Fig. 1From: Cognitive behaviour therapy plus aerobic exercise training to increase activity in patients with myotonic dystrophy type 1 (DM1) compared to usual care (OPTIMISTIC): study protocol for randomised controlled trialDeterminants of health status in DM1. Exercise therapy is intended to improve physical activity whereas cognitive behavioural therapy is intended to stimulate an active life-style by addressing perpetuating factors of fatigue such as lack of physical activity, motivation, pain and sleep disturbances and also by teaching patients to compensate for a lack of initiative (motivation)Back to article page