Dr. Belza:
I am associate professor in the Department of Biobehavioral Nursing and Health Systems at University of Washington, and I'm also president of the Association of Rheumatology Health Professionals, which is a section within the American College of Rheumatology. I also hold a position as chair of the board of directors for the Washington/Alaska Chapter of the Arthritis Foundation.
So, in answer to your question then as far as what actually causes fatigue, more than likely there are multiple causes of fatigue. It's typically not just one cause. For someone with an inflammatory condition, clearly the inflammation itself can produce things such as interleukin-1, which probably can be linked to fatigue. So, the inflammatory process if left untreated can lead to fatigue.
Frequently, people with rheumatoid arthritis are very deconditioned, and when you're deconditioned, you typically experience a lot of fatigue. It's also not unlikely that if you have rheumatoid arthritis, you may have a change in your mood, anywhere from just sadness to possibly being depressed, and depression we clearly know that there is a fatigue that can be associated with that.
And then there's any number of other medical and psychological conditions that may contribute to fatigue that someone with rheumatoid arthritis may have but may not be treated. So, if for example you have problems with anemia, you have problems with thyroid, and if those go unchecked, they too can lead to fatigue. So, typically what we would like is that people with rheumatoid arthritis look at fatigue and its role in their life relative to perhaps multiple causes.
But for someone with a chronic illness, and particularly an inflammatory condition such as rheumatoid arthritis, their fatigue never goes away. And so they don't necessarily feel refreshed when they wake up. And the reason for this is frequently because there are multiple causes, so it's not just sleep or loss of sleep that's causing the fatigue, but there might be other things, too.
So, for example, if one of the reasons you're fatigued is because you're very inactive, you lead a sedentary life, you sit in front of the TV most of the day, you drive your car to and from, your fatigue may actually be a spiral in that the more deconditioned you are, the more fatigued you are. In this particular case, what might be recommended is you try to get a little bit more active. And it doesn't necessarily mean to go joining a fitness club, but what it means is just increasing your physical activity on a daily and on a weekly basis. That would then address the deconditioning aspect.
If in fact your fatigue was related to depression or a poor mood, there might be another solution to that. Maybe a support group would be really helpful to you. Maybe seeing a psychologist or another mental health provider to really look at what are some of the psychological components to the fatigue would be really helpful.
The other thing is, is if an inflammatory process is contributing to your fatigue, you really need to make sure that you're on adequate medical management, so that would be any kind of drug therapies to really curb the inflammatory process. And these conditions are best treated by a rheumatologist, so by seeing a rheumatologist that might be very helpful. And then the other thing is, is if you have other conditions that are contributing to your fatigue, such as I mentioned anemia or thyroid problems, you really want to go to a provider to make sure that you have a good, clean bill of health.
So, it is a very gradual process. It usually helps people to work with a coach or someone that can really help set a program that you can be successful. It might be a physical therapist. It might be a nurse practitioner. It may be a physician provider of yours. It may be a mental health provider who can really help you set up a program that would be incrementally increasing the amount of activity that you're doing.
It may mean walking around the block three times a week when prior you may have only walked to the mailbox and back. It may mean if you are driving to park furthest in the parking lot so that you can get to the mall so that you get some exercise walking in. There are mall-walking groups. It's a real safe environment, it's great for inclement weather, so you do some walking. It becomes a socialization process, too.
So, the answer to your question as far as how do you get going, some of it is just doing it incremental, not thinking that you're going to get up and do an aerobic class 30 minutes three times a week, but that there are steps to it, that you are going to just walk around the block once, that you are just going to take your granddaughter out and play with them in the backyard versus sit in front of the TV.
The other thing I think is important too is that the activities we do we really like, and I think it's great that we encourage people to swim. Swimming is a great program for people with arthritis, and there are a lot of swimming programs out there with Arthritis Foundation trained leaders, warm water aquatics program. I know that from where I live in Washington state we have at least one warm water aquatics program in every single county in Washington State. But it has to be something you like. If you've never swum in the past, the likelihood of you swimming now, there's a possibility, but it's probably not that strong.
But if you've gardened in the past, maybe there's a new way of finding out how to garden and not have you increase your pain. It may mean using special attachments to your garden equipment. It may mean taking a chair out to your garden so that you can rest more frequently. But it's modifying certain activities that still increase your physical activity but does not increase your pain. The other thing that you can think about is depending on if you take any pain medications to take those just prior to an activity so that they can start taking effect prior to starting the activity.
The part that's really important is that we really focus on increasing our overall physical activity. And again, it's getting in your own mind the picture of what would work for you based on your own background, based on your own interests, based on what you really feel confident in doing. And that does vary, so we really don't have a set program for every person. We have a menu of options.
If you like to dance and you've danced in the past, you haven't danced recently, try to go find a group that you can dance with. And it may be square dancing; it may be ballroom dancing. If you like to swim, go try to find a swim group that's age-appropriate to what your interests are. If you like to walk, look for your neighbor. If you're in the position to be able to get a dog, get a dog. Have that get you out walking. It's inevitable if you have a dog, you're a walker. The two go hand in hand. So, it's really having a menu of options that you can choose from so as to increase your overall physical activity.
Dr. Belza:
Actually, all the evidence shows that people with rheumatoid arthritis who exercise receive beneficial effects. There are no studies that show exercise exacerbates the disease or makes it worse. The benefits again have to do with your muscles, have to do with your joints, have to do with your psychological well-being.
And I think we need to reset our clock we have that says we have to do 30 minutes or we have to do a set amount. If you have ten minutes, those ten minutes I know I did yesterday is better than not doing anything at all.
One needs to look at what the factors are that are contributing to fatigue, whether it be depression, whether it be inflammation, whether it be sleep disturbances, whether it be pain, whether it be deconditioning or whether it be other medical conditions. And when one is able to isolate what those few things or many things may be, then you look at treatment strategies based on what the cause is.
Just bumping this post.Just bumping it again, it deserves it.Thanks Lev Once again. Your posts are most informativeThis is really great information ! Getting out and walking is not only good for your body but also good for the mind. I get some of my best thoughts when I'm walking . Solving problems , coming up with new recipes , having fun with my husband and so much more.