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Fight fatigue & tirednes  

Fatigue has been described as tiredness, exhaustion, depression, feeling unwell, loss of motivation and limitation of mental state. Over 75 percent of people complain of fatigue at one stage in their lives particular during times of stress of concurrent illness. it can be severe – considerably impacting on quality of life and ability to self-care. Fatigue, as well as being distressing, can have a considerable impact on the ability to return to work or full time care of children, husbands, wives or other dependants.

Causes

 Clinicians and patients should look out for these aggravating causes at each consultation and treat them appropriately:

  • Anaemia, from vitamin deficiency or blood loss.

  • A thyroid deficiency (can be easily corrected by thyroxine). 

  • Disturbed sleep (pain at night, anxiety, depression passing water). 

  • Medication such as painkillers, codeine, hormones antihistamine can cause fatigue. 

  • Fatigue is common after an operation or post chemotherapy or radiotherapy.

  • Depression, boredom and a sedentary lifestyle can both cause fatigue.  

  • Viral infections

  • Mineral or salt imbalances

  • Heart failure

What can you do to help? 

If you have developed significant fatigue or tiredness which is a change from your useful pattern then the first thing to do is exclude one of the  medical conditions listed above so it is important to discuss fatigue with your doctor, as this is a genuine symptom which can seriously affect your quality of life

Sleep:. Try to get enough sleep at night - see the sleep hygiene rules below or if this fails consider a nap (siesta) in the day. 

Stimulus: You may be simply bored -  try to embark on stimulating activities which can distract you from your fatigue, such as meeting friends or going for a walk in an interesting environment. Some people find going back to work is fulfilling and useful.  

Smoking: Although a cigarette may give you an initial lift it is not long before withdrawl sets in - this causes agitation which uses up energy and later causing fatigue. Smoker by going into withdrawl at night have broken sleep patterns leading to sleep depravation and fatigue in the day - see quit smoking

Exercise: There have been 48 published RCT’s evaluating exercise interventions in patients with fatigue. These include home based exercise programmes such as walking, jogging or cycling and supervised programmes such as aerobics, resistance exercises, stretching and a general “work out” in a gym or dance class. Studies have shown that the optimal level of exercise differs between individuals and the stages of their treatments:

A study involving patients with acute leukaemia receiving intense hospital based chemotherapy evaluated a three week supervised walking programme during chemotherapy. Participants walked five times a week for 12 minutes, in the hospital hallway. The supervised exercise programme was completed by 69 percent of the participants. No adverse events were reported and there was a moderate improvement in terms of fatigue.

 A study from Michigan USA showed that women receiving radiotherapy who participated in jogging or brisk walking for 20-45 minutes 3-5 times a week had significantly greater haemoglobin levels (red blood cells) and experienced less fatigue. Another study in men with prostate cancer receiving radiotherapy showed a benefit from daily 15 minute aerobics exercise compared to sedentary controls.

The impact of exercise on the fatigue related to long term hormone therapies has been evaluated in men and women on hormone therapies such as Zoladex (or equivalent), tamoxifen, anastrozole (Arimidex). There was a reduction in fatigue, and performing aerobics exercises at home for 15-30 minutes per day, such as dancing, jogging or brisk walking, was more effective than weight lifting or resistance bands alone. Studies which involved a supervised exercise in a gym, dance or aerobics class had the best results with a combination of both aerobics and gentle resistance training being particularly effective. Five further studies evaluated the role of supervised exercise involving patients who were experiencing fatigue, which can last up to a year after chemotherapy. Aerobic exercises with stretching and resistance were supervised 2-3 times a week. Aerobic exercises were performed with an intensity of 40 percent - 80 percent heart rate max adjusted for age for 10-30 minutes. Exercise lasted at least 15-30 minutes per day. The programme was completed by 90 percent. The supervised exercise programme showed a significant reduction in fatigue as well as improved muscle strength, sleeping patterns and quality of life in favour of the exercise groups.

Other lifestyle initiatives are summarised in the table below but regular light exercise is by far the most important self help strategy which you can carry out to reduce fatigue. It is also clear from the studies summarised here that a supervised exercise programme is better than doing it alone at home. If you are a member of a gym a suitably qualified exercise professional should be able to help you. Otherwise, you can ask your oncology team or GP whether a formal exercise rehabilitation programme exists in your area, either in the hospital or your local community gym as part of the national exercise referral scheme.  

 

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A deficiency or an excess of micro nutrients such as
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- Enzymes
- Essential minerals 
- Fatty acids
can increase risk of chronic illnesses. Measuring your body's levels and empower yourself you correct your levels through diet 
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Summary – fatigue coping tactics:

  • Acceptance – it’s normal to get tried, so try not to get disheartened

  • Eat a healthy balanced diet: fruit, berries, herbs, fibre and protein

  • Eat plenty of antioxidant rich foods

  • Consider micro-nutrient testing to ensure a correct balance of micronutrients

  • Eat slow energy releasing carbohydrates: pasta, bread, rice, quinoa and potatoes

  • Avoid refined sugar in foods producing peaks and troughs in glucose levels

  • Rest – allocate set times for rests, throughout the day between activities

  • Aerobics exercise between 15-30 minutes per day, every day, if possible

  • Try gentle resistance exercise (weights or exercise bands)

  • Supervised exercise is ideal – ask for a national exercise referral

  • Distraction tactics – maintain an interest and meet up with friends

  • Stimulation tactics – listening to stimulating tapes or music

  • Try to keep comfortable – avoid being too hot or cold 

  • Not sleeping see sleep section and consider sleep hygiene rules 

  • Task avoidance – use energy saving aids: remote controls, lifts, etc.

  • Task management – organise others to help with regular strenuous tasks

 

 

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