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Important to find out reason for fatigue

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Q: I just started an exercise program two months ago and I notice that I feel more tired than I used to. Why am I so tired?

A: So you figure that you are out of shape and it is time to get healthy. Maybe your physician has told you that your blood pressure is a little high or that cholesterol is at a borderline level. Your weight has crept upward over the past few years and you know that is not a good thing. One of the answers to your problem is to get more exercise and become physically fit. The benefits of a regular exercise program include gaining more energy, stamina and experiencing less fatigue. So, if you start to feel more fatigue, it is definitely something you should pay attention to and seek medical attention.

Exercise-related fatigue

Could the fatigue really be due to exercise? That is the first thing you should consider if you felt fine before you started the exercise program. It is possible that your fatigue could be a consequence of frequent exercise. Here are some of the possible reasons for the fatigue:

1) Overtraining syndrome: Too much exercise! If you previously were doing a low amount of exercise/no exercise and then started a training program, there may be a threshold where your body just says "no more." Your muscles are sore, you need more sleep and you are getting cranky. You do not need to train for a marathon to become fit, but if that is your goal, you need to know how to train and pace yourself. A full-blown overtraining syndrome is more common in athletes but even beginners can run into trouble. The only way to get rid of the fatigue is to cut back the amount of vigorous exercise that you are doing until the symptoms improve. Regular aerobic exercise can improve your immune system but you will get more frequent colds and a susceptible immune system if you overdo it.

2) Low iron: This is more of an issue for females, but can affect men as well. If you are a woman who has heavy menstrual periods or a poor dietary intake of iron, a new exercise program can further deplete your iron supply and lead to anemia. There can be iron loss through the gastrointestinal tract with a lot of impact exercise. This is more common in long-distance runners.

3) Cardiovascular problem: A blockage in a coronary artery may not give you any symptoms until you engage in more vigorous exercise. Certainly, if you have pain in the chest/arm/jaw or back that improves when you stop the exercise, you may have a coronary artery problem. However, not everyone feels pain with this problem. You may feel fatigue as the main symptom. There are also some other heart/blood vessel problems that produce fatigue with exercise. Your physician can assist you in sorting out the possible causes.

Other Fatigue

Sometimes, you have fatigue before you start an exercise program and you become even more tired once you start the exercise program. New fatigue that is not just exercise related requires medical investigation. An untreated medical problem can make exercise a discouraging experience because it feels like you just cannot shake the fatigue problem.

1) Hypothyroidism: Low energy levels, cold intolerance, constipation, depression, weight gain-these are just a few of the symptoms of hypothyroidism. You will require a blood test to see how your thyroid gland is functioning. If you already know that you have hypothyroidism, you may not have the right dose of thyroid hormone medication.

2) Systemic conditions: There are too many possible conditions to list here, but these would include problems such as lupus, rheumatoid arthritis, chronic fatigue syndrome, diabetes, cancer, multiple sclerosis, chronic sinusitis, hepatitis, HIV and high blood pressure.

3) Stress, anxiety, depression: The mind does affect the body and you will definitely feel more tired if you are suffering from stress, anxiety or depression. In fact, fatigue may be one of the first signs of a mental-health problem. Do not suffer in silence. The right treatment along with appropriate exercise will help you feel better.

4) Alcohol: Everyone is different in how tired they feel after alcohol consumption. However, this is a simple change you can make in your lifestyle, do not drink before you exercise. Also, if you feel too tired to exercise, take a look at how much alcohol you drank the night before. Alcohol also disrupts restful sleep.

5) Sleep disruption: You will not enjoy exercise if you are always tired. It is also difficult to motivate yourself when you are tired. This can become a vicious cycle: too tired to exercise and more fatigue because you are not exercising. If you are not having a good sleep, you need to address this problem as a priority. If you do not know why you have poor sleep, a sleep study may be indicated.

The bottom-line is not to give up on exercise, find out why you have the fatigue first. With a few adjustments, almost everyone can reap the energy benefits of exercise.

Dr. Maureen Kennedy MD, CCFP, FCFP, MSc, PhD(c) Kinesiology, Dip. Sport Med., is a sport and exercise medicine physician at Sport for Life Centre, www.sportmedicinecentre.ca

Readers are welcome to ask Dr. Kennedy questions, but due to the volume of requests, replies are not guaranteed.

askthedoctor@freepress.mb.ca

Republished from the Winnipeg Free Press print edition May 1, 2012 D1

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