Cano Webinar Cancer Related Fatigue1

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Teaching Patients about

Second level
Cancer
Third levelRelated Fatigue (CRF)
Fourth level
Fifth level
Joan Hamilton
CNS Cancer Care
QEII Cancer Care Program, Halifax
Joan.hamilton@cdha.nshealth.ca
902-473-5407
11/26/2013
Nov 2013 J Hamilton
Learning Objectives
Click
edit Master
text styles
Identifyto
screening
& assessment
tools for CRF.
Second level
Identify
different
Third
level topic areas relevant to the teaching of CRF.
Fourth level
Fifthfor
level
Describe content
selected topic areas that should be
considered when teaching patients and family members

about CRF.
Describe different patient resources for CRF.
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Nov 2013 J Hamilton

Measuring Fatigue
Screening for fatigue: ESAS or ESAS -R

Second level
Third level
0
1
2
3
No
Fourth level
tiredness
Fifth level
10
Worst possible
tiredness
Worst possible
drowsiness
No drowsiness
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Nov 2013 J Hamilton
The Click
Fatigueto
Pictogram
Fitch, Bunston,
Mings, CONJ
Winter 2012
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title
style

Second level
Third level
Fourth level
Fifth level
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Nov 2013 J Hamilton
Focused Fatigue Assessment

Conduct
a focused
Second
level assessment if patient rates fatigue
>4 (moderate
Third levelor severe fatigue)
CPAC
Fourth level
Fifth level
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Second level
Third level
Fourth level
Fifth level
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When did the fatigue begin? How long has it been as
bad as it is today/this week)?
P Provoking What do you do to relieve the fatigue? What makes
O
Onset
When
did
the
fatigue
start? How
long has it been What
as bad as it isways
today/this week)?
the fatigue
worse
/better?
have you
Palliating
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Master
text
styles
Pattern?
Constant? Intermittent?
Duration
when it is present? Changes over time?
P
Provoking
Whatto
makes
the fatigue worse /better?
What
ways have
you found to influence/
helpdo you
found
influence/
help
your
fatigue?
How
Palliating
your fatigue? How do you prevent it from becoming worse? Current activity level?
Secondprevent
level
What do you do for exercise now? /in the past?
Relaxing Activities?
it
from
becoming
worse?
Current activity
Q
Quality
Describe what the fatigue is like: physically, your thoughts, your feelings, changes in
how you are behaving,
R Third
level
level?
What do you do for exercise now? /in the past?
Radiating
Other symptoms associated with fatigue(sleep, pain, mood, depression, appetite,
nutritional intake)
Fourth
level effects(eg: socializing, relationships, ADLs, memory, concentration)?
Relaxing
Day-to-dayActivities?
S
Severity
(0-10 rating: current, usual am/pm rating. What would you have rated it last week?
Fifth
level
Describe
what
fatigue
is like: physically, your
Q Quality
(intensity)
What would
you rate itthe
at its worst/best
thru day?
(If person cant quantify: rate as better/worse than before, or mild/mod/severe)
thoughts,
your
feelings,
in how
you
T
Treatment
What ways have
you found
to manage yourchanges
fatigue(what is helpful).
Not helpful?
How are
effective are they? What advice have you been given (worse /best advice)?
U
Under-behaving.
Beliefs re: cause of fatigue? Concerns? E.g., What about it concerns you the most?
standing
How bothered are you by your fatigue?
V
Values Other
Goalsymptoms
for this fatigue? What level
of fatigue is acceptable
to you?fatigue(ie.sleep,
associated
with
R Radiating
What would be livable?
Also consider:pain,
past historymood,
of symptom, disease
status, anemia, infection,
treatment history,
medications,
depression,
appetite,
nutritional
intake)
other possible stressors, nutritional intake, appetite/wt changes, family perspectives
Physical Exam:
gait, posture, range of motion,
eyes (conjunctival
pallor if anemic), hypothyroidism,
Day-to-day
effects(eg:
socializing,
relationships,
Reference: O,P,Q,R,S,T,U,V Assessment System, Fraser Health Report. in Pan-Canadian Practice Guidelines
(fatigue) February
2011. Adapted
for Therapeutic
Practices in Distress Management Course. Spring 2013.
ADLs,
memory,
concentration)?
IPODE Project/EDOPI Projet http://www.capo.ca/ipode-project
O Onset
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Master title style
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Nov 2013 J Hamilton

