Participants will be able to educate patients regarding energy conservation techniques to help their patients complete desired daily activities and remain as independent as possible.
Participants will be able to educate patients regarding energy conservation techniques to help their patients complete desired daily activities and remain as independent as possible.
After completing this continuing education course, the participant will be able to meet the following objectives:
Energy conservation techniques are beneficial for all patients who have been in the hospital and present with decreased functional activity tolerance, as well as for patients with chronic illnesses. There are four principles of energy conservation.
There are many energy conservation recommendations and tips that patients can use during all activities of daily living (ADLs). It is helpful to organize and lay out clothing at night to prepare for the next day. Patients should start with lower body dressing as it uses more energy. Using AE such as reachers, sock aids, or long-handled shoe horns will decrease the need to bend over. If patients have one arm and/or leg that is weaker, they should dress that side first. When undressing, patients should take out the stronger and more mobile arm and/or leg first. Patients should try to wear clothing that is easy to don and doff; for example, Velcro may be easier to use than small buttons or clasps.1
It is helpful to avoid using scented products such as hair products and lotions as they can irritate the patient’s lungs and lead to shortness of breath. Using warm water instead of hot water during bathing will prevent steam and condensation from causing shortness of breath. Durable medical equipment (DME) such as a shower bench, bath stool or grab bar can make bathing easier and safer. A terry cloth robe can be used to conserve energy instead of drying off with a towel.1
When planning a trip to the grocery store, patients should be sure to prepare a list of needed items. Patients can organize the list by sections of the store or aisles if possible, to decrease the time spent on additional aisles which are not needed. Using a shopping cart to transport items rather than carrying them in a basket will conserve energy. If patients will be transporting their groceries, they should make sure to keep the load in each bag light by only filling it up halfway. If possible, patients could also shop with someone who can help them carry the bags. When possible, patients should try to avoid going to the grocery store when it will be busy to decrease the wait time for checkout. If it is available, patients could also consider using a delivery service for groceries or using a store pickup option in which the workers will shop for them and then load the groceries into their vehicle for them.1
When preparing to complete housework, patients should first start with a list and divide activities up to be done throughout the week. For major jobs, they should try only to plan to do one each day – such as laundry or changing the sheets on their bed. They should try to have a balance between heavy and light tasks to avoid over-exertion. It is also helpful to clean one entire room at a time rather than traveling between rooms while cleaning. Another helpful recommendation is to have a trash can in each room to avoid having to walk to one trash can in the home. If possible, patients should buy multiple cleaning items to store one in each area of their home. For example, they can keep a bottle of sink cleaner in the bathroom and the kitchen. If the patient has multiple levels of their home, they could have a vacuum on each level as well.1
When making the bed, they should complete one side of the bed at a time to avoid having to walk around the entire bed multiple times. They can sit for tasks such as changing the pillowcases. When cleaning, patients should try to avoid spray cleaners as they may irritate their lungs and impact their breathing. When possible, patients should sit or kneel to clean the bathtub rather than standing and leaning over. When washing dishes, patients should allow them to air dry in a dish rack/strainer rather than towel drying them. Using dustpans and cleaning sponges with long handles will decrease the need to bend over.1
As a general recommendation during housekeeping – patients should have their work right in front of them rather than reaching to the side and should slide objects when they can rather than lifting them. If housekeeping tasks are becoming too difficult, patients should consider asking for help from family or friends, or hire a housekeeper.1
When cooking or baking, it is helpful to plan ahead and break down tasks into steps. Patients should try to gather all needed ingredients and cooking utensils before beginning the task of cooking. When possible, patients should make larger portions so that they can freeze the extra to reheat later. Patients should use cookware and dishes that are lightweight and easier to carry. The use of paper plates and cups will eliminate the need for washing dishes. Electrical appliances such as can openers and dishwashers can help patients to conserve their energy. Patients should try to buy easy to prepare dishes or frozen meals. If it is available, they can use a meal delivery service.1
