6. Fatigue

Flashcards about Fatigue and its Clinical Implications

What is fatigue in the context of neurodegenerative conditions?

A subjective lack of physical or mental energy that is perceived by the individual or caregiver to interfere with activities of daily living

What are the aims of fitness training?

• Prevent unnecessary secondary impairments

• Promote optimum physical activity

What is fatigue in MS?

• A subjective lack of physical or mental energy that is perceived by the individual or caregiver to interfere with activities of daily living

What are some characteristics of fatigue?

• Fatigue may be physical, mental or both

• Worse later in the day

• Aggravated by heat, depression, pain and excessive exertion

• Interferes with physical and social function

List some potential causes of fatigue in multiple sclerosis.

Anaemia, Thyroid dysfunction, Depression, Sleep disorders and Pain

Why is fatigue important in neurodegenerative conditions?

It interferes with daily activities/concentration, exacerbates other impairments, and is a known risk factor for reduced quality of life

What are the aims of fitness training in managing fatigue?

Prevent unnecessary secondary impairments and promote optimum physical activity

Is there any effect for high intensity interval training compared to continuous aerobic exercise?

no

What are some characteristics of fatigue in MS?

May be physical, mental or both, worse later in the day, aggravated by heat, depression, pain and excessive exertion, and interferes with physical and social function

Name some potential causes of fatigue directly related to MS

Depression, Sleep disorders, Pain, and Bladder dysfunction

Name some primary impairments that can cause fatigue in MS

• CNS dysfunction

  • Demyelination, axonal loss, neural circuti disruption

• Immune dysfunction

  • Higher levels of immune markers

What are some secondary impairments of fatigue in MS?

• Decreases physical activity; weakness and peripheral muscle changes

• Decrease physical activity; decrease cardiorespiratroy fitness

• Heat = increase body temp, causing heat fatigue

• Anti-spasticity medication

How to measure a patient’s fatigue level?

• Fatigue impact scale

• Fatigue severity scale

• Fatigue diary

What type of information could be recorded in a fatigue diary?

Assign a number from 1 to 10 for level of fatigue, the value or importance of the activity, satisfaction with performance, describe physical work, and list MS symptoms

What health professionals/services are involved in a multidisciplinary approach to fatigue management?

Medical practitioners, Psychologist, Physiotherapist, Occupational therapist, Continence advisor, Dietician, Social worker, Sleep clinic, Pain clinic, MS Society resources

What advantages does HIIT training have over moderate intensity continuous training?

May lead to greater improvements in cardiorespiratory fitness in a shorter training time and potential to provide greater benefits for fatigue due to metabolic adaptations

What advantages does moderate intensity continuous training have over HIIT training?

May be better tolerated by people with lower fitness levels or severe MS and may be easier to adhere to for some people

How does physio intervene?

• Addresses some secondary causes of fatigue

  • Improves fitness and strength

  • Reduces deconditioning

  • Promotes better sleep

  • Improves better health/mood

How does telephone counselling and telehealth monitoring of physical activity on fatigue on MS help?

• Decrease depression

• Decrease fatigue

• Increase self-reported physical activity

What exercise guidelines should be followed to Manage fatigue?

• Exercise at cooler time of day

• Exercise early in the day of lower fatigue

• Wear loose, breathable clothing

• Aquatic physiotherapy

• Begin with low-moderate intensity and duration, schedule rests between exercises

• Progress to moderate intensity, aim for a combination of aerobic and resistance exercise

• Include cooling strategies

What cooling strageties are recommended for physiotherapy patients during exercise?

• Pre-exercise cooling (30 mins lower body immersion in 16-17 degree water; to decreaser RPE during exercise, and decrease post-exercise fatigue

• Cooling garments - cap and vest with coolant at 7 degrees for 1 hour; to decrease fatigue

What symptoms may increase temporarily during exercise?

Sensory symptoms (pins and needles, numbness, blurred vision) may increase temporarily, but usually disappear 20-30 mins after exercise