Fatigue Duration: constant ?change over time? Pattern?
Severity 0-10 rating: current, usual am/pm rating. What would
(Intensity) you have rated it last week? What would you rate it at its
worst/best
thru
day?
O
Onset
When did the
fatigue start?
How long has it been as bad as it is today/this week)?
Click to editPattern?
Master
text
styles
Constant? Intermittent?
Duration
when it is present? Changes over time?
ChangeWhat
inmakes
medication(including
OTC)?
T Treat P Provoking
the fatigue worse /better? What ways have
you found to influence/ help
Palliating
your fatigue? How do you prevent it from becoming worse? Current activity level?
Second
What do you
do for exercise
/in the past?
Relaxing Activities?
Whatlevel
ways
have
younow?
found
to manage
your fatigue(what
ment
Q
Quality
Describe what the fatigue is like: physically, your thoughts, your feelings, changes in
how you are
behaving,
is helpful).
Not
helpful? How effective are they? What
R Third
level
Radiating
Other symptoms associated with fatigue(sleep, pain, mood, depression, appetite,
nutritional intake)
advice
Fourthhave
level you been given (worse /best advice)?
Day-to-day effects(eg: socializing, relationships, ADLs, memory, concentration)?
(0-10 rating:
current,Concerns?
usual am/pm rating. What
would What
you have rated
it last week?it concerns
Beliefs
re:
cause
E.g.,
about
U Under- S Severity
Fifth
level
(intensity)
What would you rate it at its worst/best thru day?
(If person cant quantify: rate as better/worse than before, or mild/mod/severe)
standing
you
the
most? How bothered are you by your fatigue?
T
Treatment
What ways have you found to manage your fatigue(what is helpful). Not helpful? How
are they? What advice have you been given (worse /best advice)?
Goal foreffective
this
fatigue?
What
level
fatigue
is acceptable
V Values U UnderBeliefs
re: cause
of fatigue? Concerns?
E.g., What
about of
it concerns
you the most?
standing
bothered are you by your fatigue?
to you?How
What
would
be
livable?
V
Values
Goal
for this fatigue?
What level
of fatigue
is acceptable to you?
S
What would be livable?

Also consider:
symptom,
disease
status,
anemia,
infection, treatment
Also past
consider:history
past history of
of symptom,
disease status,
anemia, infection,
treatment
history, medications,
other
possible stressors,
nutritional
intake, appetite/wt
changes, familyintake,
perspectivesappetite/wt changes,
history, meds,
other
possible
stressors,
nutritional
Physical Exam: gait, posture, range of motion, eyes (conjunctival pallor if anemic), hypothyroidism,
Reference: O,P,Q,R,S,T,U,V
System, Fraser ROM,
Health Report.
in Pan-Canadian Practice
Guidelines
family perspectives.
Physical:Assessment
gait, posture,
conjunctival
pallor,
hypothyroidism
(fatigue) February 2011. Adapted for Therapeutic Practices in Distress Management Course. Spring 2013.
Reference: O,P,Q,R,S,T,U,V
System, Fraser Health Report, in PanIPODE Project/EDOPI Projet Assessment
http://www.capo.ca/ipode-project
Canadian Practice Guidelines (Fatigue) Feb 2011. Adapted for Therapeutic Practices
11/26/2013
Nov 2013 J Hamilton
8
in Distress
Management Course. Spring
2013. IPODE Project/EDOPI Projet
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to
edit
Master
title
style
Fatigue/Tiredness Protocol (COSTaRS)
Tell me what number from 0 to 10 best describes how tired
Click
edit Master text styles
you areto
feeling.
How
worriedlevel
are you about your fatigue/tiredness? (0-10)
Second
Third level
Do you have the following: shortness of breath at rest, sudden
Fourth fatigue,
level
onset of severe
excessive need to sit or rest, rapid
Fifthblood
level loss, or pain in your chest?
heart rate, rapid
How would you describe the pattern of fatigue?
(intermittent/constant)
Does your fatigue interfere with your daily activities at home
and/or at work? Describe.
Are there times when you feel exhausted? Describe.
Stacey D for the Pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) Steering Committee.
Remote Symptom Protocols for Individuals Undergoing Cancer Treatment. University of Ottawa School of
Nursing and the Canadian Partnership Against Cancer, Ottawa, Ontario, Canada,March 2013.
11/26/2013
Nov 2013 J Hamilton

