How to Manage Fatigue and Activity Intensity

By: Kathryn Blosser, PT, DPT, CBIS

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Decreasing the intensity of symptom variability can improve tolerance of daily activities and exercise. Fewer days of very high symptoms can lead to fewer required recovery days due to intense fatigue, pain, and symptoms, so more consistent activity tolerance is likely. Improving awareness of symptom changes in the body is often a good place to start managing fatigue and activity intensity.

Create a Symptom Rating Scale

  • There is a balance between observing your symptoms too little, therefore hiding helpful messages that your body can send you, and observing symptoms too much as this can sometimes increase their intensity due to hyper-awareness.
  • It can be helpful to use tools like heart rate variability or visible outward signs (i.e., muscle shaking or frequency of falls) as information within the scale.
  • Try writing down a couple of words about your symptoms to describe intensity on your scale.
    • At first, use light, medium, and high intensity categories with their associated descriptions.
    • Next, try to expand to a more detailed list of descriptions of symptoms using levels 1-5.
  • After describing these symptoms, it may be helpful to do some grounding techniques or pleasant distracting activities to take the brain’s focus away from your symptoms. This helps to reduce overthinking about symptoms.

Observe How Daily Tasks and Exercises Affect Your Symptoms

  • Try journaling about day-to-day tasks.
  • Place those tasks and activities in the categories below: green, yellow, or red.
  • This may help you become aware of what regular activities are difficult and fall into the red category, or if there are too many activities that fall into the red and yellow categories overall.
  • The goal is to investigate what modifications can be made to improve pacing, therefore allowing better activity tolerance on a daily basis.
Green LightYellow LightRed Light
These reduce your symptoms overallThese increase your symptoms a relatively small amountThese increase your symptoms a relatively large amount
These can be used as rest break activitiesThese require a relatively short rest break afterwardsThese require a relatively long rest break afterwards
Examples: breathing exercises, yoga, meditation, weight, cold exposure, light aerobic activity, coloringExamples: exercises that feel mild to moderate in intensity, watching a sensory-friendly movieExamples: large house projects, normal movie intensity

Methods to Move Tasks and Activities from Red to Yellow

Make tasks or activities easier or less strenuous by reducing their intensity:

  • Try to better regulate the fight or flight system by using fidgets, a weighted blanket, an ice pack at the neck or low back, or belly breathing.
  • If you have known sensory sensitivities, try pitch-specific ear buds, a hat to reduce overhead lights, or light layers to better regulate temperatures. Be cautious of how much sensory suppression is done as this can create increased sensory sensitivities in some people. Always check with your healthcare provider if you think this may be applicable to you or if you have questions.
  • Cook simpler meals or ask to share responsibilities around the home to reduce the overall demand of cooking.

Make tasks or activities easier or less strenuous by breaking them up into component tasks:

  • If mowing the entire lawn is too ‘red,’ start with a segment of the lawn, hydrate and rest, then go back outside to finish another segment of the lawn.
  • If going to the grocery store during busy hours is too challenging, try to go at a less busy time or go shopping more often to purchase fewer items at a time.

If too many activities fall into the yellow or red categories, symptoms can vary greatly and flare up forcing you to rest the next day. With improved pacing and more moderate activities, symptom intensity levels are more balanced, which helps improve activity tolerance on a daily basis.

Managing fatigue and activity intensity is a life-long learning process, but taking one step at a time is often the best way to start. If you or a loved one need more specific guidance, ask your doctor if they have recommendations, or schedule an evaluation with a therapist at Sheltering Arms Institute.

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