addressed.
Motivational Interviewing- Session 2 Exploration of possible competing goals with physical activity (e.g. housework chores) and link to core values.
  Strategies to overcome obstacles to physical activity and competing goals are addressed.
  Based on the register of daily activities and steps taken (pedometer register) and GET scheme for physical activity, the patient establishes a personal physical activity goal for the following two months.
  Discuss the possible reasons for perpetuation of symptoms and difficulty to change health behaviors in CF patients, namely perfectionism, fear of movement, presence of stressful situations and boom-bust pattern. (some are already mentioned at the first motivational interview and are now emphasized).
  Exploration of emotion control importance and techniques (e.g. relaxation techniques).
Telephone sessions: Revision of the physical activity goal planning (adequacy to the patients' present situation).
  Relapse prevention (strategies to overcome new or persisting difficulties to physical activity and emotion control strategies).