Click to edit
Teaching
Master
Patients
text styles
about CRF
Second level
Third level
Fourth level
Fifth
level
10 minute
video on CRF
By Mike Evans
Goggle: cancer related fatigue Mike Evans
11/26/2013
Nov 2013 J Hamilton
10

Topic Areas for CRF Patient Teaching
Description of CRF
Second
Thelevel
Difference Between CRF & Usual Fatigue
Third
level of CRF
Symptoms
Fourth level
Rating/Measuring CRF
Fifth level
Patterns of CRF
Causes of CRF
Things that Contribute to CRF
Results, Consequences & Cost of CRF
Depression & Fatigue
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12
The Difference Between CRF & Usual Fatigue

CRF isMaster
more intense
severe, & lasts longer
commonly
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text&styles
CRF can be overwhelming & unrelenting(unending)
Second level
CRF commonly present without having performed physical
Third level
activity (not
consistent with the amount of activity done)
Fourth level
loss of energy
& strength
for a much longer time than regular
Fifth
level
fatigue
CRF not relieved with rest/sleep like usual fatigue
CRF persists over time, with an uncertainty of when it is
going to go away
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13
The Difference Between CRF & Usual Fatigue

lastto
foredit
weeks,
months text
or even
years
can
Click
Master
styles
interferes with quality of life for person with cancer &
Second level
commonly for family members
Third level
differentfrom
any other fatigue you have ever felt
Fourth level
Fifth level
called CRF because it is different from other fatigue
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14
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edit
Master
title
style
Depression and Fatigue
Depression contributes to fatigue & fatigue contributes to
depression.
Second level
Third level
Not uncommon for someone with fatigue to have depression.
Fourth level
Fifth level
Sometimes hard to determine if someone has fatigue,

depression or both.
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15
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edit
Master
title
style
Questions that may help determine if you are depressed:
Are you feeling sad/empty? How much of the day are you sad?
Second level
How long have you been feeling this amount of sadness?
Third level
(or is it more frustration because you are too tired to do what
Fourth level
you want to do)?
Fifth level
Are you feeling helpfulness, hopeless, worthless, lacking
confidence?
Are you getting enjoyment from things that usually give you
pleasure?
Do you think they are depressed?
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16
Click to
edit
Master
title
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Have
Clickyoutothought
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text
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about killing
yourself?
Second
Doyou
have alevel
plan of how you would do it?
Third level
Fourth level
Fifth level
Depression is treated differently from fatigue. If you think

you may be depressed, talk to your HP.
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17

Click
Management
to edit Master
of Cancer-Related
text styles
Fatigue
Second level
Third level
Fourth level
Fifth level
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From
Cap Map
in CPAC
Fatiguetitle
Guidelines
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to edit
Master
stylep.42

Second level
Third level
Fourth level
Fifth level
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From
Cap Map
in CPAC
Fatiguetitle
Guidelines
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to edit
Master
stylep.42

Second level
Third level
Fourth level
Fifth level
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Click
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title
style
Topic to
Areas
for Master
CRF Patient
Teaching
Strategies for Managing Mod to Severe CRF

Click
Treatto
theedit
treatable
Master text styles
Talking
About
Second
level& Keeping Track of Your Fatigue
Exercising/Physical
Activity
Third level
Education,
Counseling
& Support
Fourth
level
Conserving
Energy
Fifth
level
Nutrition
Improving Your Sleep
Distracting Yourself with Activities & Nature
Thinking & Remembering
Fatigue is a Family Affair
Contact a Health Professional immediately if:
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21
Talking About & Keeping Track of Your Fatigue
to your
HCP about
yourtext
fatigue.
Talk
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to edit
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styles
Dont assume that it isnt as important as other symptoms
Second level
or nothing that can be done to help ease it.
Third level
Fourthtolevel
May be helpful
keep track of or log your fatigue.
Fifth
level or log.
Consider using
a journal
Is there a pattern? When is it worst/least thru day?
How fatigued are you after different activities?
How long does it take you to recover from doing activities?
Rate how severe it is every couple of weeks (not daily).
This information can be helpful in planning your activities.
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22
ClickExercising/Physical
to edit MasterActivity
title style
Research shows that exercise will improve fatigue symptoms.
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to the
editmost
Master
textproof
styles
(Probably
convincing
there is for improving
symptoms
fatigue).
Secondoflevel
Third level
Often, exercise
the last thing people feel like doing.
Fourth is
level
Fifth level
With CRF, it takes energy to make energy.

