Author Archives: Jackie Aim

Identify your fatigue

Family on bikes

Use a diary to note when you feel most fatigue. Is there a pattern? Worse on certain days or times of the day?

Why not try a weekly or daily planner.

  • Plan what really needs done this week and what jobs can be broken up into more do-able chunks.
  • Plan what activities you will do for your health and your pleasure. For example, exercising, visiting friends, going to the cinema.
  • Plan things you know help to recharge your body “battery”. For example, relaxation, reading, knitting, power nap.
  • Commit to one job/ activity in the morning, one job/ activity in the afternoon and one job/ activity in the evening if you feel you still have enough energy.
  • Commit to recharging your body “battery” at least once in the day.
  • Commit to finding time throughout your week for things for your health and things you enjoy.

Remember

A battery that is completely flat is much more difficult to charge and becomes less efficient with time.

On occasions, you might decide it is worth running your battery flat because you want to do things that you wouldn’t miss for the world!!

For information on managing fatigue see:

Moving on Together (MoT): A self-management workbook by NHS Ayrshire & Arran.

For more practical tips see: Chest Heart & Stroke Scotland factsheet: Tiredness and Fatigue [.pdf].

Overcoming fatigue

Rechargable batteries

Fatigue means extreme tiredness.

Fatigue and breathlessness what helps you? Have you tried relaxation? Have you tried breathing control techniques?- if not speak to your healthcare team. Do you need some help to manage difficult or heavy tasks?

Recharge your body “battery” and allow yourself to slow down for a while. Save some energy for later. You can call on your bank of energy when you need it most.

Review what are the most important tasks to you?

  • For example housework – would you rather make your bed or clean your windows if you can’t do both?
  • If you enjoy cooking try making an extra portion to freeze for a time when you feel less able to cook.

For more practical tips see Chest Heart & Stroke Scotland factsheet: Tiredness and Fatigue [.pdf].

An example of a goal

Goal:

Over the next six months I want to lose one stone in weight so I feel more comfortable in my summer clothes while on holiday.

  1. Step -Keep a food diary for two weeks
  2. Action- Spend 30 minutes at the end of each day filling in my food diary and look for ways to reduce salt and fat
  3. Step – Cut down my portion sizes
  4. Action – Use a small plate for my evening meals Monday to Friday
  5. Step – Reduce the number of treats I eat
  6. Action – Have a chocolate biscuit only on a Monday and Friday
Why not download your own goal setting template and give it a go:

Goal setting

Goal setting is a way to focus on what is important to you and a way to make a change for the better. Start with a simple goal or two for example an exercise goal could be to aim to walk to your local shop and back.

A step ladder to success! Think SMART

  • Specific – what, when, how often, where.
  • Measurable – how can you measure if you are improving?
  • Achievable – something that is important to you and that you can realistically imagine yourself achieving.
  • Realistic – set a target which can be adapted after you get to each new step.
  • Time Frame – plan and set a time to reach your goal.

Example

I will walk halfway to the shop and back everyday for three days a week. I will take a two minute rest before coming back. I will note how long it takes me in my diary. If I feel OK I will go a little further for the next three times. I will try to take an extra walk by the end of the month. Once I can do this I will reset my goal.

Barriers to pacing

A young adult woman showing signs of distress

© Crown copyright 2009

  • Ignoring what your body is telling you.
  • Getting caught by old habits and routines.
  • Not saying “No”, or negotiating with others what is right for you.
  • Being fearful of symptoms. This can then lead to avoidance behaviours. Disrupt daily activities and plans. Then there is the risk of getting stuck in peak / trough, and not doing enough to support your continued well being.
  • Feeling overwhelmed by symptoms which may affect your mood.
  • If you are struggling to put pacing into practice you are not alone.
  • The application of pacing can be a challenge. You may be trying to change lifetime habits and ways of doing things.
  • Speak to someone, a friend / family member , or health care professional – a problem shared and talked through can often offer new solutions.

Practical tips for pacing yourself

Hand writing on a notebook

  • Plan your day; use diaries / timetables to balance activities with quieter times / rest to manage your symptoms.
  • Listen to your body – watch out for, and use, warning signs to set limits. Don’t keep going with something “just to get it finished” if your body is telling you to stop.
  • Remember symptoms can vary day-to-day. Take this into account when planning your day.
  • Think about the true cost of activities. Is one task worth more to you than another?
  • Break each activity down into manageable chunks (Occupational Therapists are trained in analysing the detail of activities and can support you with this if necessary).
  • Alternate activities throughout the day.
  • Use energy saving devices.
  • Relaxation – include the things you enjoy, the ‘nice stuff’!
  • Watch out for times you feel pressured to do too much. Set limits and say “No”.
  • Let people around you know what you are doing – they can provide support and encouragement.
  • Think about your goals and make plans, see Self management and how can it help you? “People who fail to plan, plan to fail”.

