Occupational therapist (OT) Nicole Tester treats patients with multiple sclerosis (MS). Nearly all of them share one common symptom: fatigue.
That's not surprising, considering about 80% of people with MS report fatigue, says Tester, MOT, PhD, an occupational therapist at the University of Florida (UF) Health in Gainesville and an MS specialist who treats patients at the UF Health Rehab Center, Norman Fixel Institute for Neurological Diseases.
The problem can seriously affect a patient’s physical and mental abilities, often interfering with daily activities like working, concentrating, exercising, and spending time with family and friends.
Fortunately, making small changes to your routine can fight against fatigue and give you more energy. Below, Tester shares her top tips to help manage and lessen fatigue and improve your daily life.
1. Rest before fatigue hits.
Think of your energy level like a gas tank. After a night of good sleep, you have a full tank of fuel. Every single thing you do throughout the day uses up that fuel, slowly draining your reserve. The only way to maintain that reserve, or fill the tank back up, is to rest. You can rest by sitting down to relax, taking a short nap, or doing an enjoyable activity. This allows you to engage in activity throughout your entire day. If you let the gas tank empty, you’ll crash. In these cases, it takes much longer to recover.
Use a scale of 1 to 10 to mark your fatigue both during exercise and everyday tasks (1 = no fatigue and 10 = max fatigue). When you hit a 6 or 7, force yourself to take a rest break.
2. Perform routine exercise.
This could be strength training, aerobic training, or flexibility training. In the past, physical exercise was not recommended for patients with MS because it was thought to make fatigue worse or trigger flare-ups. But now we know that engaging in routine exercise improves activity tolerance and mobility. It also helps maintain your natural sleep-wake cycle and improves mood. Also, aerobic exercise produces chemicals in the brain that are neuroprotective.
Pick a time of day to exercise that works for you to help make it a habit. An exercise buddy can help! Exercise buddies can hold you accountable and keep you motivated. The MS Society has a list of simple exercises you can do, or if you prefer more professional-led workouts, you can check out these videos from Can Do Multiple Sclerosis, a nonprofit organization that helps patients with MS.
3. Get a good night’s sleep.
No one can function at their best, physically or mentally, without good sleep. If you wake up without a good night of sleep, you start your day already tired. For the best sleep, cut your screen time and avoid drinking liquids, especially caffeine, two to four hours before bedtime. Also, optimize your sleeping environment: Make sure your room is dark, cool, and quiet. Creating a sleep schedule is also helpful. This means going to bed and waking up at the same time each day, even on weekends. And abide by the 15-minute rule: If you cannot fall asleep in 15 minutes, get out of bed to do something relaxing, such as reading or listening to soft music. Then, and only then, return to your bed to try and fall asleep.
4. Eat healthy.
Follow a nutritious diet, preferably the Mediterranean diet. Eating whole foods, healthy oils, and moderate amounts of poultry and fish offers your body enough nutrients needed to support energy. Other good options are whole-grain foods such as oatmeal and brown rice, fruits like apples and blueberries, and vegetables like asparagus and broccoli. Beans and lentils are also great choices.
On the other hand, it’s important to avoid foods that can add to your fatigue. Foods like pastries and soda often have high-fructose corn syrup that can cause inflammation and trigger fatigue. Avoid foods with added or refined sugars and fried foods.
5. Manage heat sensitivity.
People with MS generally become more fatigued in the heat. If you’re going to be in the sun or in a warm setting, use cooling vests, cooling towels, mist fans, or portable neck fans. Consider staying indoors when it’s hot and exercising in air-conditioned buildings. If you like to walk, for instance, go to a mall or big box retail store to work out. Use a cooling device when you are outdoors. If you’re planning a day outside in the heat, try to cool your core 15-30 minutes before going outdoors to minimize heat-induced fatigue. To do this, try eating or drinking a cold food or beverage, taking a shower or bath, applying an ice pack to your neck or underarms, or dipping your forearms in water for about five minutes.
6. Lower your stress level.
This includes anxiety, depression, and any other conditions you might have. Stressors increase the physical demands placed on your body and can drain you of the energy needed to complete daily physical and cognitive tasks. To lower stress, consider deep breathing techniques, box breathing, or progressive muscle relaxation (PMR). PMR is a relaxation technique where you tense one muscle group at a time, followed by a relaxation phase where you release the tension. The use of mindfulness apps, such as Calm or Headspace, can also help.
Another idea is to keep a stress journal where you write down stressful events or feelings. This can help you feel more in control of your life and give you a set time to worry. Studies show that journaling can help ease stress and manage anxiety.
7. Use your tools.
Use tools that will help you save your energy. Reachers, for example, allow you to avoid squatting or bending, while choppers and food processors help you avoid repetitive chopping. Other items that can help you save your energy include slip-on shoes and long-handled bath sponges to wash your legs and feet without having to bend over. Walking aids can lessen fatigue caused by maintaining your balance and walking. Devices such as rollators are especially helpful as they offer a seat for rest breaks and help carry objects such as ingredients for meals or laundry.
For showers, use a shower chair and consider sitting when preparing meals or folding laundry. You can also modify tasks by purchasing prechopped vegetables, ordering items online, or using grocery delivery services. Focus on single-tasking and get rid of any background distractions. Multitasking and distractors increase energy expenditure.
8. Use the 3 Ps: Plan, prioritize, and pace.
The 3 Ps are a strategy that prevents overdoing it. Often, when people feel good, they want to get as much done as possible — also called the “Energizer Bunny” effect. Unfortunately, this usually leads to a fatigue crash that can take hours or days to recover. To implement the 3 P’s, plan ahead by making a list of things you would like to get done the next day. Maybe you want to drop off and pick up the kids from school, clean the house, make dinner, and complete three hours of work remotely. Next, prioritize the tasks on the list. What is most important? If dropping off and picking up the kids from school is a simple task and they don't care who takes them, ask a neighbor to ride-share.
Making dinner is likely a must, so place that at the top of the list. In doing this, prep anything you can earlier in the day when you have more energy. If cleaning the house is also a high priority, focus on dirtier rooms first. Make a sub-list, and clean the first room on that list the next day. Then, pace the remaining cleaning chores throughout the week by doing one room a day. Also, prioritize your remote work tasks. Are some tasks urgent, while others can wait?
Remember, as you complete each task, do a little at a time and take short breaks. It is better to spread tasks throughout the day to avoid fatigue than to work like the “Energizer Bunny” and crash.
9. Ask for help.
If you have a family, create a chore list by dividing household chores. Everyone who lives with you should pitch in. This not only helps you but also helps shape your children into responsible teenagers and adults.
MS is often called “the invisible disease” because fatigue, its main symptom, is not easily visible to others. Educate your family and friends about MS, the extent to which it can cause fatigue, and how this affects you. It can especially be hard for children to understand the degree of fatigue you might have. Some resources to start conversations with family, friends, and children can be found on the MS Foundation and National MS Society. Clear communication helps create better understanding and stronger relationships with family and friends, leading to healthier and happier connections.
