by Teresa Brady,
Fatigue is common in chronic illness.
Managing fatigue is an important component of learning
to live with a chronic illness. Fatigue can lead to
depression, anger, a loss of physical and cognitive skills
and a lack of motivation.
Sleep can also be a problem. Work
simplification and energy conservation help reduce
There are five strategies to help manage
fatigue by conserving energy and using it wisely - planning,
positioning, pacing, prioritizing and adaptive
ïOne needs to think things through
and plan one's time on a daily, weekly and monthly
basis. Try to distribute strenuous work throughout the day
rather than doing it all at one time. Try to rest before
doing hard work. Plan specific tasks to do them most
efficiently. Try to eliminate extra trips. Recreation is
important, so plan to spend some energy on fun
ïUse the body in good alignment and
it will use less energy to do a task. Maintain good posture
to take the strain off joints. Use a wheeled cart around the
house and sit while working to conserve energy. Arrange work
and storage areas to be more efficient.
ïPacing is difficult but important.
Try to avoid a rush - it just uses up more energy. Rest
before you tire. It is most efficient to rest ten minutes
out of every hour, but most people have trouble fitting that
into their daily routine. It is usually possible, however,
to add some additional rest during the day. Spread work
throughout the day with planned rest breaks. Alternate
light/heavy, sitting/standing and fast/slow
ïBe selective about activities.
Prioritize which tasks are essential to get done, which can
be eliminated and which can be delegated. Try to simplify so
that which needs to be accomplished can be done in an easier
fashion. Stand back and look at the situation - then
ïUse labor-saving devices and
adaptive equipment that will conserve energy. Look for
short cuts. Use convenience foods like cake mixes and
adapted equipment like jar openers to make the job
easier. Changing habits for energy conservation seems
awkward at first but becomes easier over time. It is also
possible to reduce fatigue by building energy resources and
addressing psychological factors.
ïSystemic diseases can produce
fatigue, so try to keep the disease process under control.
Use medicines properly.
ïExercise to stay in good condition.
Emphasize exercise as well as rest. One loses 3% of one's
strength for each day of inactivity. Strive for an
energy-building program of gentle aerobics that doesn't
strain the body. Swimming, bicycling (indoors or out),
cross-country skiing, roller-blading, fast walking and
dancing are good activities. Try to work exercises into your
daily routine. There may be some initial discomfort when
starting, but avoid overkill, pace yourself and rest as
necessary. Expect only slow and gradual
ïFatigue is depressing and
depression is fatiguing. Fatigue can be a symptom of
depression which is common in chronic disease. Significant
depression should be evaluated to determine if medication is
Continually striving for perfection and being harsh and
demanding of oneself also leads to fatigue. Those who set
unreasonably high and rigid standards for themselves become
depressed and fatigued when they can't meet the standards.
They are never satisfied. They can exhaust themselves
struggling to meet unreasonably high expectations.
When feeling frantic, take a break and rest for a few
moments and think the situation through. Things will go
better and will be less fatiguing. Examine expectations and
try to determine whose they are - yours or someone else's.
Don't wear yourself out meeting expectations that are
unreasonable or are not important to you.
Take what limited energy you have and
learn to use it wisely. Try to accommodate fatigue since it
will be difficult to conquer. Try not to be so independent,
and don't be afraid to ask for help. Build your energy
resources through exercise and make changes to help deal
with the psychological component of low energy - a better
quality of life will be the result.
(Dr. Brady is a licensed psychologist and
an occupational therapist who has worked extensively with
connective tissue diseases in a variety of settings.
She is Executive Director of the Minnesota Arthritis