Occupational therapy and fatigue self-management

The importance of managing fatigue 

Fatigue impacts a person’s ability to engage in all the activities and occupations they have in their daily life - even those which are perceived to be simple, such as making a hot drink, going for a short walk, or meeting friends for coffee.

How fatigue effects daily life

Fatigue can also be a barrier to participation in more complex occupations, including work, education, housework and leisure activities. 

These activities and occupations often have both physical and cognitive demands. When someone experiences fatigue, they may struggle with both simple and more complex occupations, including:

• Decision-making
• Concentration
• Reaction times

Efficiency and performance are also reduced. This, in turn, negatively impacts a person's ability to do their job productively, safely and effectively.

Fatigue is associated with reduced health-related quality of life and an increased risk of depression. Managing fatigue, alongside appropriate reasonable adjustments, is therefore important in reducing its impact and associated risks.

Fatigue self-management strategies 

A systematic review and meta-analysis of 34 international studies demonstrated that self-management strategies can be effective in reducing fatigue and helping individuals regain control, leading to an improved quality of life (Kim et al., 2022).

Getting started

As fatigue is usually a symptom of a broader health issue, it is assumed that you have already sought professional expertise for the underlying cause of your fatigue.

Before you begin self-management strategies, an accurate assessment of your fatigue is advised as a basis for planning the right strategies for you. This starts with an evaluation, followed by an analysis to inform goal setting. 

Below are some self-help strategies and reasonable adjustments that may be helpful in managing fatigue.

1. Evaluation

How much are you really doing?

Fatigue is complex and each person experiences it differently. Therefore, a personalised approach is advised, based on each person's lived experience. This requires a detailed understanding of that lived experience.

Our perception is not always reality. Gaining a more accurate awareness of what you do each day is an important first step in fatigue management. An awareness of how fatigue affects you - and the situations and activities that increase it - can support you in managing it. 

Keep a record

A record of your activity could validate your experience and enable you to take the next steps in managing your fatigue. Alternatively, a record of your activity might be surprising, and suggest your fatigue is different to what you thought or that you are achieving more than you thought.

How to track your activity

You can choose either a paper diary or an electronic diary to keep track. Here are some tips:

• Break your day into hourly slots for a detailed perspective.
• Use digital tools like activity-tracking apps or devices such as a Fitbit for easier tracking - these devices often also monitor sleep duration and quality, which provides valuable insights.

Note how the fatigue is for you: what you feel and what you do. It is recommended that you record your activity at regular intervals - real time reporting is generally more accurate than recalling events later. The more accurate your data is, the more reliable it is as a basis for making changes. 

Set a time limit

Recording your activity for two weeks should give you a good basis for the next steps.

Note: focusing on your fatigue in this way can be a negative experience, causing some people to feel despondent initially. Setting a clear time limit can help. It's the first step to regaining control and setting meaningful goals to improve your fatigue.

This also provides a rationale for sharing it with someone who can support you and encourage you to keep going. They may also support you in the next stage: analysing your records and setting goals.

2. Analysis

Using your results, determine what is surprising and what isn’t.

• What have you learned?
• What are the triggers for your fatigue?

Consider:

• What can you do to avoid these triggers or mitigate them?
• What do you want to change?
• Are there any patterns or triggers to your fatigue?

Sometimes, the context of the activity is key to understanding fatigue triggers, such as if you are with others or alone, and where the fatigue is experienced. 

Consider whether you want to share your results with another person to seek their views and perspective. Choose someone who knows you relatively well and you would feel comfortable discussing this with. Or this could be the point that you seek help from professional, starting with your GP.  

3. Goal setting

Do you have fatigue management goals you would like to set for yourself? Make them realistic and meaningful, or use the SMART approach:

• Specific
• Measurable
• Achievable
• Relevant
• Time-bound

This approach can increase the likelihood of success. Some of the fatigue self-management strategies below are also well worth considering. 

