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Fatigue and how to manage it

Updated: Feb 13


About 10 years ago, I was asked to write a chapter on fatigue for a physiotherapy book. Then, a few years ago, I had to take a painful dose of my own medicine when I developed an autoimmune disorder and chronic fatigue. I had to adopt all the strategies I had been telling patients about for years and it wasn’t fun. But it WAS enlightening, so I’m now going to share them with you and the things I learned along the way.


Fatigue used to be a very misunderstood symptom and was generally ignored as a result. But it’s finally having it’s day of being seriously researched because of the advent of long-COVID, cancer-related fatigue (CRF) and fatigue from menopause, concussion-related fatigue to mention but a few. But even those of us with ‘normal’ fatigue can benefit from a little bit of fatigue management. Stay with me…..


To mention the obvious, frequent fatigue should not be ignored as it can be due to medical reasons that are completely reversible. It’s often the first sign that something is amiss, so getting full blood tests done with your GP is the first call. After all the tests are done, and medical reasons ruled out or treated, then you might have to consider some lifestyle strategies to help you on the road to recovery. If you are found to be healthy with nothing amiss, then frequent fatigue is a sign that you are overdoing things and you need to be more efficient with your use of energy. So the same principles apply.

Here's a bit more information to help you understand things a little more.


There are 3 basic types of fatigue:

·        Physical fatigue – your body being tired, unable to tolerate exercise or hard work

·        Cognitive fatigue – poor concentration, decision making and poor memory.

·        Emotional fatigue – being overwhelmed, difficulty in being able to deal with the usual stuff that life throws at you.

The three types are all intermingled and affect each other:  If there’s a lot of stress in your life (emotional) you will often find yourself really tired (physical) . Or think of this scenario: if you are exhausted from a hard day’s work at the desk (cognitive) you might find yourself snappy (emotional) and exhausted (physical). Get it?

The Energy Bank

Start thinking about energy, and about your ‘energy bank’. Imagine you have a piggy bank and each day you deposit energy (by rest and restorative activities) and you spend some energy( by work, exercise, planning and emotional stuff). When your energy is limited, you need to think in terms of depositing more energy and using less of it. If you overdo it on a busy day, you are borrowing energy from the next day. Or you can save up for a special occasion: you’ve a meal planned out next Friday that you really want to go to, then save your energy on Wednesday and Thursday so that you have leftover deposits of energy for Friday. Makes sense doesn’t it? This is the basis of PACING


Even nice things use energy

This was a difficult one for me to learn. We think that things we enjoy GIVE us energy, but it’s not always the case. They can drain our energy bank, even though we are having a blast. So I found that meeting large groups of people (lots of cognitive activity here chatting, interpreting situations) involves a lot of energy. Even meeting one friend for a long chat can be draining, especially if it’s someone who likes to moan (!) but even if it’s not. If these things use up your energy, you may have to stop doing them for a while, or limit your time doing them. I had to dump my friends for a while, but they forgave me. It also gave me a great excuse to get out of things I didn’t want to do (Ha!).


Exercise is good but the wrong type can drain you

All the research relating to cancer-related fatigue and other disease-related fatigue shows that moderate exercise reduces fatigue and improves wellbeing, mood and sleep. Who doesn't love that ‘good’ tired, achey feeling after exercise. But if you are very fatigued, then exercise may make you feel even more drained…..because it is also a source of (good) inflammation. If this is the case for you, then you need to chose your exercise wisely – something more gentle and slow paced until your energy picks up. I had to stop running, cycling, going for hikes and start doing things like gentle yoga and slow walks. Not what I was used to, but it forced me to see the benefits of slow exercise. And guess what, I still made massive improvement in my yoga, even though I was on the slow-as-a-turtle trail.  SLOW IS NOT NECESSARILY USELESS.


Are you the Duracell Bunny?

All this enforced slow-stream activity forced me to look at my patterns…..I was a habitual over-doer. I was always on the go, loved being busy, had a zillion friends and hobbies and very rarely rested up. I couldn’t abide even the smallest bit of boredom. In short, I was stressing my nervous system and hormonal system by constantly being in the activity zone, and not in the rest zone. Problem is, when you are constantly on the go, you don’t even feel tired until it’s too late. Oh, and on top of this, I had a long-term stress disorder, so my body was a perfect cocktail of inflammatory and stress chemicals just waiting to manifest into some disorder or another. Does any of this sound familiar?? And doesn’t it make perfect sense?  Time off from life allows you to observe and change the patterns that are not serving you well. I even learned to say No ( not before time, mind you)…..what fabulous things might you learn????