The strategies of pacing


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pacing_strategies

The ‘P’s’ of Pacing =

  • Planning – Think ahead. For example, when shopping order it online, or only carry the number of items you can comfortably manage without becoming too exhausted
  • Prioritising – What do you need to be able to do? For example, is it more important that you hang the washing out or prepare your evening meal. What’s the most important thing for you at that time?
  • Positioning – What is the best way for you to manage these tasks physically? For example, are there ways for you to complete the task without you having to stand e.g sitting down to do the ironing.
  • Problem Solving – What can you do when you have a setback? For example, looking for alternative ways to do something e.g. if mornings are particularly bad for you, you may want to postpone doing tasks until your inhalers have taken effect.
  • Practice – The more you are familiar with a task, the easier it becomes. For example, practising your relaxation will allow you to control your breathing making everyday tasks easier.
  • Perseverance – Don’t be hard on yourself. It will need more than a few attempts. For example, if you’re finding it difficult to stick to a healthier diet or give up smoking.
  • Patience – Give yourself time to get pacing right. For example, pacing is a skill you need to learn, it doesn’t come naturally to everybody, there are people who can help you with this, and you can also try some of the tips on this website.

Pacing

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Breaking up your day into more manageable chunks

  1. Get dressed
  2. Rest
  3. Wash breakfast dishes
  4. Rest
  5. Light dusting
  6. Rest
  7. Make ready meal for lunch
  8. Rest
  9. Iron 2 shirts
  10. Rest
  11. Preparing veg for evening meal
  12. Rest
  13. Cook evening meal
  14. Rest


Pacing should avoid the high peaks and low troughs and even out your energy level for the day. Notice how you can complete more tasks than before over a longer time. You should still be able to gradually build up exercise and activity in to your day using pacing.

  • Use of pacing helps you manage the symptoms you experience related to having asthma, and other long term health conditions.
  • Pacing is an important way to manage both your physical and emotional well being, and overall sense of control over your symptoms.
  • It is important to consider the activities you undertake in a day, how they impact on your symptoms, and think about pacing.
  • The essence of pacing is about ‘listening to your body’. Slow down if necessary or taking short breaks if needed to stay in control and manage breathlessness or any other of your symptoms on a day-to-day basis.
  • Remember a certain level of breathlessness is good for you.

The cycle of boom and bust

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  • Life demands – this can be any normal but demanding task from getting up in the morning to looking after your children or grandchildren
  • Risk of doing too much – There may be tasks which you enjoy but which can make you tired before you realise you have overdone things
  • Trigger symptoms – You start to notice the tell tale signs that your breathing is getting more difficult, your fatigue is getting worse, pain is increasing and you are worrying that you won’t have enough energy left for anything else
  • Rest to recover – You have to rest to get back to a steady breathing pattern , wait for pain to be controlled or until your fatigue has improved again when life demands come round again
  • Loss of fitness – The less you do, the less you are able to do physically. The more you worry about this, the more apprehensive and scared you are of attempting the same task again
  • At risk of unhelpful actions – Negative thoughts, feelings and consequences feel overwhelming and you are even less likely to attempt the task in future. You convince yourself that you will never be able to do this when life demands come round again

Peak and trough / boom and bust

day_peaks_graph_LRG
You can see that sometimes you are feeling well and can do a lot of tasks. Represented by the upward lines to each peak = over activity. If you have done too much too soon you can run out of energy and the effort makes you tired and fatigued. This is represented by the downward lines to the trough = under activity.

These terms are often used to describe the behaviours people living with a long term health condition can develop to manage their day-to-day activities.

  • They to keep going in the same way that they always have. People can forget to take into account the symptoms they are now living with and that these can vary from one day to the next.
  • People’s habits, routines, and ways of doing things can be a struggle to change. This is the challenge of putting pacing into practice.
  • Remember – Pacing is about bringing in changes that help you stay in control of how you feel.

People like you who are living with asthma can experience these peaks and troughs at different times. For example if you have had a sleepless night you may feel low in the morning. You will probably feel better after you have taken your medications and inhalers, and feel better and stronger as the day goes on. Some people describe their own asthma as a roller coaster, especially after an attack or infection. This is when pacing can really help.