This information is sourced from Homerton University Hospital NHS Foundation Trust, Torbay and South Devon NHS Foundation Trust and North Lincolnshire and Goole NHS Trust (NLG) and the Royal College of Occupational Therapists (RCOT):

• The Adult Cardiorespiratory Enhanced and Responsive service (ACERs) team at Homerton Hospital have produced a comprehensive 24 page Post Covid-19 patient information pack which includes a section on the management of fatigue
• The Torbay and South Devon NHS Foundation Trust have provided a shorter 6 page information pack covering advice and support for post viral illness and fatigue which is easily accessible for patients. It covers the key aspects of pacing, effective rest, boom and bust, adapting activities, emotional wellbeing and diet
• The RCOT have a webpage and 3 page patient leaflet which give a practical overview of how to manage post-viral fatigue after Covid-19 for patients who have been treated at home
• Boom and bust is a negative pattern of over-exertion leading to longer periods of fatigue. NLG psychological medicine team describe this succinctly  in their Boom and Bust Cycle document

The ACERs team advise keeping a note of how tiring different activities are as understanding their pattern of fatigue will enable patients to manage and adapt to this better

Patients are advised to then conserve energy using the ‘four Ps’:

Planning

• Organising daily routines according to energy levels e.g. perform strenuous tasks such as dressing early in the day
• Think about the steps that need to be completed and prepare items required for the task
• Keep frequently used items in easily accessible places
• Have duplicate items available to limit unnecessary trips between rooms
• Consider using a bag, basket, or trolley to carry supplies in one trip
• Schedule strenuous activities evenly throughout the week instead of all in one day

Pacing

• Allow plenty of time to complete activities and incorporate frequent rests and relaxation
• Perform tasks at a moderate rate and avoid rushing (which utilises more energy)
• Take a morning or afternoon nap prior to activities or outings to build up energy
• Breathe easily and properly during activities to decrease shortness of breathe
• Rethink activities with rest in mind. For example, sit instead of stand while folding clothes or preparing food

Prioritising

When faced with limited energy reserves individuals must look critically at work, family, and social roles and keep only those roles that are necessary and pleasurable. Consider:

• Can a friend or family member assist with chores?
• Eliminate unnecessary tasks, chores or steps of an activity
• Look for shortcuts and loosen the rules
• Be flexible in daily routines enables you to enjoy activities you would like otherwise miss because of fatigue.

Positioning

Performing tasks may be using more energy than required. Consider:

• Storing items at a convenient height to avoid excessive and prolonged stooping and stretching
• Make sure all work surfaces are at the correct height
• Use long-handled devices such as reachers or telescope cleaning tools to avoid unnecessary bending and reaching
• Facilitate bathing – use a shower seat and a hand-held shower head