Fatigue and pacing

Many health conditions can trigger fatigue, including stroke, Long Covid, COPD, heart attack, and others.

Fatigue is not just tiredness – it is a physiological condition which affects all aspects of a person’s life. Common symptoms of fatigue include:

• A persistent tiredness that does not get better when you sleep.
• “Brain fog”, or difficulties with thinking or memory.
• Pain or numbness throughout the body.
• The sense of a weight pressing down on you.
• Immune dysfunction – a higher risk of infections, and illnesses may last longer or be more severe.
• Muscle weakness or lack of stamina.
• Post-exertional malaise (PEM)

Fatigue can lead to low mood and isolation, affecting your ability to do normal day to day tasks.

Post-exertional malaise

Post-exertional malaise (PEM) is a characteristic feature of clinical fatigue, and is the scientific term for fatigue which gets worse after exerting yourself. This exertion might be physical (e.g. going for a walk, or completing physiotherapy exercises), or it might be mental (e.g. a stressful conversation or a long day at work).

If you have post-exertional malaise, your body will “overreact” to these stresses, and a relatively small trigger can lead to days or weeks of fatigue. Typically, this includes extreme tiredness and heavy brain fog, making it difficult to think straight or communicate. It may also include oversleeping or difficulty sleeping, pain, low mood, and muscle weakness. You should not try to “push through” post-exertional malaise, as this can make things worse.

If you experience these symptoms after exerting yourself, it is important to speak to a qualified health professional, as they may be able to advise you on what is safe for you to do in the future.

Managing fatigue

Fatigue is best managed through pacing, where you manage your activity on a day-to-day basis to avoid triggering symptoms. You may be able to build up activity slowly over time, to increase how much you can safely do.

It can often help to record your activity and your symptoms, so you can see how much activity is safe for you to do, and if there are particular activities or types of activity that are more likely to trigger symptoms. CHSS has two worksheets available to help you with tracking your activity: a “battery tracker” and an energy tracking worksheet.

It is important to rest frequently, and to build downtime into your schedule. However, it is also important that you keep to a schedule where possible – building routines is a powerful tool for managing fatigue.

When planning your days, remember that doing things that you enjoy and that make you happy are just as important as work and chores! Keeping positive and giving yourself things to look forwards to can often improve your fatigue symptoms.

By the same token, it is important to be kind to yourself, even when you are unable to do the things you want to do. You are likely to have bad days, and to be unable to do things you feel you “should” do – try to forgive yourself for this, and to offer yourself the understanding and kindness you would want from someone else.

It can be helpful to break tasks down into smaller, more manageable chunks. This allows you to set small, achievable goals, and to recognise the things you have accomplished. It also makes it easier to find time to take breaks, recovering and hopefully preventing post-exertional malaise.