Living
Pacing: Schedule daily
activities with alternating
high- and low-energy tasks.
For example, shower, then sit
for breakfast, then work for a
short period, read, work and so
on. Pace yourself at the weekly
level, too. “Don’t overdo it for
several days and then collapse,”
counsels Lowenstein.
Prioritizing: “You have to
look at what only you can do,
and what you really want to do,
and change your standards or
delegate the rest,” she says.
Planning: Look at the day
or week ahead and slot high-priority tasks into your times of
best energy, which are often in
the morning. Keep an energy
journal for two or three days
to track any patterns in your
symptoms and fatigue, allowing
you to plan better and prevent
unpleasant surprises.
Positioning: Postural supports
save energy. Whenever possible—
for example, while cooking or
bathing—sit, don’t stand.
Environmental changes, too,
can reduce demands. Reconfigure
the kitchen so that things that get
used together are in the same place,
pots and pans are closer to work
surfaces, and a stool is available
to sit on. Make similar changes
in bedrooms and bathrooms (put
clothing on lower shelves; use a
vanity and a tub seat), and in office
setups, and ultimately you can use
fewer movements to accomplish
your tasks.
Assistive devices, such
as motorized scooters, and
Fatigue often means more than feeling tired; it
can significantly affect everything from mood
to cognition. The best treatment approach is
one that addresses all aspects of fatigue.
modified helpers such as laundry
carts on wheels, further help
conserve energy.
Healthy energizers
Three tried-and-true fatigue
busters cut across the spectrum
of health: exercise, diet and good
sleep hygiene.
Exercise relieves fatigue three
ways, says Dr. Kraft. “First, it’s
invigorating; second, it builds
muscle and aerobic capacity
so you can do more work with
less effort; third, it produces
endorphins, which make you
feel good.”
People experiment to find
what works for them. Margaret
Fernández de Cañete of Córdoba,
Spain, has balance problems and
leg exhaustion, but enjoys a daily
rehab-type aqua fitness class. “I
usually feel stronger afterward,”
she reports, “although I rest for at
least 30 minutes.”
Marion Leeds Carroll of
Arlington, Mass., transferred her
skill with a wheeled walker to
walking on a treadmill, and has
progressed to a starting speed
of 2.5 miles per hour with an
occasional very short sprint. She
also uses her gym’s seated weight
machines, jumps rope and does
jumping jacks.
“Working out definitely
reduces fatigue,” she reports.
“I take my mind off my
problems, I’m in a better mood,
and I sleep better.”
Many people with MS
fatigue turn to complementary
approaches such as yoga and
mindfulness meditation.
Cognitive-behavioral therapy
has been found effective in
controlled studies. “It helps
people to focus on goals, fosters
a sense of control and helps with
the other symptoms that make
fatigue worse, such as pain,” says
Dr. Krupp. “And it helps people
to not dwell on fatigue, which
itself consumes energy.”
For diet, Lowenstein suggests
focusing on high-energy foods
and trying smaller meals
throughout the day. Caffeine,
while tempting, is probably not
a good idea, because it impairs
sleep and exacerbates bladder
and bowel problems.
Finally, good sleep hygiene
can make a big difference in
fostering the kind of restorative
rest that refills the energy
reservoir. Observe a pleasant,
regular routine; eliminate
caffeine late in the day; keep
the bedroom comfortably cool;
and clear the mind of worries.
Sleep disorders such as apnea or
restless leg syndrome can disturb
sleep as well, and should be
discussed with a physician.
