Tiredness tips from a Physiotherapist

If you’re suffering from constant tiredness it’s likely that exercise will feel like the last thing you want to do. But, exercise is one of the most important and helpful ways to feel more energised and to build your resilience. Ripal Patel is a specialist physiotherapist and professional advisor to the Chartered Society of Physiotherapy. These are her tips about how to tackle tiredness today…

What would you advise your client do to help beat feelings of tiredness?

Ripal says: Feelings of tiredness, even extreme tiredness, are not uncommon when you have a long-term condition, such as arthritis. It is likely that different combinations of factors will cause tiredness in different people at different times. However, there are a number of things you can do to reduce feelings of tiredness.

It is important not to over or under do things. People with health problems often avoid activity as they think it will make them feel worse. However, this is not helpful, even if it makes you feel better in the short term. Resting too much can make your muscles weak and stiff, making it harder to be active when you want to be.

On good days, some people will try to make the most of it and keep going after they should stop, then need to rest for long periods afterwards in order to recover. This is called activity cycling or ‘boom and bust’ behaviour. Both avoidance and activity cycling can trap you into vicious circles. You need to take control and break this cycle.
Using the three ‘P’s’ –Prioritising, Planning and Pacing can help to break the cycle.

Prioritising

• Think about the things you need and want to do. Instead of trying to do it all at once, decide which are the most important and focus on these for now.

Planning

• Plan your day, thinking about what you are going to do, when you are going to do it and how you are going to do it, breaking down and/or spreading out more tiring activities over a longer period of time. For example, instead of cleaning your whole home in one go, plan to clean only one or two rooms at a time.
• You can plan breaks in between your activities and have dedicated relaxation time.

Pacing

• Try to keep your activity level at the same level every day, not over doing it on a good day or doing very little on a bad day.
• Take regular breaks, stopping before you start to feel tired, or change activities.
• If there is a specific activity you want to do more of, start slowly and gradually increase how long you do it for over time. If you struggle to pace yourself, you can look into booking some home physiotherapy sessions to help keep you on track.

Setting clear goals

Ripal says: Setting yourself clear goals is another important tool in taking control. Goal setting is a great way to achieve the things you would like to and will give you something to work towards. Begin by asking yourself, “What do I want to be able to do?” Then make your goals SMART. This means Specific, Measurable, Achievable, Rewarding, and Timed. For example, “I want to be able to exercise” is not as easy to work towards as “I want to be able to cycle for 30 minutes in six weeks time”. Break goals down until you feel that they are manageable for you and reward yourself for achieving them.

Schedule in relaxation time

Ripal says: Making regular time to relax is also very important, so schedule it into your day. Good ways to relax include breathing exercises or simply doing something you enjoy, such as reading, listening to music, or meeting friends. Finally, look after your body by eating and drinking healthily and sleeping well and talk to family, friends and colleagues so they understand and can help you when you need it.

Why is exercise important as part of combating tiredness?

Ripal says: Inactivity due to pain and/or stiffness can cause you to become unfit and your muscles to become weak. When your muscles are weak it takes more effort to use your joints when you do move and this can leave you feeling tired. Exercise is therefore very important as it improves and maintains your fitness and muscle strength and thus reduces tiredness caused by inactivity. Exercise is also very important in managing stress, low mood and sleep disturbance, all of which can occur in people with long-term conditions, such as arthritis, and can cause tiredness.

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What kind of exercise is best?

Ripal says: Unfit and weak muscles are vulnerable and it is advisable that you talk to a physiotherapist about an individually tailored stretching and strengthening programme that you can work on safely. In addition, general graded exercise to build up your fitness is recommended. This does not have to be anything fancy; just going for a brisk walk can be enough. Graded exercise means starting slowly before gradually increasing the amount of exercise over time. Generally, the best way to start is little and often.

Joining a class can be a fun way to exercise as well as meet other people. However, make sure that the instructor is qualified and experienced in teaching people with arthritis and exercise at a pace that feels right for you. Your physiotherapist may be able to refer you to a gym or a local exercise programme.

Swimming, or just walking up and down in the pool, is a great exercise that is good for people with arthritis.

What would you say to somebody who is reluctant to exercise or fearful that it might make symptoms worse?

Ripal says: Exercising may seem like it will make symptoms worse, but it is really important for your general health and will help with your symptoms in the long term. It is important to remember that an increase in symptoms doesn’t mean that you have caused yourself damage, just that you may have done too much in one go.

For somebody reading this at home, what small things could they do today?

Ripal says: Look at your daily routine, noting any factors that aggravate your symptoms. Consider how you can do aggravating activities differently and use the 3 P’s as described above.

Ripal’s Do’s and Don’ts to start doing today

Do’s
• Prioritise, plan and pace your activities
• Set yourself SMART goals
• Make time to relax
• Graded exercise
• Be patient

Don’ts
• Over or under do it
• Be unrealistic or vague with regard to your activity levels

Tackle Tiredness Today:

If you feel tired all of the time…
Tell your GP or your rheumatologist or nurse. You do not have to cope with your tiredness alone. They may find that you’re suffering from something like depression which can make you feel very tired. There may be simple changes to your lifestyle or treatment plan that could help in the long run.