Strategies for Recharging

Active Rest and Fatigue Management in MS

“Fatigue feels as if I am an inflatable, and someone has pulled the airstopper out! My brain goes fuzzy, I can’t think clearly, my speech slurs and my eyesight goes. Swallowing becomes more difficult, my balance gets worse, and my legs feel heavy and clumsy.“ 

Fatigue is one of the most common and arguably challenging symptoms experienced by people living with multiple sclerosis (MS). Up to 80% of people with MS report that fatigue interferes with daily activities, work, their quality of life, and more. MS fatigue can also be worsened by things like heat, cold, stress, and infections. It not only drains your energy, but it can bring on or worsen other symptoms like cognitive challenges (cog fog), balance, and pain. Persistent fatigue can be one of the most disabling symptoms of MS, even when other symptoms are well-managed. But hope is not lost! 

The good news is that research has identified a number of evidence-based strategies for managing MS fatigue. These approaches include:  

• cognitive behavioral therapy techniques which address thoughts and behaviors that may exacerbate fatigue,  

• energy conservation methods,  

• exercise programs to increase stamina,  

• mindfulness and meditation practices,  

• sleep-focused interventions,  

• dietary modifications, and  

• medications.  

There is no one-size-fits-all solution. Effective fatigue management typically involves building a flexible toolbox of strategies that can be adapted to your individual needs, environment, and what’s happening in your life right now. In this article, we are going to focus on ways you can build in “active” rest to your day-to-day schedule.  

Your Energy Battery

Think of your energy like a smartphone battery. If you let it drain completely to zero, it takes much longer to charge back up. You’ve likely experienced those days. For example, you can barely get off the couch after a day of intense activity. Or maybe you need 12-14 hours of sleep just to feel minimally functional the next day. However, if you plug in your phone periodically throughout the day, even for short charging sessions, you can maintain a workable battery level for most of the things you need to do. 

This battery principle applies directly to MS fatigue. I often hear my own patients describe trying to get all their to-dos done when they’re feeling good, when they have energy. But this often inevitably leads to a crash later in the day or the next. Instead, we want to plan ahead, build rest breaks into your schedule, and not wait until exhaustion forces you to stop. 

It also means becoming more attuned and aware of your body’s signals. Is your energy gauge at 60%? Take a rest, even if you have some energy left, rather than waiting until it hits 10%. This approach prevents the boom-and-bust cycle that many people with MS experience and keeps your battery at a functional level throughout the day. 

The Power of Intentional Rest

Not all rest is created equal when it comes to managing MS fatigue. Active rest, or the deliberate practice of restorative activities, can be significantly more rejuvenating than just collapsing on the couch. Try building a few of the following activities into your daily schedule, especially if you are noticing increased stress or overwhelm.  

Restorative Rest Practices You Can Try:

• Savasana (Restful Pose): Lie flat on your back on the floor, couch, or bed for 5-10 minutes, consciously relaxing each part of your body while maintaining gentle awareness of your breath. This yoga rest pose can help reduce emotional stress and give your body and mind an energy rest break. 

• Guided Meditation or Hypnosis: In one study, audio recordings of therapeutic hypnosis and mindfulness meditation produced significant reductions in the impact of fatigue after only 4 weeks of regular use, with benefits lasting approximately 6 months. You don’t need special training; guided meditation apps or simple breathing exercises done while lying or sitting down can provide similar benefits. 

• Therapeutic Music: Studies found that listening to calming music reduced fatigue and improved body perception in people with MS. Create a playlist of calming music or nature sounds to listen to during a 5-to-10-minute rest break. 

• Scheduled Rest Breaks: Take short, intentional breaks before exhaustion sets in. For example, work for 25 minutes, then take a 5-minute savasana or meditation break before returning to your task. 

Plan With Your Energy, Not Against It

One of the most effective fatigue strategies is learning when your energy tends to be highest and planning around that window. Have you heard of the 4 Ps – Plan, Pace, and Prioritize, and Position? Research on energy management programs found that the most used and helpful strategies include prioritization, pacing activities throughout the day, learning to say no to non-essential demands, and breaking larger tasks into smaller, manageable chunks. 

Strategic Planning Strategies

• Schedule important or demanding tasks during your higher-energy times (many people find mornings work best) 

• Try to focus on one task at a time to reduce mental switching 

• Decide what truly needs to be done today, and what can wait 

• Break tasks into smaller steps 

• Alternate physical and cognitive activities to avoid overtaxing one system 

• Use assistive devices (mobility aids, reachers, scooters) to save energy for what matters most 

• Delegate or outsource tasks like cleaning or meal prep when possible 

Support Sleep and Recovery

Because poor sleep compounds daytime fatigue, addressing sleep quality is crucial. Cognitive behavioral therapy for insomnia, delivered through telehealth, websites, or apps, has proven effective at improving both sleep quality and fatigue levels. Occupational therapy-based sleep interventions similarly improved sleep quality while significantly reducing fatigue severity and impact. 

A Few Sleep Support Strategies: 

• Adjust bedroom temperature for comfort (cooling can be especially helpful for MS) 

• Reduce screen exposure before bed 

• Use cooling pillows or lightweight blankets 

• If you haven’t already discussed MS symptoms that interfere with sleep, such as muscle spasms or bladder issues with your neurology team 

• Work with a sleep specialist to get targeted strategies for your needs 

Move Mindfully

While exercise can sound counterintuitive when you’re fatigued, research shows that exercise interventions do improve fatigue. Combined training interventions (mixing aerobic, resistance, and sensorimotor exercises) may help to reduce fatigue and improve your overall stamina. The key is finding exercise that supports energy rather than drains it. 

Mindful Movement Strategies: 

• Choose low-impact or adaptive activities that match your current ability 

• Limit duration to avoid overexertion, something is better than nothing 

• Use cooling tools or take breaks to prevent overheating 

• Find an exercise companion or exercise professional (e.g., PT or trainer) to help maintain motivation 

Bringing It All Together

While individual strategies can be helpful, research shows that combining techniques, such as pairing exercise with cognitive behavioral strategies, or integrating mindfulness practices with energy conservation, produced better outcomes than any single approach alone. What works one week may need to be adjusted the next. The key is to experiment with different combinations from your own toolbox. Remember that rest itself is an active strategy, not a failure or a sign of weakness. By intentionally building restorative practices like savasana, rest breaks, meditation, or therapeutic music into your day, rather than waiting for exhaustion to force you into recovery mode, you’re taking control of your energy and giving your body what it needs.