Exercise Advice for people with fatigue
Do you have any of the below medical causes of fatigue?
Some examples of medical causes of fatigue are;
- Rheumatoid arthritis
- Chronic Fatigue Syndrome
- Glandular Fever
- Multiple Sclerosis
- Persistent Pain
Fatigue and Exercise
For a lot of people who experience fatigue, exercise would be the last thing you want to do, either because you don’t have the energy or you’re concerned it will make your symptoms worse. Research has shown that exercise is a therapy which can help to reduce fatigue and improve energy. Hence, let’s give you some exercise advice!
What is the difference between feeling tired and being fatigued?
Tiredness and fatigue are terms that are often used interchangeably. However, it’s important to understand there is a difference. Tiredness is an expected feeling after certain activities, at the end of the day (1), or after lack of sleep, and is typically resolved after a good night’s rest. Fatigue, on the other hand, is a constant feeling of tiredness or weakness, and can be physical, mental or a combination of both (2,3). If you are getting enough sleep, eating well and exercising regularly, but still continue to have low energy and motivation and find it hard to perform everyday activities, you may have fatigue.
Signs of fatigue
• chronic tiredness or sleepiness
• headache, dizziness and blurred vision
• sore/aching and weak muscles
• slowed reflexes and responses
• impaired decision-making and judgement
• moodiness, such as irritability
• impaired coordination
• loss of appetite
• impaired immune system function
• poor short-term memory
• poor concentration and ability to pay attention
• low motivation (2)
How exercise can help?
People experiencing fatigue tend to limit their level of physical activity to minimise their symptoms (4). Research has shown that appropriate exercise is safe and can help to reduce fatigue associated with multiple medical conditions.
Chronic Fatigue Syndrome
Multiple studies have shown that flexibility or relaxation therapy as a stand-alone treatment for chronic fatigue syndrome (CFS) do not significantly improve fatigue levels or physical functioning. Rather, a graded exercise program has been shown to significantly improve fatigue and physical function. Walking is highly recommended, and swimming or cycling are also appropriate. Start with 5-10 mins, gradually increasing the duration to 30 mins. As tolerance improves, weight training can be added to the program (4).
Progressive resistance exercise for people with fibromyalgia leads to improvement in physical fatigue (5,6). This improvement from resistance training has been shown to be significantly greater than improvements from relaxation therapy (6). Physical fatigue refers to “physical ability to do things” and “physical condition” (6). An improvement in this area translates to an increased capacity to manage with activities of daily living with less fatigue, or an ability to do more before becoming fatigued. This leads to a significant improvement in quality of life.
Fatigue increases in women with metastatic breast cancer as they progress through their cycles of chemotherapy (7). Research has shown that people with breast cancer who participate in structured aerobic and resistance exercise during treatment have less increase in fatigue (8) and slower decrease in quality of life compared to those that didn’t (7). Similar results have been shown for patients with colon cancer (9). Not only does exercise reduce fatigue during chemotherapy in patients with breast or colon cancer, it also reduces fatigue in the long term if it is continued (9).
Lack of energy, tiredness or exhaustion is reported by 40-80% of patients with rheumatoid arthritis as their most disabling symptom (10). Exercise is shown to reduce fatigue and disability in patients with rheumatoid arthritis. This increases their ability to complete activities of daily living, leading to higher levels of independence (1). Often, people who have rheumatoid arthritis believe that exercise will increase their pain, so avoid it. However, research has also shown exercise is safe and does not increase pain (1).
Exercise you can do
While research shows that exercise is effective at reducing fatigue, fatigue effects everyone differently. This makes it difficult to give a one size fits all exercise plan outlining the best type of exercise, the best frequency and the best duration. Usually, the best thing to do is start small at 10 minutes of exercise and gradually build up. Gentle walking is a great place to start, then as you improve start incorporating light weights.
Exercise advice tips
• Schedule exercise for a time when you know you can rest afterwards
• Understand and accept that it’s okay to rest
• Don’t be so hard on yourself
• It takes time to get better
• Tolerance will vary between individuals, it is helpful to seek guidance from an Exercise Physiologist to develop a management plan that is most appropriate to you
• See your General Practitioner for diagnosis if you are experiencing chronic tiredness
Written by Courtney Wharton.
Accredited Exercise Physiologist in Adelaide; Payneham and Mount Barker.
Courtney has a passion for helping clients who have chronic health conditions that may cause fatigue.
1. Lee EO, Kim JI, Davis AH, Kim I. Effects of regular exercise on pain, fatigue, and disability in patients with rheumatoid arthritis. Family & community health. 2006 Oct 1;29(4):320-7.
2. Better Health Channel [Internet]. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/fatigue
3. Twomey R, Martin T, Temesi J, Culos-Reed SN, Millet GY. Tailored exercise interventions to reduce fatigue in cancer survivors: study protocol of a randomized controlled trial. BMC cancer. 2018 Dec;18(1):757.
4. Van Cauwenbergh D, De Kooning M, Ickmans K, Nijs J. How to exercise people with chronic fatigue syndrome: evidence‐based practice guidelines. European journal of clinical investigation. 2012 Oct;42(10):1136-44.
5. Bjersing JL, Larsson A, Palstam A, Ernberg M, Bileviciute-Ljungar I, Löfgren M, Gerdle B, Kosek E, Mannerkorpi K. Benefits of resistance exercise in lean women with fibromyalgia: involvement of IGF-1 and leptin. BMC musculoskeletal disorders. 2017 Dec;18(1):106
6. Ericsson A, Palstam A, Larsson A, Löfgren M, Bileviciute-Ljungar I, Bjersing J, Gerdle B, Kosek E, Mannerkorpi K. Resistance exercise improves physical fatigue in women with fibromyalgia: a randomized controlled trial. Arthritis research & therapy. 2016 Dec;18(1):176.
7. Headley JA, Ownby KK, John LD. The effect of seated exercise on fatigue and quality of life in women with advanced breast cancer. Oncology nursing forum. 2004 Sep 1;31(5):977-83.
8. Winters-Stone KM, Moe EL, Perry CK, Medysky M, Pommier R, Vetto J, Naik A. Enhancing an oncologist’s recommendation to exercise to manage fatigue levels in breast cancer patients: a randomized controlled trial. Supportive Care in Cancer. 2018 Mar 1;26(3):905-12.
9. Witlox L, Hiensch AE, Velthuis MJ, Bisschop CN, Los M, Erdkamp FL, Bloemendal HJ, Verhaar M, ten Bokkel Huinink D, van der Wall E, Peeters PH. Four-year effects of exercise on fatigue and physical activity in patients with cancer. BMC medicine. 2018 Dec;16(1):86.
10. Balsamo S, Diniz LR. Exercise and fatigue in rheumatoid arthritis. IMAJ. 2014 Jan;16(1):57-60.