A holistic approach to beating fatigue

Fatigue is a persistent foe, but you can help patients beat fatigue and feel better. Discover a holistic approach that can help improve your patients’ health outcomes.

Fatigue is the cardinal symptom of individuals with suboptimal health status (SHS) and almost all sufferers of SHS (90.5%) experienced fatigue.1 SHS is characterised by the following: feelings of exhaustion without a significant increase in physical activity; lethargy at work; tiredness unrelieved by rest; and associated headaches, dizziness, eye pain or tiredness, muscle or joint stiffness, pain on the shoulders, neck or waist, or heaviness of the legs when walking.1

The approach to the management of SHS, aimed at alleviating symptoms and preventing progression to overt disease, is centred around holistic health-promoting lifestyle interventions. This approach includes nutrition, exercise, rest and sleep, stress management, interpersonal relationships, health responsibility and spiritual growth. Such an integrated approach has been associated with a significant improvement in SHS scores and recovery from SHS to health.2,3

Nutrition, physical activity and sleep are especially important in alleviating fatigue, either in the context of SHS or overt disease.

Good nutrition is key. Caloric intake is necessary for the energy requirements of the body. Insufficient calorie intake slows down metabolism leading to fatigue and lack of energy. Vitamins and minerals are essential for health, and fatigue is a common symptom of micronutrient deficiency. Moreover, several clinical trials indicate that some nutritional interventions with common herbs may help alleviate both physical and mental fatigue.4-9 The role of nutritional interventions on fatigue management is an active area of research.

Exercise improves vigor. Exercise is commonly recommended as an intervention to combat fatigue. An analysis of 12 population-based studies found that exercise was associated with reduced feelings of fatigue and low energy among individuals with fatigue.10 Furthermore, active adults were shown to be 39% less likely to suffer from fatigue compared with sedentary individuals (odds ratio 0.61; 95% CI 0.52, 0.72) and the benefit of exercise was dose dependent.

Good sleep habits boost energy. Insufficient or disrupted sleep may have the greatest impact on the development of fatigue.11 Several studies have shown that individuals with inadequate sleep, poor sleep quality and suboptimal sleeping environments developed fatigue and performed poorly at work.12 Hence, sufficient sleeping hours, sleep hygiene and reasonable working hours are recommended to address fatigue. In clinical practice, the following may be advised to improve sleep quality and quantity: avoidance of alcohol, caffeine and nicotine; regular exercise; stress management; and reduced bedroom noise.13

In summary, fatigue is the primary feature of SHS and is brought about by the complex interaction of multiple factors. Hence, the management of SHS directed towards fatigue requires a holistic approach that promotes healthy lifestyle interventions, especially nutritional interventions, physical exercise and sleep.


  1. Yan YX, et al. J Urban Health 2012;89:329-338.
  2. Chen J, et al. J Transl Med 2014;12:348.
  3. Bi J, et al. BMJ Open 2014;4:e005156.
  4. Dunstan RH, et al. Nutrition J 2013, 12:115.
  5. Benton D, Young H. Curr Top Nutraceutical Res 2015;13:61-70.
  6. Kim HG, et al. PLoS One 2013;8:e61271.
  7. Yamano E, et al. Med Sci Monit 2013;19:540-547.
  8. Nagai H, et al. Appl Human Sci 1996;15:281-286.
  9. Jones K, Probst Y. Aust N Z J Public Health 2017;41:338-344.
  10. Puetz TW. Sports Med 2006;36:767-780.
  11. Caldwell JA, et al. Neurosci Biobehav Rev 2019;96:272-289.
  12. Sargent C, et al. Int J Environ Res Public Health 2016;13(9). pii: E842. doi: 10.3390/ijerph13090842.
  13. Irish LA, et al. Sleep Med Rev 2015;22:23-36.