One of the only predictable symptoms of amyotrophic lateral sclerosis (ALS) is fatigue. It results from muscle weakness and spasticity. People with ALS will often complain of feeling tired, decreased strength, and an overall lack of energy. With effective management, the symptoms of fatigue can be minimized. People with ALS can improve their overall quality of life by learning the signs of fatigue, which factors worsen fatigue symptoms, and how to conserve their energy.2
The noticeable signs of fatigue typically include:2
Other noticeable signs may include:2
There are many factors which may exacerbate fatigue, including immobility, overexertion, disruption in sleep, pain, excessive weight loss, protein malnutrition, and weakness with breathing.2
Other factors that exacerbate fatigue include:2
Some anti-fatigue strategies which are helpful for patients with ALS include learning methods to make all tasks easier. This may include the use of assistive devices or adaptive equipment such as a motorized wheelchair to decrease exertion required for functional mobility compared with a manual wheelchair.2
Patients need to pace themselves and take rest periods often. Becoming breathless during a task should be an indicator that it is time to stop. Patients should save enough energy to enjoy at least one valuable experience every day. It is important to alternate activities with rest periods. A handicapped parking sticker will decrease the distance patients have to walk when going to appointments or shopping. The department of motor vehicles (DMV) has a form that can be completed by the patient’s physician.2
Patients should try to establish a regular pattern of sleep. If a patient wakes up at night, they should try to determine why and find a possible solution. Patients should avoid prolonged bathing in warm water as that can worsen muscle fatigue. Patients should make sure that they are meeting their nutritional requirements every day and consult a dietician if needed to avoid any unnecessary weight loss. Patients should avoid stressful situations whenever possible.2
It is helpful if the patient’s family members understand the symptoms of fatigue and do not take any of their emotional upsets personally. Patients should notify their doctor if they feel noticeably weaker or have difficulty breathing after taking a medication. They should ensure that their living environment is accessible for daily activities and is set up to promote energy conservation. Social isolation, quick physical deterioration, and unnecessary hardship can result if patients fail to manage their fatigue. Effective management of symptoms will allow them to maximize their wellness and capabilities to improve their overall quality of life.2
Patients with chronic obstructive pulmonary disorder (COPD) can benefit from energy conservation techniques as well. They should plan for periods of rest. If the patient has swelling in their feet or ankles, they should elevate their legs when resting or sitting for extended periods. They should avoid working long days and rest in between leisure activities. Conserving their energy will involve using less energy with daily activities to have more energy to complete additional activities throughout the day. This may involve the patient cutting down on some activities or incorporating the use of energy-saving assistive devices or techniques. Patients should discuss their own limitations if completion of self-care and home care activities becomes too tiring.3
Patients with COPD should simplify tasks and set realistic goals. They should understand that tasks do not have to be completed the same way that they have always completed them. All activities – including housework, exercise, and leisure activities – should be planned ahead of time and spaced out throughout the day. Patients should avoid scheduling too many activities in any one day. Activities that take the most energy should be completed at the time of the day when patients feel their best and have the most energy to expend. Rest periods can be used before and after activities as needed. Patients must stop and rest as soon as they feel tired during an activity. They should not wait until the activity is completed before they take a rest period. The activity may need to be finished later in the day or on another day.3
Patients should rest for 20-30 minutes after a meal. When needed, patients should ask family and friends for help with tasks. It is important to get a good night’s sleep with the elevation of their head while sleeping. While rest periods throughout the day are important, patients should not nap too much during the day, to allow for good sleep at night.3
All daily activities that can be completed while sitting should be completed while sitting – such as shaving, drying their hair, etc. Assistive devices should be used as needed – such as a walker, a shower chair, a hand-held shower head, a bedside commode, a long-handled dressing stick, a shoehorn or a sock aid. When possible, patients should wear clothing with zippers or buttons in the front to avoid having to reach behind them for dressing.3
Patients can navigate stairs if their doctor says it is acceptable. They may need to rest partway up the steps if they become too fatigued. Activities should be arranged to avoid ascending and descending the stairs many times throughout the day. Patients with COPD should avoid extreme physical activity. They should not push, pull or lift heavy objects (over 10 pounds) to avoid having to strain.3
