Strategies for managing fatigue

Forward planning

Set priorities

On days when you already feel tired, only do the tasks that are high priority. Give attention to those things that deserve it, the truly important things for you. So for example, if your relationship with your partner is highly valued to you, you may plan to spend time talking with them over dinner, or arranging an activity together; if caring for your children is something you value highly you might include activities with them such as listening to them read or cook them a nutritious meal; if your health is a high priority to you, include some exercise each day, eat some healthy food, make that appointment you have been meaning to do.

Set daily / weekly goals

Decide what your goals are first: what do you value most? Write down the things you have to do and arrange them in order of priority. Ask yourself if each task really needs to get done, and then cross off those that are not necessary. If there is one really important thing you need to do, arrange your day around this task.

Plan ahead

Plan and follow a daily schedule. Using a calendar or planner will help memory recall and reduce cognitive demands. Organise your day / week and identify which days will be mentally and physically busy, and use strategies to reduce demands of other tasks for that day, eg keep extra meals in the freezer so you don’t need to cook on a busy day. Think ahead and plan activities so that you don’t overstretch yourself or put yourself under time pressure.

Time blocking

Divide your day into blocks of time. Each block is dedicated to accomplishing a specific task, but you need to factor in the activity and the travel required to be involved in that activity.

Consider best hours for activity

Some people function best in the mornings, so complete demanding tasks then, as activities carried out when you are tired are less likely to be successful. Be mindful not to overload your morning even though that’s when you feel good. You still need to pace yourself, or fatigue in the afternoon will continue. If you have returned to work away from home, factor in the time you will need to be alert for your commute home.

One task at a time

Avoid multitasking to make sure you are completing each task error free.

Clean environment

Keep areas uncluttered so it is easy to identify what needs to be done. Think about how and where things are stored, keep regularly used items in easy reach.

Delegate / boundaries

Delegate tasks to others to share the workload. Set boundaries on when others can interrupt to improve efficiency.

Pacing

Activity pacing has two parts:

1. Conserving energy for activities you value (for example, playing with your kids; undertaking a pleasurable recreational activity)
   
   
2. Setting graduated activity quotas to help you to increase your ability to do activities (tolerance) and reduce the impact of fatigue

Current best research indicates that both over activity and avoidance of activity are associated with poorer outcomes.

Break it down

Using a ‘paced’ approach gives you a way to break everyday activities and exercise into smaller bits:

• Doing little bits often
• Finding the middle road between not overdoing and not underdoing
• Alternate cognitive (thinking) activities with physical activities eg If you have been sitting in front of your computer for a while, get up and go for a walk or purposefully take information to someone else within the building / organisation.
• Alternate complex or more stressful tasks with more routine or simple tasks. This provides opportunities to rest within more realistic time frames to complete the task.
• Use a checklist if needed.

Pacing is important in fatigue management because it helps you to stay active, doing the things you care about and want or need to do, feel more in control of your life while avoiding putting yourself out of action for a few days.

Gradually increase your activity

Pacing uses a ‘time-contingent’ approach to activity. This means activity that is based on a measurement (such as an amount of time, a distance, number of repetitions). This measure gives you a target and a limit for the activity – for example 15 minutes of walking or 10 minutes on your computer / phone. It gives you a base from which to build ‘activity tolerance’, which is important to allow you to do everyday tasks. Be aware of your limits and be prepared to gradually build on them. Every step up, physically, cognitively and emotionally needs time for your body to readjust…so you may feel quite fatigued the first time, but better the next time… these step ups are also necessary to reach your best outcome.

Regular rest

Schedule rest periods

Take regular rest breaks. Consider 5 to 10 minutes for every hour of activity. It may be as simple as closing your eyes and zoning out, listening to a mindfulness meditation app or going for a short walk outside. Some people may need a short 20 to 30 minute nap in the afternoon (note: only prior to 4pm) to give you more energy to help you through the day.

Set a regular routine

Go to bed and rise at the same time, with alarms if necessary. Routines form good habits that help your mind function more efficiently. They also reduce the amount of decision making required each day and the effort that involves. An example may be to limit yourself to a simple wardrobe to reduce decision making on what to wear each day.

Healthy lifestyle

As with virtually every aspect of a concussion injury, fatigue will be less of a problem if you maintain a healthy lifestyle:

• Sleep well and wake refreshed (reduce naps if they affect your night’s sleep)
• Regular exercise to help you feel positive and energised
• No / minimal alcohol or illicit drugs that can affect your mood, reactions and hydration
• Eat a healthy diet. Consider smaller more regular meals to ensure you have enough dietary resources to remain focussed and active
• Limit caffeine / energy drinks / sugar as they provide a false expectation of your body’s energy levels
• Learn stress management techniques, to deal better with stress and pressure
• Maintain contact with friends and family

Helpful insights

• LISTEN to your BODY
• When fatigue gets in the way it is a mistake to push through
• When fatigue gets in the way it is a mistake to not go back to that activity, after a rest
• Being physically active in heat / direct sunlight increases fatigue
• With fatigue you have a greater sensitivity to known weaknesses (eg. food / alcohol intolerances)
• Immunity levels are lower than usual, so you are more at risk of illness
• If you stop doing everything due to fatigue/your symptoms, you will become deconditioned and it will take a lot more effort to improve
• Try new things
• If trying something new, make no other changes on that day so that you can judge its effect on you
• Be kind to yourself
• When you think you are back to normal, still consider pacing strategies with breaks to manage residual fatigue for your lifestyle balance.