Fatigue management
Open Door - February 2005 pages 8-9
Fatigue is one of the commonest symptoms of MS and can often have a major impact on people's lives. As an 'invisible' symptom, fatigue is sometimes misinterpreted by family, friends or colleagues, who mistakenly assume that the person with MS is depressed or just not trying hard enough.
Fatigue does not relate to relapses, nor to any permanent increase in disability, although previously experienced symptoms may recur during fatigue but subside after rest. However, people can experience fatigue that interrupts their daily life or that prevents them from working whilst having no other symptoms.
Fatigue in MS is very different from the tiredness or exhaustion that people without MS experience following strenuous exercise or a busy day at work. It is characterised by the sudden loss of energy and the inability to continue an activity that is out of all proportion to any activity undertaken. MS fatigue can not be worked through, as can sometimes be done with non MS fatigue, and recovery time also tends to be much longer.
Heat can increase fatigue in MS and some people with MS find that symptoms get worse during spells of hot weather.
Fatigue can also be caused or worsened by the effect of living with MS as well as by the MS itself. Other symptoms, such as depression, being in pain, or sleep disturbance from bladder problems or spasms, can all worsen fatigue. Fatigue may also occur as a side effect of medications or be the result of inactivity, poor diet, stress or an infection.
Although for some people drug therapy can help with fatigue, treatment is primarily based on helping someone find ways of managing their life to prevent or lessen the impact of fatigue. An occupational therapist is often central to the development of management strategies.
Occupational therapists (OT) look at all the physical, psychological, environmental and social issues that are relevant to the individual. By suggesting adaptations, equipment and different ways of tackling tasks, an OT works with the individual to enable them to achieve maximum independence.
The following sections describe the six principles of fatigue management. The principles are illustrated with ideas on managing fatigue sent in by people with MS who live with the symptom and are taken from our booklet Tips For Living With MS.
1. Take frequent rests
- Listen to your body. Don't be tempted to overdo it if you are having a good spell - you might pay the price in a day or two!
- It can be helpful to divide the day into three parts: be active in two of them and rest well in the third
- If you have a big event coming up, prepare for it by getting as much rest as possible beforehand - and remember that rest means doing nothing at all
Many people find it difficult to sit and do nothing and allow their mind to rest properly. Relaxation techniques can give focus to periods of non activity and help to achieve a deeper level of rest than simply sitting down. Relaxation can also help to reduce stress and anxiety, which can increase fatigue.
Tips for relaxation
- Choose a quiet place free from distraction.
- Body temperature drops during relaxation, so ensure the room is warm enough or cover yourself with a light blanket.
- You may want to loosen clothing and/or remove glasses or jewellery.
- Find a comfortable position, either sitting or lying. If sitting, have your head supported.
- Close your eyes to avoid distraction.
- Practise your chosen technique - some people use tapes, soothing music or meditation. Like anything new, it may take a few sessions to achieve the desired result.
- Maximise benefits of relaxation by doing at least 20 minutes every day.
- ENJOY!
2. Prioritise activities
- Prioritise tasks into those that are essential and those that can wait
- Save your energy for what you can do rather than struggling with tasks you find difficult - delegate these to other people!
- Conserve your energy whenever possible. If you have to go upstairs to use the bathroom, save up other chores that need doing upstairs, to avoid having to make separate journeys. Also, keep duplicate cleaning materials upstairs and downstairs
- Explore the possibility of working from home or cutting down your hours to part-time work
3. Plan ahead / time management
Make a daily or weekly timetable of activities that need to be done and try to put activities in order of priority so that those that must be done are done before you run out of energy. Break large complicated tasks into smaller stages that can be spread throughout the day, eg peel potatoes in the morning to cook in the evening. Set yourself realistic targets. An important word in time management is NO.
Myths about time
- Those who are the most active get the most done
- If I do it myself it will be done faster and better than if anyone else does it
- The harder one works, the more work is done
- Time can be 'saved'
4. Lead a healthy lifestyle/exercise
Try to keep generally fit. Exercise is essential, but remember to balance the exercise with rests. Eat a well balanced diet. Excess weight, alcohol and smoking can all have a negative effect on fatigue.
- Remember the saying 'Use it or lose it'. Keep mobile, even if it only sitting in the garden - fresh air does wonders for depression. If possible, stand up and have a walk round every so often, to prevent stiffness in your legs
- Take regular exercise if you are able. Swimming is a good option. Even if you are not a strong swimmer, spending time in warm water can be beneficial and relaxing
- Exercising with a friend can be fun and can help to keep you motivated
5. Adopt a good posture
Try to maintain an upright and symmetrical posture during all tasks. If necessary, rest on a perching stool while carrying out tasks. Avoid excessive twisting and bending and remember to rest in order to reduce strain on your joints and soft tissue. There is a chapter on posture in our pages on Exercises for people with MS and in the book Are you sitting comfortably..?.
6. Organise tools, materials and work area
It is suggested that people divide their working space into different areas to make use of energy more efficiently
Vertically
Area A: From shoulder to extended arm height
Objects that are lightweight and used less often
Area B: Between hip and shoulder
Tools and objects in continual use
Area C: From the hip to the floor
Heavy and less used items
Horizontally:
Area D: From your body to your finger tips with elbows bent
Items in current use
Area E: From the end of area D to your finger tips with your arm extended
Items used less often
- Fit a jar/bottle opener beneath a wall mounted kitchen cupboard. This requires very little strength to use
- Buy a laundry bag so that you can drag washing to the machine rather than having to carry it
- Read,order or download the MS Trust's book Living with fatigue
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Disclaimer
Open Door articles are reproduced as published. They are not updated to take account of subsequent developments. Use appropriate caution in acting on the information in any article.