Fatigue is a feeling of deep tiredness that does not greatly improve with rest.
It empowers people with Parkinson’s to adapt, engage in meaningful activities, and have a better quality of life despite the challenges posed by the condition.
What is fatigue?
Energy and fatigue in Parkinson’s are complex and impacted by many factors, often influenced by both the condition itself and medication side effects. You may experience fatigue that is disproportionate to physical activity, impacting your daily functioning and quality of life. Fatigue (daytime sleepiness) is not resolved with naps or sleep.
If you have physical or mental exhaustion, this could be fatigue. Conserving your energy will help manage fatigue and improve quality of life. Fatigue is common in people living with Parkinson’s. It impacts everyone differently and for some is the most debilitating symptom.
Often bundled in 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.
Causes of fatigue
The cause of fatigue in Parkinson’s can be difficult to work out – sometimes it may be a direct symptom or 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 to discuss changes to your medication or make necessary lifestyle changes. An occupational therapist may also have further ways to help you.
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.
Pace yourself
- Allow time to complete activities
- Use ‘off’ periods to rest
- Divide big actions into smaller tasks
- Shift between heavy and light tasks
- Do not ignore feelings of fatigue.
Helpful aids and 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.
Exercise and 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.
How do I access an OT?
Accessing occupational therapy services can make a significant difference in managing the symptoms of Parkinson’s, improving quality of life and maintaining independence.
It’s advisable to explore all available pathways to find the support that best suits your individual needs. Look to:
- getting a GP referral to an OT with Parkinson‘s experience
- your state-based Parkinson’s organisation for advice on OTs to access
- private health to see what is covered in relation to OT consultations and expenses
- NDIS or My Aged Care plan supports.
Infosheet reviewed by Occupational Therapy Australia
Occupational Therapy Australia (OTA), the professional association and peak body for occupational therapy that fosters evidence-based practice, enables lifelong learning and promotes the future of occupational therapy.
OTA exists to support occupational therapists to support their community. To find an OT go to: www.otaus.com.au
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.
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.
Lin, I., Edison, B., Mantri, S., Albert, S., Daeschler, M., Kopil, C., Marras, C., & Chahine, L. M. (2021). Triggers and alleviating factors for fatigue in Parkinson’s disease. PloS one, 16(2), e0245285. https://doi.org/10.1371/journal.pone.0245285
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