Fatigue management
What is the feeling of fatigue?
Fatigue is a feeling of constant tiredness or weakness and can be physical, mental or a combination of both. It can affect anyone and most adults will experience fatigue at some point in their life.
What is post-viral fatigue?
• Post-viral fatigue (PVF) is when the fatigue that started with a viral infection continues for a longer period after infection has gone.
• Fatigue can be difficult to describe, others ‘don’t get it’.
• It is complete physical and mental exhaustion, different to the everyday tiredness that everyone will experience at times.
• Recovery after activity changes, so rest and sleep may feel unrefreshing. Fatigue can impact every part of life including school or work, home life, social activities, sport and relationships.
What is the difference between tiredness and post-viral fatigue?
| Tiredness | Post-viral fatigue |
| The state of wishing for sleep or rest − weariness | Unable to carry out everyday activities, i.e. having a shower can cause a crash |
| Fatigue is a lack of energy and motivation | Fatigue that affects every aspect of your life |
| Drowsiness and apathy, a feeling of not caring about what happens | Complete physical and mental exhaustion, different to everyday tiredness |
| Fatigue can be a normal and important response to physical activity, emotional stress, boredom, or lack of sleep | Fatigue that started with a viral infection, continues for a longer period after infection has gone |
| Exercise and sleep can help with feeling refreshed | Rest and exercise is unrefreshing. |
Supportive strategies
Fatigue management techniques
Managing your fatigue needs to be looked at like a jigsaw, sadly there is no magic wand or pill, but making small changes to all aspects of your everyday life helps your fatigue.
These are areas of considerations:
Activity diary
Activity diaries can help you to:
• notice and understand patterns
• pinpoint variations in fatigue during the day and over the course of the week
• manage symptoms more effectively
• take time to mentally reflect on what you did, when and why?
If you wish to try using an activity diary, give yourself five minutes either in the morning, afternoon or evening to reflect on your day and to fill it out. If this is difficult to remember, you could try setting an alarm.
Try to look at what activities take low, medium or high levels of your energy, and to notice these patterns and responses in your body. Try to be aware of what is ‘rest’ for you (which is low sensory stimulus) or a relaxing activities.
Remember
Energy usage is physical, cognitive, social and emotional, therefore include all elements of activity in your diary.
The 5Ps
Once you have started to notice and understand your energy, start using the 5Ps to consciously think about what you are doing.
| Plan | Look at the activities you normally do on a daily and weekly basis and develop a plan for how you can spread these activities out. • What do you need to do? • When will you do activity? • What does each stage involve? • What time of day is better? |
| Priortise | Some daily activities are necessary, but others aren’t. • Is it important to you? • What do you have to do? • Does it need to be done today? • Can you get someone to help you? • Does it need to be done at all? |
| Pace | Pacing yourself will help you have enough energy to complete an activity. • Can you break the job down into different stages? • Can you build rests into the task? • Can you sit and rest where possible? • Can this be done in manageable chunks over a period of days? Slow and steady − be the tortoise not the hare! |
| Pleasure | • When experiencing fatigue, it is common to focus on everything that you have to do, you need to remember to do activities that you enjoy as well. • Gentle self -nurturing activities, can restore your energy and give you a sense of wellbeing. |
| Permission | • Allowing yourself to do things differently. • Permission to listen to your body, to not push yourself, to be kind to self • Permission to say “no” when you feel unable to meet the expectations of others or yourself. • Permission to say “no” to your own inner critic (that parrot on your shoulder saying “must” “should” or “need to”). |
The 4Ds
How can you moderate your activities using the 4Ds?
| Do it now | Important and urgent: • the deadline or task is essential • sometimes when things are playing on our minds we can procrastinate and use up energy worrying, therefore it may be better to just get it done and finished. In this case, factor in rest and recovery before and afterwards. |
| Delay | Important but not urgent: • does it have to be done immediately or can this be spread out over time/days? |
| Delegate | Not important, but urgent: • can you ask someone to complete task? |
| Dump | Not important or urgent: • if it is not imperative right now and doesn't hold any value, is it better to ditch it? This is not just for physical activities, it includes cognitive, social and emotional. |
Boom and bust
Many people find themselves in a ‘boom and bust cycle’, having peaks and troughs of energy throughout the day. It is important to reduce the peaks and troughs to be consistent with energy use.