Fatigue is the most common symptom of multiple sclerosis (MS). 75-95% of all people with MS have fatigue, with 50-60% reporting that fatigue is one of their worst problems. Fatigue is one of the major reasons for unemployment among people with MS. Fatigue is defined as a lack of physical energy, mental energy, or both. MS-related fatigue is different. People have more “off” days than “on” days. Patients with MS should ask themselves whether their fatigue is interfering with their everyday activities or overall quality of life. If the answer is yes, they should notify their doctor. There are two general types of fatigue. Chronic, persistent fatigue refers to lethargy or exhaustion which limits activities and goes on for more than six weeks, more than half of the days, during some portion of the day.4
Acute fatigue is lethargy which limits activities and has either appeared for the first time or has become noticeably worse over the last six weeks. Acute fatigue may be an early warning sign that other MS symptoms are going to flare up or become worse. Although fatigue is common in MS, MS may not be the reason or possibly the only reason that patients feel tired.4
Many factors can cause or contribute to feeling fatigued. Another medical condition, such as a minor infection, could cause increased fatigue. Heat and humidity can lead to fatigue. Some medications have fatigue as a possible side effect. Sleep problems – including difficulty falling asleep, staying asleep, or getting the right kind of sleep can prevent patients from feeling rested when they wake up. Stress can make everyone feel tired, especially those whose lives are already stressful due to MS. This can also include happy occasions such as holidays or weddings which cause increased stress. Depression and anxiety can cause fatigue in everyone and these conditions are common in patients with MS.4
There are several broad categories of MS-related fatigue. In fatigue related to mobility problems, daily activities that require physical effort may be exhausting for patients with MS, especially those with leg weakness. In fatigue related to respiratory problems, MS can affect breathing, making daily activities especially tiring. Primary MS fatigue is the category that remains when all other causes of fatigue have either been ruled out or treated with success.4
Spasticity medications for MS can cause increased fatigue, so patients on those medications should speak with their doctor if they believe their symptoms may be related to medication. Smoking puts extra stress on the lungs which makes fatigue worse and can compound the effects of MS. For this reason, patients with MS should be educated on smoking cessation. Eating a well-balanced diet that is low in fat can provide energy and help to combat the symptoms of fatigue.4
Patients with MS should plan their day around their natural body rhythms and try to establish a sleep schedule. They should schedule the activities which must be completed for the times when they have the most energy. Drinking warm milk 30 minutes before bedtime may help with sleep. If the patient has been in bed trying to fall asleep for more than 30 minutes, they should get out of bed and complete a quiet activity until they feel tired and then try again to fall asleep. Patients with MS should save their energy for activities that are most important to them. They should set priorities, eliminate low priority tasks, and focus their energy on the high priority tasks. A 10 to 30-minute nap can give fatigued muscles a break and provide replenished energy.4
It is important to drink plenty of water, as well as other chilled drinks to keep their body temperature in a comfortable zone and avoid overheating. Cool showers, being near an air conditioner, swimming or participating in pool therapy, and wearing lightweight clothes can also help with staying cool and comfortable. A proper exercise program should increase the patient’s energy level and not completely diminish it. Patients should save their exercise for planned sessions and not use energy in situations where it can be saved. For example, they should take the elevator and not the stairs whenever possible. Deep breathing, visualization, yoga, and tai chi are all relaxation exercises that patients can learn to complete on their own.4
Cancer-related fatigue is different from other types of fatigue. Patients with cancer may describe their fatigue as feeling weak, listless, or drained. It can cause the patients to feel too tired to complete daily activities such as eating or walking to the bathroom. This cancer-related fatigue can even make it hard for the patient to think or move. It does not go away with rest. Managing fatigue is an important part of good cancer care so patients should be open and honest with their care providers regarding their fatigue and how it is impacting their daily lives.5
Cancer-related fatigue can last anywhere from months to years and often continues after cancer treatment has ended. Fatigue often gets worse at the beginning of chemotherapy treatment and then gets better until the next treatment. Fatigue typically gets worse throughout radiation treatment. Cancer-related fatigue can vary greatly from day to day and it can be overwhelming for patients. The causes of cancer-related fatigue are not well understood. The symptoms can be the result of the cancer itself and/or the cancer treatment.5
