Despite its widespread prevalence, fatigue is often overlooked in healthcare settings. Although it is related to pathology, fatigue usually defies explanation by a single disease or condition. Moreover, people without disease also complain of fatigue. The pathophysiological underpinnings of fatigue remain unclear, and no gold standard diagnostic test exists to assess fatigue.

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Nevertheless, experts have delineated factors that contribute to fatigue—even in otherwise healthy individuals—as well as ways to combat it. How? Here are five fatigue-fighting strategies to consider.

Sedentary lifestyle

Living a sedentary lifestyle results in weakness and muscle atrophy, both of which are problems worsened by aging. Physical activity improves strength and enables muscles to become more efficient and to conserve adenosine triphosphate (ATP), the molecule that transfers and stores energy in cells. 

Results from a small experimental study published in Psychotherapy and Psychosomatics indicated that after 6 weeks, otherwise healthy adults can beat feelings of fatigue with low-intensity exercise.

“Six weeks of low and moderate exercise training performed by sedentary adults without a well-defined medical condition or an unexplained fatigue syndrome but reporting persistent feelings of fatigue resulted in similarly beneficial effects on feelings of energy,” the authors wrote.

“The effects for symptoms of fatigue were moderated by exercise intensity, and the more favourable outcome was realised with low-intensity exercise. Changes in feelings of energy and fatigue following exercise training were unrelated to changes in aerobic fitness,” they added.

Although the American College of Sports Medicine (ACSM) recommends 30 minutes of exercise daily, 5 days a week, experts say people can still benefit from shorter periods of exercise throughout the day. Also, you don’t need to break a sweat to derive benefit from exercise—taking the stairs or walking will suffice, according to the ACSM.

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Stress

Stress can lead to fatigue, which in turn can result in impaired performance. In a study published in BMC Research Notes, German researchers examined the relationship between stress and fatigue, including contributing factors.

Looking at the results of 2,483 respondents, the researchers found that 25.9% of men and 34.5% of women noted moderate fatigue during the past 6 months, with 9.7% reporting severe fatigue persisting 6 or more months. After adjusting for covariates, they found that fatigue was most highly correlated with perceived stress and self-perceived health status, with female gender, divorce/separation, lower “social class,” and health status playing a role.

They concluded, “Elevated fatigue and perceived stress overlap most in terms of: low socioeconomic status and poor self-perceived overall health. Fatigue could be a stress-related disorder triggered by long lasting tension.”

Mechanisms tying stress and fatigue could involve excess cortisol production by the adrenal glands, which lowers ATP production directly and indirectly via inflammation. Even as little as 10 minutes a day of meditation, Tai chi, yoga, breathing exercises, and guided imagery could all be viable strategies to lower stress levels, the experts say.

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Sleep

Physicians often burn the midnight oil, so getting enough sleep may seem like a luxury. But lack of sleep heightens cortisol levels and increases inflammation, which results in fatigue. 

Good sleep hygiene is the key to better sleep according to the National Sleep Foundation, which suggests the following:

• Maintain a consistent sleep schedule by-
  • Having a fixed wake-up time on weekdays and weekends
  • Prioritising sleep with a target bed time
  • Making gradual adjustment to sleep times in or 2 hour increments
  • Keeping routines like brushing teeth and donning pajamas to mentally prepare for sleep
• Set aside 30 minutes to wind down with relaxation exercises, stretching, light reading, and so forth
• Dim the lights in the bedroom because bright lights can decrease melatonin production
• Stop using electronics between 30 and 60 minutes before sleep, which can inhibit melatonin production via light and lead to mental stimulation
• Minimise tossing and turning, and if restless after 20 minutes, get up and stretch or read in dim light to wind down
• Focus on relaxation—not sleep—and engage in meditation, mindfulness exercises, or paced breathing to facilitate relaxation
• Keep naps short and limit them to the early afternoon so as not to interfere with bedtime rest

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Diet

Poor nutrition that lacks proper vitamin and mineral content reduces ATP production, leading to feelings of fatigue. Additionally, overindulgence in processed foods can also decrease energy production. Conversely, eating too much food can spike blood sugars and lead to fatigue. Of course, obesity can lead to fatigue, and result in further inflammation.

Older people are particularly sensitive to fatigue secondary to poor diet, and can increase protein consumption—up to 1–1.2 g/kg body weight/day or up to 1.5 g/kg/day in those with acute or chronic diseases—to maintain muscle.

In a review article published in Nutrients, researchers suggested some possible nutritional interventions to combat fatigue.

“Plant-based proteins are considered to have less anabolic effects (partly due to their low content in essential amino acids and leucine) than animal proteins. However, it has been suggested that an adequate protein intake can also be achieved by combining plant-based and animal protein sources,” they wrote.

“Additionally, fast digested proteins seem to better stimulate muscle protein accretion, even if results should be confirmed in larger trials. Some proteins are metabolised to short chain fatty acids (i.e., propionate, butyrate and acetate) which are used by muscle cells to produce energy. Short chain fatty acids also promote muscle anabolism and display anti-inflammatory properties. Therefore, it would be interesting to see if protein supplementation may also exert its beneficial effect in alleviating fatigue symptoms,” they added.

Other expert tips to improve energy levels via diet including the intake of fruits, vegetables, and whole grains. Furthermore, smaller meals and snacks throughout the day can sustain nutrient flow with fewer spikes in blood sugar.

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Social isolation

Two types of social isolation exist: objective and subjective. Objective social isolation involves a dearth of contact with others due to contextual factors such as a small social network, lack of participation in social activities, or infrequent social interactions. Subjective social isolation refers to a perceived shortage of social resources like companionship or social support.

According to the authors of a systematic review published in the World Journal of Psychiatry, both types of social isolation can lead to fatigue.

“Several studies consistently demonstrated that both subjective and objective types of social isolation positively correlate with sleep disturbance, depression, and fatigue. Subjective social isolation, such as emotional loneliness coming from low support from co-workers, was associated with poor quality of sleep,” wrote the authors.

It should come as little surprise that the elderly are at particular risk of social isolation. In those at risk, it’s a good idea to make a point to get together with others at least once a week, whether it be family, friends, or neighbors. It’s also a good idea to be proactive and try to make new friends.

This story is contributed by Naveed Saleh and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members.