Self-management strategies 

Evidence-based self-management strategies shown to improve fatigue for some people (depending on the underlying cause) include: 

Improve your understanding of fatigue - enhancing your understanding of fatigue is the first recommended step to begin to manage it. Your GP may be able to recommend the best sources for information

Energy conservation - gaining a balance of activity with rest is vital in energy conservation. Remember that physical and cognitive activities use energy, so consider balancing both with rest each day

Developing an appreciation of rest - including its duration, amount and timing, and understanding what works best for you and can be incorporated into your lifestyle

Analysing how you undertake activities - this is important as it shows you where you may be able to conserve energy 

For example: 

• Sitting rather than standing to perform tasks
• Good ergonomics (your physical working environment)
• Organising your work environment and tasks so you do not have to continuously fetch items
• Limiting and balancing thinking and decision-making activities, such as emails, online shopping and personal finances  

Avoiding distractions as much as possible by creating a protected, quiet space can also be effective because it improves concentration, which can be impacted by fatigue, and boosts productivity.

Pacing

Pacing, also referred to as 'activity pacing', is a self-management skill used to balance time spent on activities with rest. It supports a person's ability to carry out their meaningful occupations.

Key elements of pacing

• Breaking up activities into smaller tasks, spread throughout the day 
• Adjusting different parts of an activity to reduce the energy demands
• Incorporating rest periods into activities to enable recharging of energy
• Stopping, pausing and resting between activities where possible 
• Sitting and resting wherever possible (RCOT 2023)  

How pacing helps

Over time, pacing can help build up tolerance for activities by gradually increasing how long you can do them.

To pace your activities effectively:

• Set a specific time for the activity;
• plan when and how long to rest; and
• don’t wait until fatigue symptoms start - rest proactively.

Plan ahead

As with energy conservation, it is important to pre-plan your activities for a day or week - including frequent breaks - before fatigue symptoms appear. Pacing is not an instinctive response when you start to feel fatigue - so be proactive.

Balance activities across your day and week

• Space out the more physically and emotionally challenging activities across each day and week, with less intense activities and rests in between
• Some activities - like making a hot drink or a snack - generally require fewer cognitive demands, so more of these habitual activities can be undertaken
• Others, such as having a meeting with multiple people, are more demanding 

Even on a 'good day', you should still pace your activities. Consider whether some activities can be undertaken in manageable pieces of time, rather than completing them in one go. This supports good habit formation and should help prevent sudden fatigue from overexertion. 

Know when to push yourself - and when not to

Activity pacing can also lead to a better understanding of when you can push yourself a little further - and when not to. It might also enable you to prioritise the activities that are most important and meaningful to you, rather than trying to do them all and then having negative consequences the next day.

Track and reflect

Keeping a diary of your plans and your experiences afterwards could help with this. It is worth reflecting on how you feel after doing all your activities, as some can be energising. You might also have a better time in the day to do the more demanding activities.  

Exercise and fatigue management 

Important: it you have a chronic health condition, you are advised to seek medical advice before beginning a schedule to increase your exercise levels. 

Choose what you enjoy

Choose exercise(s) that you like and are most likely to continue. You can also choose the frequency, duration and intensity, striking a balance between between achievable and ambitious.

Getting started

A good starting point might be:

• Three times per week
• 30–60 minutes per session (depending on how strenuous the activity is)
• Begin with low to moderate intensity

Example 1:

• Two 30-minute walks
• One yoga or Pilates session

Example 2:

• One 45-minute low/moderate intensity gym session
• One 30-minute swim
• One 30-minute walk

Monitor and review 

Continuous review of your exercise progress and fatigue level is important. You can alter the exercises based on how you feel, but do this gradually.

If your fatigue symptoms get worse after increasing the intensity or duration of exercise, it is recommended that you continue at the level of exercise until the symptoms stabilise.

Over time, you could work towards meeting the NHS recommendation for adults:

• At least 150 minutes of moderate aerobic activity, or
• 75 minutes of vigorous activity each week, or
• A combination of both (Exercise - NHS).  

Stress and anxiety management 

High levels of stress and anxiety release cortisol throughout the body, which can lead to feelings of exhaustion. Therefore, managing stress and anxiety can be helpful for people experiencing fatigue.

Relaxation techniques, such as yoga and mindfulness, may be beneficial. Achieving a good occupational balance also helps ensure that time is allocated for rest and leisure activities.

