From the Guidelines
Fatigue should be addressed through a comprehensive approach that includes lifestyle modifications and medical interventions, prioritizing the identification and treatment of underlying causes, as recommended by the most recent guidelines from 2020 1. To combat fatigue, it is essential to start by ensuring adequate sleep, maintaining regular physical activity, and following a balanced diet.
- Ensure 7-9 hours of quality sleep each night
- Maintain regular physical activity with 30 minutes of moderate exercise most days
- Follow a balanced diet rich in fruits, vegetables, lean proteins, and whole grains
- Stay hydrated by drinking 8-10 glasses of water daily
- Limit caffeine and alcohol consumption
- Manage stress through relaxation techniques like meditation or deep breathing exercises If fatigue persists despite these measures, it is crucial to consult a healthcare provider, as it could indicate underlying conditions such as anemia, thyroid disorders, depression, or sleep apnea.
- Blood tests may be ordered to check complete blood count, thyroid function, vitamin levels (particularly B12, D, and iron), and metabolic function
- Medications like modafinil (100-200mg daily) or methylphenidate (5-10mg twice daily) might be prescribed for specific conditions causing fatigue, as suggested by earlier guidelines 1 However, the most recent guidelines from 2020 1 emphasize the importance of a comprehensive approach to addressing fatigue, including the identification and treatment of underlying causes, rather than relying solely on medication. Fatigue occurs when the body's energy demands exceed its resources, affecting both physical and mental function, and can be exacerbated by poor sleep, nutritional deficiencies, hormonal imbalances, or chronic stress that disrupts the body's natural energy regulation systems. A thorough evaluation, including a focused history and physical examination, is necessary to determine the underlying causes of fatigue and develop an effective treatment plan, as outlined in earlier guidelines 1.
From the Research
Fatigue Overview
- Fatigue is a common and debilitating health problem that can significantly affect an individual's well-being and occupational safety 2
- It can be classified as physiologic, secondary, or chronic, with different approaches to evaluation and management 2
Cognitive Behavioral Therapy for Fatigue
- Cognitive behavioral therapy (CBT) is a form of non-pharmacologic treatment that has been shown to be effective in reducing fatigue symptoms in patients with chronic fatigue syndrome (CFS) 3, 4, 5
- CBT can improve physical function and fatigue in patients with mild to moderate CFS, with effects persisting at 1-year follow-up 6
- A 16-week standard CBT intervention has been found to improve physical function and fatigue, while a shorter 8-week interpersonal oriented CBT program can improve physical function 6
Management of Chronic Fatigue Syndrome
- Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic and potentially debilitating disorder with no proven treatment or cure 2
- Treatment should prioritize comorbidities and symptoms based on severity, and patients should be educated about pacing their activity to avoid exceeding their limited energy capacity 2
- Exercise can be harmful to patients with ME/CFS, as it can trigger postexertional malaise, and should be avoided or approached with caution 2
Effectiveness of CBT for Fatigue
- Studies have consistently shown that CBT is effective in reducing fatigue symptoms in patients with CFS, with medium to large effect sizes 3, 4
- CBT has been found to be more effective than usual care and other psychological therapies in reducing fatigue symptoms 4
- The evidence base for CBT in reducing fatigue symptoms is strong, with multiple studies demonstrating its effectiveness 3, 4, 5, 6