Energy Management
Manage fatigue and preserve energy
Review status: Waiting for team review. An AI editorial check was completed on 2026-08-14 by claude-opus-5. It checks clarity, attribution and scope against the sources, and it is not a Compass team or clinical sign-off. Waiting for clinical review. Last updated 2026-08-14.
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Planning 3
- Notice what drains energy mostIdentify the daily tasks that leave you most fatigued.Why it matters: Fatigue in ALS/MND is a limited budget, and you cannot spend it well without knowing where it goes.
- Prioritise what matters mostDecide which activities you most want your energy to go to.Why it matters: Choosing deliberately means the things that matter are not what gets dropped at the end of the day.
- Adjust one routine to reduce effortUse pacing, rest, or help to lower the cost of one activity.Why it matters: Changing one routine is achievable, and it usually shows what else is worth changing.
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Energy conservation means using your energy wisely. You plan and adapt how you do things so that limited energy goes to what matters most to you, rather than being used up on things that exhaust you unnecessarily.
In ALS/MND, this matters because energy can be in shorter supply:
- Weakened muscles work harder, so everyday activities can take more effort and tire you sooner. This includes dressing, washing, moving around, and even talking.
- Fatigue is common, and can have several causes. Some of them are treatable (see the symptom management card).
- Running out of energy can mean missing out on the things you most want to do, or feeling wiped out afterward.
The goal of energy conservation is not to do less for its own sake. It is to do more of what matters by spending your energy thoughtfully. Think of energy like a budget: if you spend it carefully on what you value, you have more for the things and people that matter, and fewer crashes.
What it involves (covered across this card):
- Prioritising. Putting energy into what matters most to you.
- Planning. Organising activities so they are less tiring.
- Pacing. Spreading effort and resting before you are exhausted, not after.
- Making tasks easier. Using equipment, techniques, and a helpful setup to reduce effort.
A mindset that helps: conserving energy is a smart, active strategy, not "giving in". Adapting how you do things so you can keep doing them is a way of staying in control and protecting your quality of life.
How firm is the ground here? Energy conservation is widely recommended by occupational therapists and physiotherapists, but it rests on professional consensus and experience rather than on trials in ALS/MND. The techniques are low risk, and you can adapt them or drop the ones that do not suit you.
This card focuses on the practical side of managing energy. If fatigue is a big problem, also see the symptom management card, since some causes (like night-time breathing) are treatable. The next questions cover planning, pacing, making tasks easier, and who can help.
Evidence for this answer
The sources the Compass team used to write this answer. Highlighted phrases in the answer above correspond to the statements below.
Statement 1 of 2. Fatigue is one of the most commonly reported symptoms in ALS/MND, and several different things can contribute to it.
Supports this. Guidelines for the physiotherapy management of MND — Irish Motor Neurone Disease Association · Clinical guideline · 2014
The MND physiotherapy guideline's fatigue section covers both halves of this. It calls fatigue commonly experienced and worse than in matched people without MND, and it then lists what feeds into it: excessive activity, stress, depression, pain, poor cardiopulmonary function, medication and disturbed sleep.
“Fatigue is a commonly experienced debilitating symptom, and can impact on quality of life for patients with MND (Lou et al., 2003).”
Section 3.4e Fatigue ManagementLink checked August 2026
Adds context. Physical therapy review — Research review
Adds a figure for how common. It reports a survey in which people with ALS ranked fatigue first out of thirteen symptoms, at 90 percent, ahead of muscle stiffness and cramps, and notes that fatigue was also the symptom least often treated. It is one survey sample reported in a review, not a population estimate.
Link checked August 2026
Statement 2 of 2. Some of the things that cause fatigue in ALS/MND can be treated, night-time breathing among them.
Supports this. Guidelines for the physiotherapy management of MND — Irish Motor Neurone Disease Association · Clinical guideline · 2014
The guideline treats night-time breathing as a contributing cause of fatigue that has a treatment. It names poor cardiopulmonary function and impaired sleep as contributing factors, says nocturnal hypoventilation is common in MND and contributes to poor sleep, and recommends that physiotherapists refer for non-invasive ventilation where it applies.
