Fatigue

Fatigue is a general medical term which denotes that an individual is perpetually tired and has no energy. It is not to be mistaken with tiredness which is transient and can be relieved by sleep. Fatigue affects an individual’s motivation and ability to engage in general activities of living.

Favrat and Cornuz (2022) define fatigue as a sensation of being exhausted during or following usual activities or feeling a lack of energy preventing engagement with these activities.

Fatigue is both a symptom of other illnesses and a condition itself and may be either chronic or acute depending on the cause (Finsterer and Mahjoub, 2014).

The signs and symptoms of fatigue vary according to the cause and are broadly split into those which are physical and those which are mainly mental or emotional in nature. The National Institute for Health and Care Excellence (NICE, 2021a) identify the common signs of fatigue as including:

• being exhausted during or after normal activities
• being too exhausted to engage in normal activities
• feeling tired, which is not relieved by common strategies of rest

Cognitive symptoms of fatigue include forgetfulness, anxiety and difficulties with word finding.

As well as the signs and symptoms of fatigue, living with fatigue can have an impact on an individual’s ability to work as well as their personal, family and social life.

There are many causes of fatigue which may be physical, emotional and/or mental health and social and/or lifestyle related. 

Physical causes

The physical causes of fatigue vary and include:

• anaemia
• arthritis
• autoimmune disease
• bacterial or viral infection, e.g. mononucleosis
• chronic fatigue syndrome
• fibromyalgia
• heart disease
• kidney disease
• liver disease
• medication
• pain
• sleep disorders
• thyroid disease

Mental health-related causes

The mental health-related causes of fatigue include:

• anxiety
• depression
• eating disorders
• grief
• seasonal affective disorder
• stress

Lifestyle-related causes

The lifestyle-related causes of fatigue vary and include:

• alcohol use
• drug use
• obesity or being overweight
• poor diet (NICE 2021a).

Understanding the cause is key to knowing how to manage fatigue. It is therefore important that nurses in the process of making an assessment in order to obtain a nursing diagnosis are thorough in their holistic assessment of the individual presenting with fatigue, understanding the causes of stress might be physical, psychosocial, or occupational (Favrat and Cornuz, 2022). 

Some groups are known to be at a higher risk of fatigue than others. Those at a higher risk for fatigue include:

• women
• people who are overweight
• people with a lower socioeconomic status
• people with a psychosocial or physical disability (NICE, 2021a). 

In terms of diagnosis, most reasons for fatigue are related to other factors such as the ones identified above. Fatigue is a highly subjective experience and so understanding it as an entity in itself is difficult. Nevertheless, rating scales exist which help nurses to better understand the level and impact

The management of fatigue may be as simple as removing the cause, e.g. treating anaemia. Managing causality may also include the need to address mental and emotional health issues either medically or via therapies.

Most people presenting with fatigue will benefit from education and support which focuses on issues like physical activity, managing rest and sleep, engaging with relaxation techniques and the adoption of healthy lifestyle habits such as a better diet, moderating alcohol consumption and stopping smoking and drug use.

There is some evidence that exercise as a therapy has an impact on the fatigue suffered by individuals diagnosed with chronic fatigue syndrome (Larun et al, 2019) and that cognitive behavioural therapy is more effective than other psychological therapy approaches (Price et al, 2008). However, NICE (2016) cautions against exercise which is not part of a programme overseen by a chronic fatigue syndrome specialist as there is a risk

References 

Bennett S, Pigott A, Beller EM et al. Educational interventions for the management of cancer‐related fatigue in adults. Cochrane Database Syst Rev. 2016;11(11): CD008144.
https://doi.org/10.1002/14651858.CD008144.pub2

Favrat B, Cornuz J. Assessment of fatigue. 2022. https://bestpractice.bmj.com/topics/en-gb/571 (accessed 8 November 2022)

Bower JE. Cancer-related fatigue-mechanisms, risk factors, and treatments. Nat Rev Clin Oncol. 2014;11(10):597–609. https://doi.org/10.1038/nrclinonc.2014.127

Elbers RG, Verhoef J, van Wegen EEH et al. Interventions for fatigue in Parkinson's disease. Cochrane Databasef Syst Rev. 2015;10:CD010925.
https://doi.org/10.1002/14651858.CD010925.pub2

Finsterer J, Mahjoub SZ. Fatigue in Healthy and Diseased Individuals. Am J Hospice Palliat Med. 2014;31(5):562-575. https://doi.org/10.1177%2F1049909113494748

Larun L, Brurberg KG, Odgaard-Jensen J et al. Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev. 2019;10(10):CD003200. https://doi.org/10.1002/14651858.CD003200.pub8

National Institute for Health and Care Excellence. Tiredness/fatigue in adults. 2021a. https://cks.nice.org.uk/topics/tiredness-fatigue-in-adults/ (accessed 8 November 2022)

National Institute for Health and Care Excellence. Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management: NICE guideline [NG206]. 2021b. https://www.nice.org.uk/guidance/ng206/chapter/Recommendations (accessed 08 November 2022)