Long COVID Self-Management - Fatigue Management

It is common to feel tired after being sick with COVID-19. Also, the recovery time is different for everyone. The following are some symptoms that can happen after recovery from COVID-19. 

Physical changes

This includes less strength, more pain, dizziness, less balance, and headaches.

Mental changes

This includes confusion, poor attention span, difficulty with speech, difficulty remembering things, and less ability to focus.

Emotional changes

This includes negative changes in mood such as feeling more irritable and frustrated.

Keeping track of your activities and symptoms using a daily planner can help you understand more about your current abilities and limits. 

Principles of Energy Conservation to Help Manage Fatigue

• PACING with precaution
  • Self-monitoring
  • Self-management
• PLANNING
  • Activity goals
  • Activity log
• PRIORITIZING
• POSITIONING
  • Use adequate posture when performing activity
• PROBLEM SOLVING
• PERMISSION
  • Allow yourself to have some break periods and rest

Remember

The most important energy conservation tip is to listen to your body. Stop and rest BEFORE you get tired. Plan rest times. Rest often.

Pace Your Activities

Pacing is defined as “an active self-management strategy whereby individuals learn to balance time spent on meaningful activity and rest for the purpose of achieving increased function and participation in meaningful activity.”

Pacing is a way for you to do activity, and can help reduce the chances of getting symptoms after exercise.

Some Pacing Strategies to Consider

• Insert regular rest periods into your activity.
• Use a time-based approach for your activity (e.g., stopping after 10 minutes or five repetitions) instead of a symptom-based approach (e.g., stopping when my energy is depleted).
• Having a timer can help remind you to take breaks.
• Don’t try to get it all done at one time.  Break down your activities into smaller parts.
• Alternate your activities; for example, alternate a ‘thinking’ activity (banking) with a ‘doing’ activity (washing dishes).
• Alternate heavy and light activities throughout the day
• Gradually increase your participation.  When ready, try increasing your interval by 10 per cent. For example, if you are managing well with 10 minutes of activity, you can try increasing it to 11 minutes the following week (10 per cent of 10 minutes = 1 minute increase).  After increasing your activity time, it is important to think about how this change affected you and whether it matches up with your current energy levels.

What is a Break or Rest Period?

A rest or break can be anything that you find to be nourishing, restful or energizing. You can take a break by:

• Alternating positions (e.g., going from sitting to standing).
• Switching tasks (e.g., heavy to light activity; changing from a cognitive to a physical task).
• Doing mindfulness or relaxation exercises.
• Lying down or sitting down.
• Doing deep breathing and stretches.
• Participating in a light leisure or social activity (e.g., calling a good friend).

Planning and Prioritizing

Pacing and planning are “best friends.”  It is very difficult to do one without the other; in fact, they complement each other. Using a daily planner is highly encouraged.

The Benefits of Planning 

• It is a basic and essential tool that can help to increase your activity involvement.
• It can provide you with structure to your day.
• It can ensure that essential tasks are completed.
• It can be used as a communication tool for your family.
• It helps with pacing and can promote the “just right” challenge (not doing too much or too little during the day).

Steps to Making a Plan

• Take time each day to think about your day.
• Start by creating a to-do list for the day or the next day.
• When writing your list, remember to include “something for you” in your daily plan (e.g., leisure activity, listening to music, talking to a friend, walking in nature, taking a bath, etc.).
• Think about your activities and give them a rating (light, medium, heavy) based on the demand (cognitive, emotional and/or physical).  If you are having a good day, feel free to do more. But remember that doing too many heavy activities through the day may result in fatigue the next day. So, think about how to pace yourself.
• Consider limiting the number of heavy activities in a day.
• Consider when you have the most or least energy when planning your activities. Schedule activities that require more energy at the time of your day when you have the most energy.
• Review your list and priorities for the day.  Evaluate your activities using the four Ds.
• Can any activities be deleted or eliminated?
• Can any activities be delegated, or can I ask for help? Many people have difficulty asking for help.  Other people have nobody to ask. Carefully consider what your particular situation allows. Take this time to rest or participate in a nourishing activity for you.
• Can any activities be deferred or delayed until tomorrow/later in the week?
• It is common to delay exercise due to competing demands on your time. Put your exercise program as a priority to help with your recovery.
• Do it – your priorities for the day (remember to think about how you will plan and pace these activities?)
• Put your priorities into your plan and review it to make sure it is realistic.
• Follow through with your plan (this can be the hardest part!)
• Take some time at the end of the day or shortly after to reflect on how the plan went. Think about what went well and what you might change next time to improve the plan.

Things to Remember About Planning

It is common to experience “bad days” from time to time. It might be tempting to stop all activity when having a bad day. Instead, think about how you can modify your activities today. Consider having a “bad day plan” created ahead of time. Make a list of the activities that you are able to do on those days and the activities you should avoid.

• Consider outside factors and how they could impact your symptoms (e.g., weather, other people, environment, etc.).
• It is important to be flexible; things can come up during the day that you weren’t expecting.

The following will help a person to feel less tired: being physically active, sleeping well and dealing with stress and anxiety. It is important to weave these into your daily plan.

Be Mindful of Your Posture and the Position of Your Body When Participating in Activity

The following are useful suggestions when doing physical activity:

• Check your posture regularly. 
• Limit the need to bend, reach and twist.
• Think about how your posture is affecting your breathing.
• If you feel tired, listen to your body and sit down whenever possible;  it requires 25 per cent less energy to do the same task seated than it does if you’re standing.
• Remember to change your posture regularly during the day (sitting versus standing).
• Make sure the seat is high enough. Your legs require less energy to push off from a higher surface.
• Arrange your work heights to suit your activity, when possible. For more information please visit the Posture page.
• Your heart needs to work harder when you have your arms above your head. If you feel short of breath when reaching above your head for things, look into re-organizing your environment or using devices with long handles to reduce the amount of overhead reaching.
• Push or pull rather than lifting objects. Slide objects along the counter.
• Carry items close to the body.

Practice and Positive Attitude

The following is helpful advice that you can consider applying on yourself:

• Change takes time, be gentle on yourself and those around you.
• It can be overwhelming to change everything at once, start with one task at a time.
• Set yourself up for success! Setting small, achievable goals will help you to stay motivated.
• Worry can take up a lot of mental energy. It can impact fatigue and make some symptoms worse. Low mood can zap energy too. Consider whether anxiety and/or mood might be contributing to your symptoms. If applicable, please refer to the module on Stress, Anxiety and Mood.

For additional strategies to manage cognitive fatigue, please visit the Cognition page.