Using an Activity Diary
By using an activity diary, this will be enable you to make a note of everything you do on a daily basis and also make you aware of any patterns and triggers associated with your fatigue.
This is an example of an activity diary:
A typical activity diary can be used to record: your sleep pattern; your morning/evening energy levels (out of 10); the different types of activities that you have completed throughout the day; and how fatigued you feel after each one using the Fatigue Scale below:
A response of 0 would indicate that you do not feel at all fatigued after an activity; and a response of 10 would indicate that you feel totally fatigued and exhausted.
It can also be helpful to keep a note of your daily symptoms; alongside your activity diary.
Analysing your Diary
Once you have completed a week’s worth of diaries you should be able to notice any BOOM BUST patterns; what constitutes a good day or a bad day; the different type and levels of activity that fill your week; the different type and level of exertion that causes the most fatigue or triggers PEM; how often you are resting and re-charging; how often you are moving around; how you aresleeping; and how the types of environments that you have been in have contributed to your
By recognising how different types and levels of exertion make your feel after completion, it can allow you to identify specific patterns. This allows you to better manage your time and energy and puts YOU in control.
An activity diary is also a useful tool to find your baseline and/or energy envelope.
Finding your Baseline
Establishing a baseline level of activity is important before introducing any further activity or exercise.
Once you have completed some activity diaries, you should be able to see what your triggers are; look at what changes you can make; and find a level of activity that can be achieved consistently everyday whilst avoiding BOOM BUST and PEM.
When establishing a baseline, it is important to remember that your activity levels may be significantly less than they were pre-Covid. Remember that you are now working with a different post-viral body and there is no limit to the time your body may take to heal. It is likely that you will have good and bad days due to the fluctuating nature of post-viral fatigue, however finding a baseline level of activity that you can achieve consistently, whilst reducing BUST days and minimising your overall Post Exertional Malaise levels, will help in the long term. Once you are aware of your baseline level of activity, it is important not to be attempted to do any extra, even if you are feeling well. Post Viral Fatigue cannot be pushed or worked through.
A good way to manage your daily activities is by finding a mid-point of activity that is achievable on both good and bad days. On bad days you should avoid under-exertion and on good days you should avoid overexertion – all the time ensuring a good balance between activity and rest (PACING) and ensuring a safe level of activity that does not exacerbate your symptoms.
The overall aim is to reduce the BOOMS and BUSTS. Start low and go slow, know when to stop and aim for gradual reconditioning.
Recognising your Triggers
Knowing when to stop
It can often be challenging knowing when to STOP! Most people often only stop at the point where they feel they can no longer continue or when they are already experiencing an increase in their symptoms. This means relying on your body to tell you to STOP!
Imagine you are in a car and the car needs to stop to prevent it from hitting a brick wall. You would need to apply the brakes before hitting the wall. With fatigue, you need to stop before you reach the point of over-exertion (the wall), even if you still feel well.
Recognising Different Types and Levels of Exertion
Exertion can be defined as anything that stresses or strains the body. The body can be exerted in many different ways, and it is important to look at which type(s) of exertion contribute to you feeling fatigued and experiencing PEM. Identifying these triggers is vital to recovery. Keeping an activity and/or symptom diary can help you to become more aware, however when completing diaries and making a connection between over-exertion and PEM, it is important to note that PEM can be delayed by 24-48 hours.
Some different types of exertion include:
- Physical Exertion – physical activity, exercise
- Orthostatic Exertion – standing for long periods of time
- Cognitive Exertion –reading, writing, watching tv, using a computer, scrolling through your phone
- Social Exertion – attending meetings, long conversations or challenging social interactions
- Sensory Exertion – loud repetitive noises, bright or flashing lights
- Emotional Exertion – stress, arguing, tragic events
- Environmental Exertion – proximity to allergens, temperature, changes in weather/season
In addition to different types of exertion, there are also different levels of exertion – HIGH, MODERATE and LOW. Each activity that you do will use a different amount of energy.
Daily activities don’t tend to be carried out in isolation and your day may consist of a combination of tasks which use varying levels of energy. Mixing different types of activity and exertion throughout the day can help to maintain energy levels. Being aware of the types and levels of activity you are completing and how you are exerting your body allows you to become more aware of what you are doing. It is important to look at how you can split up your activities to maintain a balance of different types and levels of activity/exertion throughout the day, and to also recognise when and how to rest and re-charge afterwards.
Knowing When and How to Rest & Re-Charge
Resting, relaxing and re-charging are an extremely important part of managing fatigue. Good quality rest and relaxation is vital to re-charge your body’s energy and healing. Relaxation is also important as it can help to calm your body down when it is stressed which, in turn, supports regulation of your body’s autonomic nervous system (the system which controls breathing and heart rate).
You should acknowledge rest and relaxation as part of your daily schedule and plan rest breaks, up to 30 minutes long, in advance where possible. Regular rest should be taken before you become tired and even if you are feeling well – remember the ‘stopping distance’ analogy.
For some people, resting is simply sitting and watching television or scrolling through their smartphone however, it is important to not just rest the body, but the mind and senses too. The type of rest and re-charge that you need will depend on the area of the body that has been exerted.
When managing fatigue, it is important to ensure you are taking frequent re-charge breaks throughout the day in between activities. This is known as PACING.
Managing Activity and Exercise
Whilst activity and exercise are important to regain and maintain muscle strength and endurance; with fatigue, exercise should be safe, balanced, gentle and within your limitations. Vigorous exercise, or anything that triggers PEM, is not recommended!
As the goal of PACING is to minimise PEM, it is important to find a consistent level of activity that is manageable for you, whilst keeping your expectations low. The simple rule is: if you are experiencing PEM then you are doing too much. You cannot push through your fatigue. Any activity which sends your heart rate above your anaerobic threshold has been shown to trigger PEM therefore you should aim to stay at around 55% of your Maximum Heart Rate (see below) when completing activities or exercise, in order to avoid or reduce PEM.
You should aim for a gradual and flexible return to normal day-to-day activity initially and then only when you feel your fatigue is improving should you try a small amount of light activity followed by REST. The aim is to work on (1) frequency; (2) duration and then (3) intensity. Start low and go slow!
Remember: If you don’t overdo it on good days, you will avoid the severity of symptoms on bad