Cancer, as well as cancer treatment, can alter normal protein and hormone levels which are linked to inflammatory processes which could possibly cause or worsen fatigue. Cancer treatment destroys both normal and cancerous cells and this can lead to a build-up of cell waste which requires extra energy from the body to eliminate. Cancer creates toxic substances in the body that alter the way normal cells function. In many cases, fatigue has more than one cause.5
Some common causes of cancer-related fatigue include:5
Patients with cancer must plan their day to include times for rest. They should take short naps or rest periods, each lasting 30 minutes or less instead of taking one long nap during the day. Too long of a rest period or nap can lower their overall energy level and make it difficult to sleep well at night. It is common for patients to have sleep problems while being treated for cancer. They may have trouble falling asleep or may sleep too much.6
Certain medications used to treat pain, nausea or depression can lead to feeling tired. Patients should speak with their cancer team if they are feeling tired all the time as medication dosage changes or changing to another medication can help. It is a good goal to sleep 7-8 hours each night – including going to sleep and waking at the same time to establish a healthy sleep routine and avoiding caffeine in beverages, medications, or foods for at least 8 hours before bedtime should help them sleep better.6
While exercise is important, patients with cancer should avoid exercising too late in the evening. Moderate levels of exercise regularly, especially walking, can decrease fatigue and help with sleeping better. If they still have trouble sleeping, they may benefit from working with a mental health professional to address sleep issues. Energy conservation is a way that patients with cancer can ensure they have enough energy to do what they need to do every day. They may need to accept the reality that they may not be able to do everything that they want to do.6
Prioritizing daily tasks in order of importance should be the first step. They should plan ahead and space out activities throughout the day. Completing tasks slowly will allow them to save energy to complete tasks once they begin. It is important to remember to incorporate rest periods between daily activities. Patients with cancer should make sure they do not stand for activities too long or that they do not complete activities, including bathing, in extremely hot or cold temperatures. They should sit whenever possible to complete activities. The use of a shower chair and a chair in the bathroom at the sink can help with activities of daily living. They should store frequently used items within easy reach. For activities that are too taxing such as lawn mowing or vacuuming, patients with cancer should ask others for assistance. This will not only allow the patient to conserve energy, but it will also help family and friends to feel that they are truly helping. It is important when asking for assistance that family and friends are given specific things to do. It may be helpful to have someone who can assist with coordinating assistance in case there are times when the patient is too fatigued to even ask for help.6
Cancer treatment can impact how patients eat or swallow, as well as how things taste. This can make it difficult to eat well. Patients with cancer must eat enough to provide energy and to allow their bodies to heal. Dehydration can worsen fatigue, so patients with cancer must get at least 8 cups of fluids every day. They should also include fiber, protein and fat with every meal and snacks to keep their blood sugar levels more stable and have a sustained feeling of energy.6
Having cancer is stressful. Cancer treatment leads to even more stress. Patients must discuss their stress levels with their cancer care team. They may benefit from joining a support group, counseling, stress management training, or relaxation exercises to help with overcoming their feelings of fatigue. Distraction can be a great way for patients with cancer to cope with fatigue. They can use music, reading a book, or having relaxing visits with family or friends to distract themselves from their feelings of fatigue without utilizing too much energy.6
Many recommendations can help patients with cancer in completing activities of daily living. They must plan ahead to avoid rushing and allow themselves plenty of time to complete daily activities. Sitting to bathe and dry off will conserve energy. Another helpful tip is to don a terry cloth robe instead of using a towel to dry off. It is helpful to use a shower organizer to minimize the need to lean over or reach too far. Long-handled brushes and sponges can help with washing their feet and backs. Grab bars in the bathroom can be helpful, as well as the use of an elevated toilet seat can conserve energy by decreasing the need to sit too low when using the toilet.7
It is helpful to lay out clothing and toiletry items before dressing. To decrease the need to lean over to put on clothing and shoes, patients should bring their feet to their knees if possible, to don socks and shoes, as well as to thread their legs through their pants and underwear. If they cannot cross their legs in that manner, adaptive equipment such as reachers, sock aids, and shoehorns can help with lower body dressing. Comfortable shoes with low heels and slip-on style are preferred. For female patients with cancer, it is helpful to fasten their bra in the front and then move it around to the back. Shirts that button in the front are easier to don than pullover shirts.7
