The boom and bust cycle and fatigue: your questions answered

30 July 2020
Lady resting on a walk with her dog and holding her partners hand.
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Fatigue is a common symptom for people with arthritis, on the bad days it can feel a real struggle to do everyday tasks. Some people describe it as feeling totally shattered, like they have flu, you might find it hard to think straight (this is sometimes referred to as brain fog) and you may feel anxious.

When people live with chronic fatigue, it's common to see a boom and bust cycle. This is when you might ‘do too much’ on one day and feel unable to do anything the next, due to your levels of fatigue.

Here Joseph Loades, a physiotherapist based at the Royal Blackburn Hospital answers your frequently asked questions relating to fatigue and the boom and bust cycle.

How is fatigue different to feeling tired?

Feeling tired is usually activity dependent. For example, following a busy day at home or work or following a vigorous exercise session, it’s normal to feel tired.

Fatigue is very different, it can occur at any point during the day and it doesn't have to be triggered by something. Fatigue can make the body and brain feel slow, sluggish and heavy.

Fatigue can be an overwhelming feeling of exhaustion physically and mentally. You can feel completely drained of energy.

Fatigue can be common in arthritis, whether it’s osteoarthritis or an inflammatory condition. 

What are the main symptoms of fatigue?

The main symptoms of fatigue include:

  • heaviness in the body, feeling drained or difficulty finding focus
  • feeling that your body feels slower and that it is more difficult to co-ordinate your movements
  • you can find it difficult to concentrate
  • feeling very overwhelmed and low in mood.

The management of fatigue is very difficult, especially from a medical perspective.

What advice would you give to help maintain a balance in energy?

Eating a healthy diet

If you experience fatigue, you should try to eat a varied and balanced healthy diet. Overeating can increase feelings of fatigue and under-eating or not following a balanced healthy diet can make fatigue symptoms worse.

Try to find what works best for you and ensure you always stay hydrated throughout the day.

Some people find having smaller regular meals better to manage their fatigue than having large meals.

The benefits of exercise

As fatigue can come and go without cause, you may find exercise is beneficial to manage your fatigue.

Exercise can be anything that gets the body moving and can work as a good distraction mechanism until the fatigue settles. Taking a walk and getting some fresh air can help fatigue pass.

I would advise you try a variety of different exercises little and often, as some of the time you may not feel up to some types of exercise.

The trick is to do more vigorous exercise when you feel up to it and do gentle exercise during periods in fatigue.

Yoga and Pilates based exercises can be useful during flare ups. I would encourage you to try a wide variety of exercise to find out what works best. For example, swimming, walking, weight training, Pilates, yoga, cycling or stretching.

Also, exercise doesn’t have to be physical, using mindfulness, meditation and relaxation exercises can be helpful.

Getting rest

If you're unable to function well whilst experiencing fatigue, I'd recommend doing a restful activity.

Read, if you can concentrate, walk, if you feel you can, have a relaxing bath or do something that you enjoy that doesn’t require much effort.

If you rest and focus on the fatigue, you can end up judging the fatigue and this can impact how you feel about yourself.

Distraction and mindfulness exercises can be useful to help you manage during a flare up.

What tips do you have for sleep?

Sleep is essential to optimise your energy levels. Ensuring you get a regular routine with sleep and ensuring you don't sleep too much or too little.

Sleep may need to be adjusted based on how active you are. Be careful of the boom and bust cycle and try to pace yourself, if this is an option.

If your sleep is broken or you struggle to get off to sleep this can be a problem. Try to keep a regular sleep routine to ensure an effective circadian rhythm (your body’s natural sleep clock).

Avoiding exercise, alcohol, caffeine two hours before bed can help this.

If you’re having restless nights due to pain or you’re struggling to sleep and becoming distressed by this, get up and try some soothing activities until you feel tired. Here’s some tips for good sleep.

Talk about how you are feeling

It’s important to try and share your experiences with people who are important to you.

It may be useful to provide friends and family with information on fatigue to help them to understand what you are going through.

It’s taken me years of speaking to help my understanding of fatigue!

Help and support

If you have any questions about fatigue, we're here to support you.