A person gains energy by exercising , rather than draining
energy by doing nothing.
Check with a HP before beginning to exercise.

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Exercising/Physical Activity
fatigue is no longer severe(7-10) for most of the

Once
Clickyour
to edit
Master text styles
day, probably time to put some exercise into you day.
Second level
Third level
Goal: Gradually work up to 30 minutes of moderate exercise
Fourth level
most days of the
week.
Fifth level
An example: Start out with 2-3 mins of walking, rest a min,

walk 2-3 mins, rest a min. Gradually work up to 10 mins of this.
Then, gradually the rest times in that 10 mins until
you are walking a full 10 mins with no rest.
Then, begin adding more walking & so on.
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24

you cant do 30 mins of exercise at one time, break it into 2-3

IfClick
to edit Master text styles
sessions ,but as a goal, not <10 mins of exercise at each time.
Second level
Third level
Over time, gradually push yourself to increase that 10 mins .
Fourth level
Fifth level
Most people, start with walking. (stretching or yoga).

Some move to swimming or biking as they get more energy
but many just continue with purposeful walking
(arms swinging & a good stride).
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will probably
you
Moderate
Click to exercise
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text make
styles
sweat a bit.
Second level
Third level
Moderate
exercise can cause you to be
Fourth level
slightly out of breath
but still be able to
Fifth level
talk. If you get too winded, slow your pace
down but keep moving to keep your heart
rate up.
If exercise makes you feel or continually

sore, talk to your HP.
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Strengthening should be added to build muscle & bone strength.
Second level
Third
levelyou are doing your full 30 mins of exercise
Can start
it before
Fourth level
most days of week.
Fifth level
Strengthening will help your walking. Weights or elastic bands

can be used. Begin with low weights (1 lb) & low repetitions.
Cycling, alternating stepping and yoga are also examples of
strengthening.
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ClickExercising/Physical
to edit MasterActivity
title style
Exercise should be done during day when you have the most
energy
Click to
Master
text
(notedit
end of
day when
yourstyles
usually tired).
Second level
The exercise
should not make you feel like you want to go to
Third level
bed for the
rest of
the day. Pace yourself.
Fourth
level
Fifth level
Resting afterwards does not mean going to bed. Maybe sit

with feet up for 20-30 minutes and read or listen to music.
Important to set realistic goals. If you need more assistance,
consult PT.
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balance or unsteadiness issues: consider using a cane or

IfClick
walker until you feel solid, steady and safe.
Second level
Third level
If you are unable to stand or walk you can modify an exercise
Fourth level
program with
a PT (ie. like low intensity seated exercises)
Fifth level
If you have fever(or another infection), talk to HP.

You may be advised to wait until it is resolved so that their
energy is used to fight the infection
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29
Click
to
edit
Master
title
style
Education, Counseling &Support
Including(incorporating) helpful strategies in your daily life.
Second
level
Learning
skills/techniques
to manage stress & fatigue.
Third level
Fourth level
Exploringways
of managing different feelings & thoughts
Fifth level
around fatigue.
Learning from others who have CRF.
Distracting yourself.
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Click to edit
Master
title
style
Conserving Energy
conservation (EC) is an approach used to manage CRF.
Energy
Click to
Second level
EC means finding a balance between rest & activity,

Third level
conserving energy so that it can last through the day.
Fourth level
Fifth level
The need for EC will depend on the severity or level of fatigue

you are is experiencing.
For a person with CRF, it takes a much longer time for their
energy to be replaced.
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Second level
Third level
Fourth level
Fifth level
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Click to edit
Master
title style
Conserving
Energy
Usually need to place more attention on EC when a person is
Click
to edit
Master
textorstyles
experiencing
moderate
fatigue
greater (rating of 4 or >).
Second level
Third
level
An OT
can help
with energy conservation strategies.
Fourth level
Fifth level
A person who is at the top end of the fatigue scale,

experiencing severe fatigue, will need detailed education &
support to manage their days.
There are a number of strategies for conserving energysome
call them the 5Ps.
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Click to edit Pacing

Master title style
When you start feeling fatigued, stop the activity, rest &
then
Clickcontinue.
Second level
Break tasks
Thirddown
level or take a number of breaks.
Fourth level
Fifth
level your body & mind for a period of
Resting means
resting
time. It does not mean sleeping.

