Molly is a physiotherapist working in neurology, and here she talks about fatigue.A
When Lesley, Bay editor, asked me to write an article, the first thing that came to mind was fatigue – we’re all surviving Covid in more ways than one, and I sense we are reaching a point of fatigue keeping up with the changes and restrictions we face every day.
On a more clinical note, fatigue is a recognised after effect of covid infection, and this needs to be managed as much as treating the acute infection. Whether it’s patients who were admitted in hospital, or those who self-managed at home, there are reports of people who were previously fit and healthy be-fore covid who are unable to return to their normal levels of health and energy for weeks after the onset of symptoms.
Fatigue is a common symptom of many different infections, and it is a normal part of the body’s response to fighting infection. Usually, fatigue goes away once the body has dealt with the infection. What we’re now seeing with post-covid patients relates more to Post Viral Fatigue Syndrome (PVFS), a fatigue that starts during the infection and contin-ues for a longer period of time after the infection is gone. Symptoms of PVFS include inability to sustain normal levels of physical activities, sleep disturb-ance, inability to focus, short term memory loss, headaches, and muscle pains to name a few. How-ever, we must not be mistaken that the ongoing presence of fatigue means persistent viral infection; in the absence of other coronavirus symptoms, the person is no longer infectious to others.
How to manage PVFS
Managing PVFS is a combination of strategies. Whilst it wouldn’t be possible to go into great depth on each strategy, I would nevertheless list these simple ideas as a starting point to recovery:
- REST – yes, good old-fashioned convalescence is the most important one. During the infection stage, this will allow your body to heal itself. Literally, taking things easy, a good night’s sleep, healthy diet, avoiding stressful situations, not returning to work, school or domestic duties until you are well again. Post infection stage, rest is still a key element in terms of breaking up activities with rests in between, so your body continues to heal.
- ACTIVITY MANAGEMENT – this applies to both physical and mental activities, as both require energy consumption. During infection, activity should be kept low, although if possible, move around slowly and gently to aid with circulation, whether this means getting up to move or moving around in bed if you’re too unwell to get up. If you feel your fatigue is improving, try small amounts of light activity – this will be a lot less than what you think! The idea is to stop before you feel tired, finding a balance, and likely a lot of trial and error. Activity management needs to be flexible and any increase in activity should be gradual, within your physical and mental limitations. Any vigorous, sporting or prolonged activities should be discontinued until you are fully recovered and remained well for a period of time. You cannot exercise your way out of PVFS.
- MENTAL WELL BEING – looking after your mental and emotional health is particularly important. Avoid stressful situations wherever possible. Having PVFS can be frustrating at times, and you may also feel low or anxious with day to day life. Signs of depression include tearful-ness, loss of interest in activities, or loss of self-esteem. If this is the case, seek help, either from your GP, support groups, family or friends.
- NUTRITION – this is as basic as it gets – stick to a healthy balanced diet with plenty of fresh fruit and vegetables, and adequate fluid intake. Small and frequent meals may be more palatable if your appetite is poor. It’s also better to cut down on alcohol and caffeinated drinks as these are dehydrating and can also impact on sleep cycle (see below). Sugar and high-energy food/drinks can give you an initial boost of energy, which often results in a ‘crash’ and can worsen fatigue. If your appetite remains poor, or you’ve lost a lot of weight during infection and you struggle to put it back on (if you are not overweight before being ill), ask for help from a dietician on foods or strategies that are worth trying.
- SLEEP – as we’ve already noted, sleep is a form of rest, and during acute infection, you may have increased sleep requirements as part of your body’s natural healing process. However, it is easy to fall into the cycle of staying in bed day and night, which can also lead to disrupted sleep cycle. You may find you are sleeping more in the day and unable to sleep in the night, and this is unhelpful if you’re trying to manage fatigue. If this is the case, try to establish a routine for getting up and going to bed roughly the same time each day, and if you need to rest in the day, include a short daytime nap. Try to reserve sleeping for night time if possible and aim for at least 8 hours. Relaxing before bedtime, avoiding caffeine/alcohol (both stimulants) and keeping the bedroom quiet and peaceful (no TV or computer work) can all help to create a conducive environment for sleep.
- MANAGING EXPECTATIONS – recognise it can be difficult to accept and adapt to feeling fatigued when you expect to make a quick recovery and return to your normal life. Many people feel guilty and try to ignore fatigue in order to carry on with usual activities. Others may also have expectations of ‘return to normal’ that are not realistic post infection and this adds to the pressure of doing more than is helpful.
School, work and other responsibilities need to be adjusted to allow for pacing of physical and mental activities. Acceptance and support is crucial for managing fatigue, and asking for help to achieve both is more useful than trying to carry on ‘as normal’ hoping the fatigue will sort itself out.
We don’t confidently know the scientific answer as to whether managing fatigue in different ways lead to different outcomes in terms of recovery. What we do know is that people who experienced fatigue reported that they wished they had received good advice earlier in their journey. Our understanding of coronavirus and how it affects the human body is still in its early days in medical research terms, although this doesn’t mean you need to suffer in silence with fatigue. Getting specialist advice based on available evidence as early as possible is your best chance of managing fatigue and shaping your recovery. If you or someone you know is suffering from fatigue, or PVFS, call for your free consultation and see what’s possible for you.
All the best to everyone for the rest of 2020, and here’s to a healthier, brighter 2021. In health and happiness. Molly
Ability Neuro Physio Enabling you to live well
British Association for CFS/ME (BACME) – Post-Viral Fatigue: a guide to management. May 2020
ME Association Information on Post-Viral Fatigue (PVF) and Post-Viral Fatigue Syndrome (PVFS) following coronavirus infection. May 2020