Setting a baseline
• Your baseline is a level of activity that is sustainable even when you are experiencing fluctuating levels of energy. Find a low level baseline of activities (be it physical or cognitive) that you can manage daily, this is your ‘baseline’. Aim for symptom stability
• Keep your activities at your planned level: avoid being tempted to do more on a good day.
• Do an activity or task every day. Establish a routine
• ‘Over activity’ or ‘excessive rest’ will be different for each person
• It may be helpful to alternate small flexible amounts of physical and cognitive activities with a longer period of rest/ relaxation in between.
Supply and demand of energy
Supply is what gives you energy and demand is what takes your energy. Demands include responsibilities, work, housework, etc. Everyone's demands will be different. It is helpful to evaluate your supply and demand of energy to reflect on how you can use your energy more effectively.
Balancing your energy
Does your energy look like a balanced see saw? Perfectly balanced?
It is unrealistic that energy usage is perfectly balanced. The general theme is that demands will out way your supply. This is often true even when we are well.
What changes can you make to lower the demand and increase your supply. How can you use the 5Ps and 4Ds to help manage your energy more effectively?
Good supply of energy
| Sleep | • Restorative sleep is key to managing fatigue • Sleep can help levels of fatigue • Sleep hygiene can improve your sleep. |
| Effective rest | • Rest is an essential part of pacing and recovery • The quality of rest rather than the quantity of rest • Minimising sensory demands and having a break between tasks • Rest = minimal brain and body activity = this is when we are ‘recharging’ • Rest and activity are interlinked • Think about your day as a bridge of activity and rest as pillars supporting the bridge • Be aware of ‘should’ and ‘ought to’ thoughts which do not help you rest • Identify how rests can be regulated across your day, prioritise them. |
| Diet | • Be mindful of what you are eating • A Mediterranean type diet is best • Plan, if possible, for easy quick snacks, meals and nourishing drinks, batch cooking • Drink plenty of fluids, especially water, milk or sugar-free drinks • Probiotics are worth considering to help your gut and other Long COVID symptoms – try Phyto V supplements. |
| Movement / exercise | • Introduce slowly and gently − consider starting with low level stretches, walking short distances and at a low intensity • Give the body time to adjust and notice the impact of gentle exercise over a week or so. |
| Nurture and joy | • Prioritise and plan to be in nature throughout your week, when you can • Plan time for you and things that you enjoy, but make them realistic and time limited • Don’t forget you need fun in your life • Remember that stress and worry use energy so give yourself time and be kind to yourself • You need a balance of rest, routine and fun |
Recharge
You may like to think of your energy reserves as a battery. If you use up all the energy, you must then take time to recharge it.
• If you can 'top up' your battery as you go along, and you will always have some energy in reserve, which will reduce your feelings of fatigue.
• This often means choosing to stop before you are forced to stop, by having 'pre-emptive' therapeutic rest periods.
• Stopping to recharge your batteries before they are empty is key.
Breathing exercises
Breathing exercises, relaxation, mindfulness and meditation techniques are good ways to support your long COVID recovery, by helping you to just stop and rest, and they also help to calm the central nervous system down.
• Insight timer is a free meditation/relaxation app for smartphones and computers. You can find a variety of self-help techniques for sleep, anxiety, stress, calming music/ nature sounds and insightful wellbeing talks − visit www.insighttimer.com/en-gb
• There are also lots of relaxation and breathing exercises on YouTube.
Why nurture, joy and rest is important when managing fatigue?
It has been found that COVID-19 can affect the autoimmune system.
The sympathetic system prepares the body for any potential danger. The sympathetic system controls ‘fight or flight’ responses. In other words, this system prepares the body for strenuous physical activity. The events that we would expect to occur within the body to allow this to happen do, in fact, occur.
The parasympathetic system aims to bring the body to a state of calm. The parasympathetic system regulates ‘rest and digest’ functions.
Fight and flight
For lots of patients with a diagnosis of post COVID syndrome, they are constantly in the ‘fight or flight’ response. In terms of fatigue, you will be using more energy if you are constantly in that response. Therefore, engaging the ‘calm’ will help restore your energy. Your body knows what to do but you need to help it. What change can you make to help engage the ‘rest and digest’?
Sympathetic response (stress) vs. parasympathetic response (relaxation):
Pacing up
Once you are confident and managing the activities and the daily routine you have chosen, it may be time to consider adding in activities or making a slight increase to your existing tasks. This is called ‘pacing up’.
Remember there may be a slight increase in fatigue initially. This is entirely normal and will settle as soon as you find your ‘new norm’, assuming the increase is timely and appropriate.
Try using SMART goals