If you push yourself too far, it often results in not being
able to do anything for the rest of the day. If you really
push it, it can wipe you out for 2-3 days.
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Click to edit Pacing

Master title style
Learning how much energy you have for different activities, &
how
Click
to
edit
Master
text
styles
much you need to rest, is a trial & error process &
Second
levelperson.
different
for each
Third level
Fourth level
Do one activity
at a time.
Fifth level
Avoid rushing.
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Planning
your
Include
others
in your
planning & share your
Plan
Click
today.
edit
Master
text
styles
plan with those who need to know.
Second level
Third level
Plan activities
when you are least fatigued.
Fourth level
Rest when you
arelevel
most fatigued.
Fifth
Plan so there can be a rest period before & after activities.

Resist adding unplanned events into your days.
Plan the easiest ways of doing things, requiring the least
amount of work.
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Prioritizing
most
important
things
you want to do in your
What
Clickaretothe
edit
Master
text
styles
day?
Second level
Third level
What is realistic
to get done?
Fourth level
Fifth level
What activities can wait until another time or day?

Do you actually need to do the task yourself or can someone
else do it?
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37
Click toPosition
edit Master
title
style
and Posture
while standing
& sitting.
Keep
Clickgood
to posture
edit Master
text styles
Use good body positioning.
Second level
Make sure your work area is at a height good.
Third level
Avoid reaching.
Keep what is needed handy.
Fourth level
Use walking aids.
Fifth level
Dont do heavy lifting .
Slide (push or pull) objects instead of carrying them.
It takes 25% less energy to sit rather than stand, so sit when
you can.
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Severe Fatigue
who experience a
Group
Clickoftopeople
edit receiving
Master treatment
text styles
period of really intense fatigue.
Second level
It often occurs with dose dense chemo ---ie, treatment for
Third level
some blood
cancers, intensive chemo, BMT, with major
Fourth level
complications.
Fifth level
People with this severe fatigue have difficulty doing basic
activities of daily life.
It is not understood why some people can become so
severely fatigued.
Sometimes treatment can be delayed or discontinued.
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39
Click
to
edit
Master
title
style
Energy Conservation with Severe Fatigue
Conserve energy for the simplest of tasks.
An OT helps people learn how to conserve energy for
Second level
everyday activities.
Third level
Important to keep doing some activity.
Fourth level
Fifth level
If you dont work at it, push yourself a bit, you will get weaker.
Often takes baby steps to begin getting out of bed and
spending time in the chair.
Building stamina is a gradual process.
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Stay out of Bed!!
heart
a muscle
& it gets
outstyles
of shape like other muscles
The
Click
toisedit
Master
text
when
it isnt being
Second
level worked as much as usual.
Third level
The heartgets
out
of shape quickly by lying down for most of
Fourth
level
Fifth
level& circulation problems)
day. ( risksfor
lungs
Unless you are napping, not feeling well, really fatigued, or

need to be in bed for medical reasons, you should really be up
as much as possible (moving around, sitting in the chair)
Nov 2013 J Hamilton

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Stay out of Bed!!
edge
of the bed
Sitting
Click at
tothe
edit
Master
text
does
not provide
Second
levelback or arm
support.
It can
be very tiring.
Third
level
styles
Fourth level
Fifth
So when sitting
up,level
choose in a chair with

both back and arm support.
Nov 2013 J Hamilton

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Click toImproving
edit Master
title style
Your Sleep
Improving sleep can improve feelings of fatigue.
Second
levelthe same routine for going to bed.
Develop
& follow
Third level
Fourth
leveldo quiet things like read or listen to calm
Before going
to bed,
Fifth level
music, have hot
milk, have a bath (lukewarm not hot).
Go to bed & get up at same time every day. (helps the body get
into a rhythm & relax). It may take a while to get into a
bedtime routine. People say it is worth it.
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Click toImproving
edit Master
title
style
Your Sleep
Dont spend time in bed unless sleeping. reading or TV in
bed.
Click
to lay
edit
Master
text
Dont
in bed
once you
arestyles
awake in the morning.
Second level
Third level
Napping
Fourth
level
Limit naps.
(Taking
a number of small naps thru the day often
Fifth
level
interferes with
night
time sleep, as does taking a nap in late
afternoon nap or napping too long).
Goal: avoid napping thru the day.
Try to only have one nap, early afternoon
Stop all the cat naps
20-30mins? 1 hour?
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you cant
sleep Master
when youtext
go to styles
bed, dont toss & fret for
IfClick
to edit
hours. Get up after 15 mins. Try doing a quiet activity & when
Second level
you get sleepy, do the bedtime routine again & go to bed.
Third level
Fourth level
If you wake in the
Fifthmiddle
level of the night & cant get back to
sleep, it is recommended that you get up after 15 mins,

