Fatigue

Fatigue is common in people living with Parkinson’s.

If you have physical or mental exhaustion, this could be fatigue – a feeling of deep tiredness that does not greatly improve with rest.

Impacts of fatigue

Fatigue impacts everyone differently and, for some, is the most debilitating symptom impacting your quality of life. Often bundled with depression, anxiety, sleep disturbances, and apathy, fatigue is hard to tease out. It starts a cycle of inactivity that can reduce muscle strength and heart function and cause poor mental health. Learning to manage fatigue by using your energy efficiently can help to overcome this cycle. Managing fatigue includes optimising medication regimens, incorporating regular physical activity, ensuring adequate sleep, and addressing any coexisting conditions such as depression or sleep disorders. Fatigue is best managed by your multidisciplinary care team of health and social care professionals. This may include your GP, Parkinson’s nurses, an occupational therapist, a physiotherapist, a pharmacist and a counsellor or psychologist.

Causes of fatigue

The cause of fatigue in Parkinson’s can be difficult to pinpoint – sometimes it may be a direct symptom or sometimes it is a side-effect. Motor symptoms such as tremor, slowness of movement (bradykinesia), muscle stiffness and involuntary movements (dyskinesia) can all make muscle fatigue worse. Medication side-effects, dosing, timing and wearing off are other factors that may cause fatigue and daytime sleepiness. Sleep disturbance also adds to daytime fatigue. Some medications may trigger fatigue, particularly benzodiazepines, muscle relaxants, or anticholinergics. Other medical disorders may also contribute to fatigue and should be investigated with your treating professional, e.g. thyroid, vitamin or hormonal issues.

See your GP or Parkinson’s Nurse Specialists to discuss changes to your medication or make necessary lifestyle changes. Remember, most Parkinson’s symptoms can be reduced with a combination of exercise, nutrition, medication on time, lowering stress, drinking plenty of water and good sleep habits.

Key Facts

Fatigue is a prevalent and often debilitating symptom of Parkinson’s, affecting up to half of those diagnosed.
There are two main types of fatigue: physical fatigue (feeling deeply tired or weary) and mental fatigue (difficulty concentrating).
The exact cause of fatigue in Parkinson’s involves neurodegenerative processes and the side effects of medications.
Managing fatigue includes strategies from a range of allied health professionals including occupational therapists and dietitians.

Ways to conserve energy

If fatigue is difficult to treat medically, it is important to maximise your energy use. Remember that people with Parkinson’s only have so many teaspoons of energy each day. Decide where and when to use your teaspoons up to make your days more manageable.

Plan ahead

Write a to do list and spread your activities throughout the day or week
Consider what activities are the most tiring and plan when best to do them
Finish the most important things when you have the most energy
Time important actions with your medication schedule so you finish during ‘on’ times (when your medication is most effective)
Schedule time for short naps to recharge your energy
Work out if you can do an activity in a different way that requires less energy
Reduce tiring movements such as bending, reaching and lifting
Share household tasks with others
Get a care team together early. Look to GPs, physiotherapists, occupational therapists, speech pathologists, dietitians, social workers, and specialist Parkinson’s nurses.

Pace yourself

Allow extra time to complete activities
Use ‘off’ periods to rest, have a nap but not too late in the day or for more than 30 minutes to not affect your overnight sleep
Divide big actions into smaller tasks
Shift between heavy and light tasks depending on how you feel
Do not ignore feelings of fatigue.

Helpful aids & equipment

Using a shower chair helps prevent unnecessary waste of energy from the legs and balancing in the shower.
Aids such as a long-handled shoehorn or back/toe washer can help prevent high energy movements such as bending and reaching.
Labelling cabinets and drawers could alleviate some cognitive fatigue.

Hydration & diet

Stay well-hydrated
Eat a healthy (plenty of fruits and vegetables) and balanced diet
Eat foods with a low glycaemic index (low GI) to provide longer lasting energy.

Exercise during ‘on’ periods

Exercise in the morning to get most use of your baseline dopamine
Physical activity builds strength and stamina to overcome fatigue.

References:

Folkerts AK, Nielsen J, Gollan R, Lansu A, Solfronk D, Monsef I, Ernst M, Skoetz N, Zeuner KE, Kalbe E. Physical Exercise as a Potential Treatment for Fatigue in Parkinson’s Disease? A Systematic Review and Meta-Analysis of Pharmacological and Non-Pharmacological Interventions. J Parkinsons Dis. 2023;13(5):659-679. doi: 10.3233/JPD-225116. PMID: 37334618; PMCID: PMC10473113.

John Hopkins How to fight Parkinson’s disease-related fatigue

Kostić VS, Tomić A, Ječmenica-Lukić M. The Pathophysiology of Fatigue in Parkinson’s Disease and its Pragmatic Management. Mov Disord Clin Pract. 2016 Mar 11;3(4):323-330. doi: 10.1002/mdc3.12343. PMID: 30363584; PMCID: PMC6178705.