“Assistive devices such as NIV have been shown to improve hypercapnic symptoms such as headaches, restlessness, nightmares and poor quality sleep, and therefore improve QOL in patients with MND (Lou et al. 2010).”
Section 3.4e.2 Evidence, FFLink checked August 2026
Used across the whole answer
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Planning and pacing are the heart of energy management. A few simple, well-known techniques can help. They are often summarised as prioritise, plan, and pace.
Prioritise: decide what matters most
- Choose where your energy goes. Each day or week, identify the things that matter most to you, and protect energy for them.
- Let go of, delegate, or simplify lower-priority tasks. Not everything has to be done by you, or done perfectly.
- Ask: does this need doing now, by me, this way? Often the answer opens up an easier option.
Plan: organise to reduce effort
- Spread demanding tasks out rather than clustering them, and across the week, not all in one day.
- Plan tiring activities for when you have most energy. Energy patterns differ from person to person, so notice your own.
- Build in rest around big activities (an important outing, an appointment), both before and after.
- Prepare ahead. Gather what you need before starting, so you are not making extra trips.
Pace: work with your energy, not against it
- Rest before you are exhausted, not after. The aim is to take breaks before you hit the wall rather than after. Therapists often treat this as the core pacing idea.
- Break big tasks into smaller steps, with rests between.
- Alternate heavier and lighter activities, and sitting and standing tasks.
- Slow down. Doing things at a steadier pace often uses less energy than rushing.
- Notice your warning signs of tiredness, and respond early.
A note on "boom and bust": it is common to overdo it on a good day and then crash. Gentle, consistent pacing usually leaves you better off than big bursts followed by exhaustion. That holds even when you feel able to do more.
These techniques take some experimenting to fit your life, and an occupational therapist can help you tailor them (see the later question). The next question covers making specific tasks easier.
Evidence for this answer
The sources the Compass team used to write this answer. Highlighted phrases in the answer above correspond to the statements below.
Statement 1 of 3. Planning and pacing techniques may help people pace themselves and reduce fatigue.
Qualifies this. Guidelines for the physiotherapy management of MND — Irish Motor Neurone Disease Association · Clinical guideline · 2014
The MND physiotherapy guideline does recommend teaching energy conservation, but it puts it more tentatively than this sentence does. It says the techniques may encourage pacing and may reduce fatigue, and the (4) marks it as the guideline's lowest evidence level, expert opinion and formal consensus rather than trial evidence.
“Teaching energy conservation techniques may encourage patients to pace themselves and reduce levels of fatigue (4).”
Section 3.4e Fatigue Management, recommendation GGLink checked August 2026
Statement 2 of 3. People with ALS/MND are advised to stop and rest before reaching exhaustion, rather than pushing on until they are worn out.
Supports this. Physical therapy review — Research review
This review of physical therapy in ALS says therapists should teach people with ALS not to carry any activity through to the point of extreme fatigue, and suggests spreading effort over several short sessions across the day with enough rest in between rather than one sustained push.
Link checked August 2026
Statement 3 of 3. Steady, consistent pacing is expected to leave someone better off than bursts of activity followed by exhaustion.
Qualifies this. Physical therapy review — Research review
Points the same way but does not go as far. It warns against activity taken to the point of extreme fatigue, lists exhaustion that stops you doing daily tasks the next day as a sign of overuse, and favours short sessions with rest between them. It says this about exercise programmes and offers no comparison showing that steady pacing leaves people better off overall.
Link checked August 2026
Used across the whole answer
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Beyond planning and pacing, how you do a task and how your setup is arranged can save a lot of energy. The idea is to reduce unnecessary effort so you have more left for what matters.
Sit instead of stand:
- Do tasks sitting down where you can. This includes preparing food, dressing, washing, and even some household jobs. Sitting takes the effort of standing and balancing out of the task. A perching stool or chair in the kitchen or bathroom helps.