do a quiet activity & return to bed when you get sleepy.
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on, avoid
caffeine
& other stimulation like
From
Clicklate
toafternoon
edit Master
text
styles
exercising.
Second level
Third level
Getting daily
exercise tends to help a person sleep better.
Fourth level
Fifth level
Sleep in a cool quiet place.

Dont watch the clock.
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Click
to
edit
Master
title
style
Contact a Health Professional immediately if:
if
Click
CRFtosuddenly
edit Master
getstext
much
styles
worse
Second
levelloss of balance (new)
feeling
dizzy,
Third level
suddenly
get
SOB
at
rest
(or
SOB
gets
worse)
Fourth level
Fifth
level
rapid heart
rate
pain in chest
loss a lot of blood
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47
Patient Resources

Cancer Related fatigue MikeEvans Video online

Second level
Third level
Fourth level
Fifth level
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A Pan-Canadian Practice Guideline: Screening, Assessment and Care of Cancer-Related Fatigue
in Adults with Cancer
Howell D, Keller-Olaman S, Oliver TK, Hack T, Broadfield L, Biggs K, Chung J, Esplen MJ,
Gravelle, D, Green E, Hamel M, Harth T, Johnston P, McLeod D, Swinton N, Syme A, and
Olson K on behalf of the Cancer Journey Advisory Group of the Canadian Partnership
Against Cancer.
Toronto:
Canadian Partnership Against Cancer (Cancer Journey Advisory
Third
level
Group) and the Canadian Association of Psychosocial Oncology, Feb 2011.
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http://www.capo.ca/Fatigue_Guideline.pdf

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A Pan-Canadian Practice Guideline: Prevention, Screening, Assessment and Treatment of Sleep
Disturbances in Adults with Cancer
Howell D, Oliver TK, Keller-Olaman S, Davidson J, Garland S, Samuels C, Savard J, Harris C, Aubin
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Pan-Canadian Practice Guideline: Screening, Assessment and Care of Psychosocial Distress

A(Depression,
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Howell D, Keller-Olaman S, Oliver T, Hack T, Broadfield L, Biggs K, Chung J, Esplen M-J, Gravelle D,
Green E, Gerin-Lajoie C, Hamel M, Harth T, Johnston P, Swinton N, Syme A. A Pan-Canadian
Practice Guideline: Screening, Assessment and Care of Psychosocial Distress (Depression,
Third level
Anxiety) in Adults with Cancer, Toronto: Canadian Partnership Against Cancer (Cancer Journey
Action Group)
and
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level Association of Psychosocial Oncology, August 2010.
http://www.capo.ca/ENGLISH_Depression_Anxiety_Guidelines_for_Posting.pdf
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http://www.evolute.ca/oncology_research_project/
Kristina Karvinen kristina@nipissingu.ca
Learning modules : Physical Activity for Cancer Survivors
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Fitch,M. , Bunston,T. & Mings,D. (2012). The fatigue pictogram: assessing the
psychometrics of a new screening tool. Canadian Oncology Nursing Journal, Winter,
22(1), 42-46.
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Cano Webinar Cancer Related Fatigue1

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Teaching Patients about

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considered when teaching patients and family members

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Screening for fatigue: ESAS or ESAS -R

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Focused Fatigue Assessment

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Focused Fatigue Assessment

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Focused Fatigue Assessment

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What would be livable?

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The Difference Between CRF & Usual Fatigue

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The Difference Between CRF & Usual Fatigue

called CRF because it is different from other fatigue

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Sometimes hard to determine if someone has fatigue,

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Depression is treated differently from fatigue. If you think

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Strategies for Managing Mod to Severe CRF

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Talking About & Keeping Track of Your Fatigue

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With CRF, it takes energy to make energy.

Check with a HP before beginning to exercise.

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fatigue is no longer severe(7-10) for most of the

An example: Start out with 2-3 mins of walking, rest a min,

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you cant do 30 mins of exercise at one time, break it into 2-3

Most people, start with walking. (stretching or yoga).