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Understanding how and why MS fatigue fluctuates throughout the day

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Summary

In what they believe to be the first study of its kind, researchers asked participants - 38 with relapsing remitting MS and 38 without MS - to record levels of fatigue together with details of their mood, exposure to stress and physical activity at six time points during the day, for four consecutive weekdays. They hoped this would give a better understanding of how these factors contribute to fatigue fluctuations.

There were substantial moment-to-moment and day-to-day fluctuations in fatigue in people with MS. On average, their fatigue levels started higher and remained higher throughout the day, increasing more rapidly in the earlier part of the day, peaking in late afternoon then levelling off in the evening. People without MS started at a lower level and had a slower, steadier increase in fatigue levels across the day.

Many of the factors in daily life that influence fatigue were similar for both people with and without MS, but physical activity seemed to have a greater effect on people with MS, and a poor night's sleep had a greater effect on people without MS.

The researchers conclude that a better understanding of the changing levels of fatigue experienced by each person provides opportunities to develop personalised strategies for managing fatigue.

Background

Fatigue is one of the most common symptoms of MS but the causes are not well understood. A wide range of factors can contribute to fatigue, including low mood and stress at work or in personal relationships. The combination of contributing factors means that fatigue levels can vary from day to day and within a day, making it particularly hard to cope with.

In what they believe to be the first study of its kind, UK researchers wanted to get a better picture of how fatigue levels vary from moment-to-moment and day-to-day and at the same time capture details of people's mood and their levels of stress and recent physical activity. By recording fatigue in the context of daily life, they hoped to get a better understanding of if, when and why fatigue levels fluctuate.

How this study was carried out

Over four weekdays, 76 participants - 38 with relapsing remitting MS and 38 without MS - were asked to record levels of fatigue together with details of their mood, exposure to stress and what they were doing at six time points during the day, between 10 am and 8 pm. At the start of the day, they were asked to rate the quality of the previous night's sleep and in the evening they were asked to score their overall fatigue level for the day.

What was found

As might be expected, there were substantial moment-to-moment and day-to-day fluctuations in fatigue in people with RRMS. On average, their fatigue levels started higher and remained higher throughout the day, increasing more rapidly in the earlier part of the day, peaking in late afternoon then leveling off in the evening. People without MS started at a lower level and had a slower, steadier increase in fatigue levels across the day.

In both groups, greater exposure to stress (for example deadlines at work or family conflict) and low mood were associated with higher fatigue levels, positive mood with lower fatigue levels. Increased fatigue was associated with recent physical activity in people with MS but not in those without MS. However, physical activity was recorded as a simple Yes/No score with no indication of intensity; this extra detail would have added more value to the data. Surprisingly, a poor night's sleep did not affect the next day's fatigue levels in people with MS but did increase fatigue levels in people without MS.

What does it mean?

This research highlights the variation in fatigue experienced by each person with MS and reinforces the need for personalised approaches to manage it effectively. Future studies of MS fatigue could explore ways to improve positive mood and respond to stress arising from personal relationships and the work environment. Ways to manage peak fatigue in the afternoon and after physical activity could also be explored.

Powell DJH, et al
Tracking daily fatigue fluctuations in multiple sclerosis: ecological momentary assessment provides unique insights
Journal of Behavioural Medicine 2017 Mar 9. [Epub ahead of print]
Abstract
Read the full text of this paper

More about managing your fatigue

It's not possible to make fatigue go away completely but there are techniques that can be used to reduce the impact on your daily life. Health professionals, typically MS nurses, occupational therapists or physiotherapists, can help you find ways to manage fatigue. Perhaps more than any other symptom of MS, the most important person in the management of fatigue is yourself.

Keeping a fatigue diary is a good place to start. You could do this yourself using a notebook with columns ruled for date/time, current activity, fatigue score (1=low level of fatigue to 10=extreme fatigue) and notes about how you are feeling. If you do this for at least week, it will help you to see patterns in your fatigue levels and identify activities or incidents which are particularly draining. Knowing more about how your fatigue levels respond to the ups and downs of daily life will allow you to plan for times when you have more or less energy and look at ways to deal with low mood, stress within the family or at work or other factors you might identify from your diary.

You can learn more about techniques for managing fatigue in the A-Z of MS or in Living with fatigue which can be read online, downloaded as a pdf or ordered as a printed version.

You can read more about keeping a symptom diary in the A to Z of MS. Or you can read, download or order a printed copy of the book MS and Me: a self-management guide to living with MS. This book helps you learn more about your own MS and find the most effective ways to manage it.

Research by topic areas...

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Drugs in development

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Economics

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Other

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Other treatments

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Physical activity

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Psychological aspects

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Rehabilitation

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Manca A, Dvir Z, Dragone D, et al.
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Services

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Stem cells

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Symptoms and symptom management

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Vitamin D

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Work

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Martin Baum on MS awareness week 2021

Martin Baum on MS awareness week 2021

15 Apr 2021 - 00:00

As we approach another MS awareness week after what has been a very different last 12 months, Martin Baum reflects on the impact the coronavirus lockdown has had on him.

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