See Achieving occupational balance for more information, as well as the RCVS Mental Health Initiative (MMI) guide: Understanding and managing stress in the veterinary workplace.

Sleep quality

Sleep quality is essential for overall wellbeing. Improving sleep is a huge area in itself, and again, is very individual.

Forming good sleep habits

Positive results have been reported with good sleep habits, which include: 

• Having a regular pre-bedtime routine
• Keeping the bedroom quiet, dark and at a good temperature
• Not eating late in the evening
• Avoiding too much alcohol in the evening
• Practising mindfulness techniques

For more advice on improving your sleep, visit How to fall asleep faster and sleep better on the NHS Every Mind Matters website. 

Peer support

The benefits of peer support in self-management interventions are well documented. Having a trusted family member, friend or colleague to share your goals and progress with can be both motivational and encouraging.

Discussions with employers

It’s important that your employer and/or manager is aware of your fatigue. Fatigue can impact the organisation, and when your employer is informed, they can better support you with reasonable adjustments.

Topics to discuss may include:

• Work schedules - limiting overtime, avoiding back-to-back shifts and ensuring rest periods between shifts
• Work environment - optimising lighting and temperature, reducing noise levels, and ensuring ergonomic workspaces
• Education and training - information on ergonomics, manual handling, and understanding the risks of fatigue and how to manage them

As further motivation, there is evidence that as people improve their ability to manage work demands and self-manage fatigue, their self-efficacy increases - which in turn improves mood (McCormack et al., 2018).

Essential reminders 

• Plan as much as you can before you start
• Have routines
• Balance demanding activities with less demanding ones
• Pace activities across each day with rest in-between
• Organise your workspace so everything is easy to access
• Prioritise what you do and when you do it
• Make time for the activities you enjoy
• Stick with it! Health behaviour changes take time - on average, it takes 66 days to form a new health-related habit (Kim et al., 2022)
• Managing fatigue alone is difficult. Sharing your experiences and receiving encouragement and support from others is recommended

Accessing support from an occupational therapist

If you would like professional support with managing fatigue, an occupational therapist can:

• Provide education on fatigue, its impact, living with fatigue, and fatigue management
• Undertake a standardised fatigue assessment (e.g. Fatigue Impact Scale), and help you analyse results and plan strategies
• Carry out an occupational performance measure and develop personalised management goals
• Conduct a standardised Quality of Life assessment and create tailored management strategies
• Offer Cognitive Behavioural Therapy (CBT)
• Provide mental well-being sessions
• Offer support with stress and anxiety management, especially in the workplace (which can reduce fatigue by improving mood)
• Enrol you in a group Occupational Therapy Fatigue Management Programme. Group programmes offer shared experiences and peer support, helping you realise you're not alone in your challenges with fatigue
• Advise on self-management strategies tailored to your fatigue needs
• Carry out a home assessment to suggest energy-saving adaptations
• Recommend energy conservation and activity pacing strategies
• Offer guidance to employers and colleagues on suitable workplace adjustments

References and resources 

References

Bryant, W (2024) Rest-do days: How to live with fatigue and get things done. London, Hammersmith Health Books 
 
Kim, S. Xu, Y., Dore K. Gewurtz R. Larivière N and Letts, L (2022) Fatigue self-management led by occupational therapists and/or physiotherapists for chronic conditions: A systematic review and meta analysis Chronic Illness 18(3) 441-457 
 
McCormack, R.C. et al. (2018) ‘Impact of a fatigue management in work programme on meeting work demands of individuals with rheumatic diseases: A pilot study’, Musculoskeletal care, 16(3), pp. 398–404.  

Resources

Explore helpful guides and information to support your wellbeing:

• Understanding and managing stress in the veterinary workplace - RCVS Mind Matters Initiative (MMI)
• Fall asleep faster and sleep better - Every Mind Matters - NHS
• Sleep and tiredness - NHS
• Sleep problems - Every Mind Matters - NHS
• Eat well - NHS
• Exercise - NHS
• Getting my life back - PDF guide, RCOT (2018)
• Lift up your everyday - managing energy -  PDF guide, RCOT (2023)  

About the author

The pages in this section were written by occupational therapy expert Professor Nicola Spalding - view Nicola's biography.