Fatigue – It’s Not Just Physical!

If you read our article from last week, you will know that one of the most common mistakes people make when managing fatigue is assuming that it’s all physical. In reality, the experience of fatigue goes well beyond that!

If fatigue were purely physical, then why do we feel absolutely exhausted after a demanding day sitting at our desks? Or after a lunch out fulfilling social expectations with the in-laws?

Well, because it’s not purely physical. 

Despite being exercise physiologists, and therefore experts in the physical realm, we always take a holistic approach to fatigue – which means considering all the things that contribute. 

The Three Types Of Fatigue 

One of our commonly used questionnaires is the Modified Fatigue Impact Scale (MFIS), originally created in 1994 to better understand and support people with Multiple Sclerosis who experience fatigue. Since then, it has been applied to a range of conditions that include fatigue as a major symptom. 

What we love about this tool is that it includes three well-defined and applicable fatigue categories: physical, cognitive and psychosocial. By breaking down fatigue in this way, it allows us to really understand our clients’ unique patterns and experiences and in turn, better tailor strategies to manage their fatigue.  

Physical fatigue is easy to understand – we’ve all experienced that tiredness following physical exertion. So to complete the full picture, we will touch on the other two, and how we consider them in the context of our programs. 

Cognitive Fatigue

Think back to the earlier example of the fatigue we experience after a day at the office. Whether it’s slaving away on spreadsheets, writing up patient notes, or upskilling at an online seminar, your brain is working hard to process and output information. This processing, despite being physically stationary, is work and will add to fatigue. 

For those people experiencing chronic fatigue, what were once automatic cognitive tasks start to become significant. Reading the morning paper, remembering the route to your favorite coffee shop, retaining the days of your children’s after-school activities… If somebody struggles with cognitive fatigue, in particular, they’ll find that the cognitive load of these tasks really do accumulate. 

‘Rainbow task scheduling’ is a tool that we use in the fatigue space to rank tasks and space them out accordingly over the day or week based on their ‘load’. Not only can this be done with physical tasks, but also cognitive ones. By using pacing as a strategy, what once was a red task, can work its way down to orange and then green over a period of time. 

Psychosocial Fatigue

As the name suggests, psychosocial fatigue accounts for the combination of psychological and social contributors, which even if we don’t realise it, are constantly intertwining. If we imagine ourselves at that lunch with our in-laws – psychologically we are managing our own thoughts, feelings and perceptions, socially, we are managing our behavior. This, of course, requires energy! Not to mention, the weight of other people’s thoughts, feelings and perceptions can vary substantially, influencing the demand of these social obligations. 

Day to day we find ourselves in numerous situations just like this; with work colleagues, friends, family members and even strangers. It’s not until you’re feeling tired, or you’re having a rough time mentally, that you notice how demanding these situations can be, right? For people with chronic fatigue, it can feel like that all the time. Interestingly enough, even using social media outlets such as Facebook and Instagram can contribute to fatigue!

Identifying whether this category is a significant contributor to someone’s fatigue is the first step, and then managing and slowing increasing exposure to these situations is the second. On top of that, consider which interactions (i.e. which people) are the most and least demanding and as discussed, what internal thought processes may be further contributing to the load of the experience. 

Collaboration

In complex cases, facilitating the best outcomes for the client often means collaboration with other health professionals. Perhaps somebody has made great progress from a physical standpoint but is stuck in the psychosocial realm, or maybe their job has intensive cognitive requirements. Occupational therapists can be great to assist with persistent cognitive fatigue, and psychologists, with the challenges that sometimes come with psychosocial fatigue. 

We are the first ones to jump on board with a multidisciplinary approach if we think the client will benefit from it.  

A Silver Lining

Although it can feel like fatigue is coming at you from all angles (and really, it is) the more you, or your clients, are able to understand that fatigue and its sources, the more manageable it becomes. If you need any guidance along that journey to understanding, we would love to help you out!

Author: Tessa Nielsen

Clinical Exercise Physiologist and Content Creator at Specialised Health

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