Accept that you are no longer the boss of your body

This one can be hard to get your head around, but when you have fatigue you no longer have the right to boss your body around without consequences. Do we ever have that right, I wonder….We always expect our body to do what we want and then get all angry and upset when it doesn’t. When your body is fatigued, IT is the boss and not you and you just have to suck it up actually. It might even get you ( and me) to respect our bodies a bit more when it IS back to normal. Sermon over.


The 3 Ps – Planning Pacing and Prioritising

The 3 Ps are the foundations of fatigue management. This stops the boom/bust cycle of overdoing things, then being exhausted, then feeling good and overdoing it again…..etc etc. This is a hard one if you are used to your body doing what you want it to do, but once you manage your fatigue better, it gives your nervous and hormonal systems time to recover.

·        Learn to listen to your body and pace yourself. Not easy if you usually have the energy to do whatever you want. Acceptance is the key.

·        Decide what’s really important on a given day and week and prioritise it and stick to it. Stop doing unnecessary stuff. Life is full of unnecessary stuff. Keep it simple stupid!

·        You may well have to plan ahead a bit if you have a high-energy day coming up, and plan some low energy days around it.

Google ‘Fatigue Management’ and you’ll find loads of occupational therapy resources about it to help you, including fatigue diaries and such lovely things….(ahem!).


Sleep is very important

The massive benefits of good quality sleep are finally being researched properly. Sleep is hugely anti-inflammatory, according to one of my buds who has done a PHD on it.  When I first got my chronic fatigue, I went from being an Olympic champion at sleep, to having broken and unsatisfactory sleep. I always think the term Sleep Hygiene is a bit daft, but google it and you’ll get loads of evidence-based tips on how to facilitate good sleep.


Take anxiety seriously and make a relaxation plan

I feel like I have studied anxiety in the University of Life. It’s been my life-long companion, so I know a bit about it. Quite a lot of anxious people are not even aware of it, because it’s their default existence. Some signs are:

·        Spinning thoughts and can’t silence your mind

·        Always overthinking things, being indecisive

·        Having to have things a ‘certain way’ for you to be ok

·        Constantly on the go, cannot sit still

·        Broken sleep, especially if it’s accompanied by the spinning thoughts

Frequent anxiety is bad for your health and your nervous system, because its not in the head, it’s a hormonal and chemical reality for your body. That’s just a fact. So get serious about it and start thinking of a relaxation plan to give your body a break, and helps it to recover from fatigue.  Read my blog with relaxation ideas and thoughts here.


Make a date with your couch:

Resting is so restorative…..When all else fails, make a date with your couch. No head activities like crossword, work planning…you need cognitive AND physical rest. And block out weekend on your calendar when you are not available. For anything.


Measure your fatigue:

There are loads of fatigue scales out there to measure the impact of fatigue on your life. Measuring it is good, because typically fatigue does not get better quickly, and slow changes are harder to detect. As an all-round, decent does-what-it-says-on-the-tin scale, my favourite is the Fatigue Severity Scale. Google it, download a PDF and take a measurement of where you are at on this date. Take about 1 measurement a month, and don’t look at it in between, in case you start remembering what you wrote the last time. Over time, you can track changes and congratulate yourself on your improvement.


Gradually return to activities.

This one is a no-brainer. Once you feel your fatigue is somewhat controlled, you can start doing more physical activities…gradually. Just like you gradually build up mileage when you do a marathon, having slow weeks and rest days, you do the same with fatigue….build up gradually, take rests, have slow weeks….I’m still at this stage of my fatigue journey so I’m not there yet. The same goes for cognitive tasks: if your job involves a lot of planning, thinking, interpreting, head-based activities, then you need to 'train up' for this too, as this is very tiring for the brain.



If you would like individualised advice, contact me for a 1:1 session on Zoom (

For more exciting (!) educational information.......




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