Whenever possible, patients should complete home modifications to assist with energy conservation. For example, patients should place chairs throughout their home to allow for seated rest periods as needed.7
The following are tips for energy conservation during housekeeping:7
The following are helpful tips for shopping:7
The following tips are helpful for meal preparation for patients with cancer:7
The following recommendations will assist patients with cancer with childcare:7
For patients with cancer who are still working, they should plan their workload to take advantage of times of the day when they have the most energy. Whenever possible, they should alternate work tasks that are physically demanding with less taxing activities. Patients should arrange their workspace to allow them to access the most commonly used equipment and supplies easily. It is important to continue the completion of leisure activities, especially with a friend. When choosing an activity, patients should plan one based on how much energy they have at that time. They should balance activities with rest breaks.7
Fatigue is a major issue for patients with post-polio syndrome (PPS). Patients with PPS report that fatigue is the most persistent and debilitating symptom they experience. It can affect their ability to work, their mobility, and their overall quality of life.8
In adults without a chronic disease or disability, fatigue typically is reduced when they retire due to a decline in overall stress. However, for patients with disabilities, including PPS, their fatigue typically remains the same or gets worse as they age. Assistive devices, adaptive equipment, and assistive technology can help to protect weak muscles in patients with PPS and may include braces, canes, walkers, or power wheelchairs.8
Self-management refers to methods, skills, and strategies which effectively guide activities to achieve a goal or objective. For patients with a chronic disease or illness, self-management helps them with overcoming the physical and emotional issues caused by their disease to achieve their highest possible quality of life and maximize their physical capabilities.8
Concerning fatigue, patients can manage their activity level by planning and scheduling daily tasks, setting priorities, pacing, and requesting assistance when needed. While patients with PPS were traditionally told to minimize exercise to conserve their energy, current research has shown that patient-centered gentle exercise programs can be beneficial.8
Mrs. Jones is a 57-year-old female who was recently diagnosed with breast cancer. She is divorced, and her children are both grown and married, so she lives alone. Her daughter and son-in-law live nearby and try to be supportive. Mrs. Jones has been having difficulty completing even the most basic daily tasks without feeling exhausted. She finally decided to speak with her cancer treatment team, and they recommended that she meet with an occupational therapist (OT) to discuss energy conservation techniques.
The OT completes a home assessment with Mrs. Jones and determines that she would benefit from a tub transfer bench to help her with transferring into and out of the bathtub, as well as to provide her with a place to sit while bathing. The OT also recommends a shower organizer for Mrs. Jones to store her shampoo and body wash without having to reach overhead to retrieve them while bathing. The OT provides her with a long-handled bath sponge to help her with washing her feet and back. Mrs. Jones reports that she also gets fatigued when drying off after showers, so the OT recommends that she purchase a terry cloth robe and take a 30-minute rest period in the robe after the shower to decrease the need to use a towel to dry herself off.
Mrs. Jones reports to the OT that going downstairs to complete laundry is one of the most exhausting tasks she has completed since being diagnosed with cancer. They decide that Mrs. Jones will ask her daughter to complete laundry for her once a week to decrease the need for her to complete this activity. This will allow her daughter to be able to truly help Mrs. Jones as she has been asking every day what she can do to help her mother. Mrs. Jones also reports that cooking has been difficult for her, but she loves to cook. They decide that she will use her slow cooker to prepare meals whenever possible and she will make a double batch so she can save half in the freezer to reheat. When she does cook at the stove, the OT recommends that she move her barstool to the stove to sit when cooking stovetop meals. At the end of the visit with the OT, Mrs. Jones reports that she is worried about mowing her lawn when springtime comes again. She loves her home and enjoys being able to watch the wildlife on her front lawn.
Healthcare providers can utilize their knowledge of energy conservation techniques to assist patients with debilitating conditions, such as ALS or MS, with managing their fatigue to improve their overall quality of life and allow them to remain as independent as possible with desired daily tasks. Energy conservation techniques can also be beneficial for all patients who may experience fatigue due to generalized weakness, decreased endurance, or prolonged hospitalizations.