Managing Your Fatigue  by Teresa Brady, Ph.D. Fatigue is common in chronic illness. Managing fatigue is an important  component of learning to live with a chronic illness. Fatigue can lead to depression, anger, a loss of physical and cognitive skills and a lack of  motivation. Sleep can also be a problem. Work simplification and energy conservation help reduce fatigue. There are five strategies to help manage fatigue by conserving energy and using it wisely - planning, positioning, pacing, prioritizing and adaptive equipment. ïOne needs to think things through and plan one's time on a daily, weekly and  monthly basis. Try to distribute strenuous work throughout the day rather than doing it all at one time. Try to rest before doing hard work. Plan specific tasks to do them most efficiently. Try to eliminate extra trips. Recreation is important, so plan to spend some energy on fun activities. ïUse the body in good alignment and it will use less energy to do a task. Maintain good posture to take the strain off joints. Use a wheeled cart around the house and sit while working to conserve energy. Arrange work and storage areas to be more efficient. ïPacing is difficult but important. Try to avoid a rush - it just uses up more energy. Rest before you tire. It is most efficient to rest ten minutes out of every hour, but most people have trouble fitting that into their daily routine. It is usually possible, however, to add some additional rest during the day. Spread work throughout the day with planned rest breaks. Alternate light/heavy, sitting/standing and fast/slow activities. ïBe selective about activities. Prioritize which tasks are essential to get done, which can be eliminated and which can be delegated. Try to simplify so that which needs to be accomplished can be done in an easier fashion. Stand back and look at the situation - then reorganize. ïUse labor-saving devices and adaptive equipment that will conserve energy. Look for short cuts. Use convenience foods like cake mixes and adapted  equipment like jar openers to make the job easier. Changing habits for energy conservation seems awkward at first but becomes easier over time. It is also possible to reduce fatigue by building energy resources and addressing psychological factors. ïSystemic diseases can produce fatigue, so try to keep the disease process under control. Use medicines properly. ïExercise to stay in good condition. Emphasize exercise as well as rest. One loses 3% of one's strength for each day of inactivity. Strive for an energy-building program of gentle aerobics that doesn't strain the body. Swimming, bicycling (indoors or out), cross-country skiing, roller-blading, fast walking and dancing are good activities. Try to work exercises into your daily routine. There may be some initial discomfort when starting, but avoid overkill, pace yourself and rest as necessary. Expect only slow and gradual improvement. ïFatigue is depressing and depression is fatiguing. Fatigue can be a symptom of depression which is common in chronic disease. Significant depression should be evaluated to determine if medication is needed.   Continually striving for perfection and being harsh and demanding of oneself also leads to fatigue. Those who set unreasonably high and rigid standards for themselves become depressed and fatigued when they can't meet the standards. They are never satisfied. They can exhaust themselves struggling to meet unreasonably high expectations.   When feeling frantic, take a break and rest for a few moments and think the situation through. Things will go better and will be less fatiguing. Examine expectations and try to determine whose they are - yours or someone else's. Don't wear yourself out meeting expectations that are unreasonable or are not important to you. Take what limited energy you have and learn to use it wisely. Try to accommodate fatigue since it will be difficult to conquer. Try not to be so independent, and don't be afraid to ask for help. Build your energy resources through exercise and make changes to help deal with the psychological component of low energy - a better quality of life will be the result. (Dr. Brady is a licensed psychologist and an occupational therapist who has worked extensively with connective tissue diseases in a variety of settings.  She is Executive Director of the Minnesota Arthritis Institute.)