Managing Fatigue in Parkinson’s Disease

By Jessica Stuart
Occupational Therapy Student

Parkinson’s disease (PD) is the second-most common neurodegenerative disorder in the United States, with approximately  90,000 Americans diagnosed with the disorder each year. PD presents with both motor symptoms and non-motor symptoms. One of the most common non-motor symptoms experienced by people diagnosed with PD is fatigue. Fatigue can be an extremely debilitating symptom and it is often described as one of the most upsetting Parkinson’s disease symptoms. 

In turn, fatigue can cause negative effects on ADL performance, participation in meaningful activities, social engagement, and overall quality of life. However, occupational therapy can assist patients with managing their fatigue in order to maximize their performance with self-care tasks and improve their quality of life. 

Here are a few strategies to keep in mind when treating patients experiencing fatigue as a result of Parkinson’s disease.

Energy Conservation Strategies

One of the most efficient ways to assist patients with managing fatigue is through energy conservation strategies. These strategies can assist individuals by giving them the tools to participate in meaningful activities while reducing the risk of falls and increasing their quality of life. 

Energy conservation is achieved by finding a good balance of work, rest, and leisure in order to decrease the demand put on the body and increase the ability to participate in meaningful activities. There are many different strategies to assist with modifying activities in order to reduce energy spent, but there are four key points that can be used throughout the day:

1. Prioritize: Decide on the most important task or activity that needs to be done today and what can be done later. For example, if you have a doctor’s appointment one day, don’t plan on going grocery shopping the same day. Save the grocery shopping for the next day or later in the week.
2. Plan: Schedule activities throughout the day and week to avoid doing too many things within too short of a timeframe. Planning ahead can also include laying out clothes the night before to assist with conserving energy while dressing the following day.
3. Pace: Maintain a slow pace and rest before you feel tired. Utilizing rest breaks frequently and whenever possible. For example, when washing dishes only wash a set number before taking a break, and make sure the break is taken before you feel tired.
4. Position: Sitting, when possible, while performing self-care tasks or other meaningful activities can assist with conserving energy. Additionally, utilize assistive equipment such as a reacher, sock aid, or long-handled shoe horn to limit the amount of bending and reaching performed. 

Sleep Hygiene

While fatigue can present as a symptom on its own, it can also exist along with other symptoms such as sleep disturbances. Researchers conducted a study to identify triggers that cause patients with Parkinson’s disease to experience increased levels of fatigue. Over half of the participants in the study reported that a poor night’s sleep causes increased levels of fatigue the following day. 

Occupational therapy can promote better sleep performance by assisting individuals with improving their sleep hygiene. These strategies might include:

1. Stick to predictable routines: Establish regular times for sleeping and waking to assist with improving sleep performance each night
2. Modify the environment: Creating an environment that promotes optimal sleep can be achieved by modifying factors such as noise, light, temperature, bedding, etc.
3. Establish sleep hygiene routines: Introduce a nightly routine that starts about an hour before bed to help begin winding down. During this time, turn off electronics, engage in relaxing activities, etc.
4. Encourage health management behaviors: Reduce caffeine intake, avoid caffeine in the evenings, eat a balanced diet, cessation of smoking, etc. 

Exercise

In addition to identifying triggers, the researchers also asked patients with PD what they found helpful to reduce the fatigue they experience. Approximately half of the participants reported that exercise decreased the level of fatigue experienced. Furthermore, research has found that the weekly recommended level of physical activity for patients with PD is 150 minutes, or approximately 20 minutes a day. 

While this is true, it should also be noted that there are inconsistent findings on how exercise affects fatigue and more research needs to be performed in order to better understand the relationship. 

Some studies have shown that aerobic exercise has positive effects on sleep performance and fatigue, but the findings are inconsistent and additional research is necessary. Additionally, some research has shown that yoga has assisted with reducing levels of fatigue experienced by patients with PD. In fact, one study that combined occupational therapy with yoga found that participants experienced improved perceived levels of fatigue following the intervention, as well as improved activity participation. 

Overall, more research needs to be completed in order to better understand how exercise affects fatigue, but there is evidence to support the use of exercise with decreasing levels of fatigue experienced by individuals with PD.  An occupational therapist can assist with the creation of an appropriate exercise plan that is tailored to the patient’s specific needs while adjusting as needed.

Fatigue is a debilitating symptom experienced by those diagnosed with Parkinson’s disease, and more research needs to be performed in order to best understand how to assist with managing fatigue in order to improve ADL performance, increase social engagement, and enhance quality of life.