Make things reachable and ready:
- Keep frequently used items within easy reach, at a comfortable height, to avoid bending, stretching and extra trips.
- Organise your space so what you need most is closest.
- Gather everything before you start a task.
Let equipment do the work:
- Use tools and aids designed to reduce effort for eating, dressing, washing, and jobs around the home (see the daily living tools card). The right aid can turn a tiring task into an easy one.
- Use labour-saving devices and appliances where they help.
- Mobility aids save energy for getting around, leaving more for other things (see the mobility cards).
Position and posture:
- Set things up at a good height to avoid awkward, tiring positions. This applies to work surfaces, chairs, and bed.
- Use supportive seating so you are not using energy just to hold yourself up.
Simplify and accept help:
- Simplify tasks. Try easier-to-manage clothing and fastenings, simpler meals, and lighter loads carried more often rather than one heavy trip.
- Accept and arrange help for the most draining tasks. Letting others take on what exhausts you frees your energy for what you value. That is a smart trade, not a failure.
Watch out for hidden energy-drains, like long phone calls when talking is tiring, or tasks done the hard way out of habit. Small changes add up.
An occupational therapist is expert at spotting these savings for your daily life and home. The next question helps you balance saving energy with doing what matters.
Evidence for this answer
The sources the Compass team used to write this answer. Highlighted phrases in the answer above correspond to the statements below.
Statement 1 of 1. Equipment and adaptive aids are a standard part of ALS/MND care for everyday activities such as eating, dressing, washing and jobs around the home.
Supports this. NICE MND guideline — NICE · Clinical guideline
NICE NG42 covers exactly this list. It tells teams to assess and anticipate daily living needs across personal care, dressing and bathing, housework, shopping, food preparation, and eating and drinking, and then to provide the equipment without waiting. NICE frames the purpose as taking part in daily life and keeping quality of life, rather than as saving effort.
“Provide equipment and adaptations that meet the person's needs without delay, so that people can participate in activities of daily living and maintain their quality of life as much as possible.”
Recommendation 1.10.2Link checked August 2026
Supports this. Guidelines for the physiotherapy management of MND — Irish Motor Neurone Disease Association · Clinical guideline · 2014
The MND physiotherapy guideline says the same thing independently, and adds that aids need reviewing over time as well as providing promptly, because what helps changes as the condition does.
“Timely provision and regular review of aids and appliances is essential in maximising the patient's function.”
Key recommendations, 3.4b.1LLink checked August 2026
Used across the whole answer
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Energy management is not about resting all the time or giving things up. It is about spending your energy on what gives your life meaning. Getting the balance right is personal, and worth thinking about deliberately.
Put energy toward what matters:
- Protect energy for the things you value. That means time with people you love, activities that bring you joy, and the moments that make life feel like yours. These are exactly what energy conservation is for.
- It is fine to "spend big" sometimes. For a special occasion or something important to you, you might choose to use a lot of energy and plan extra rest around it. That is a good use of energy, not a failure of pacing.
Balance with rest:
- Build rest in proactively, rather than only resting when you crash. Plan breaks, and plan quieter days after busier ones.
- Quality rest matters. Good sleep supports your daytime energy, and so does treating anything that disrupts it (see the symptom management card).
- Listen to your body and adjust; your energy will vary day to day.
Let go of guilt and "shoulds":
- You do not have to justify how you use your energy. Choosing rest, or choosing to spend energy on enjoyment rather than chores, is legitimate.
- Releasing lower-value tasks (or handing them to others) is not laziness. It is making room for what counts.
- Some days will be harder, and that is okay; balance is found over time, not perfectly each day.
Keep doing things, adapted:
- The aim is to keep participating in life, finding adapted ways to do what you enjoy rather than dropping it. An occupational therapist can help you find ways to keep doing meaningful activities with less energy cost.
A guiding question: "What do I most want to have the energy for?" Let the answer shape how you plan, pace, and rest. The next question covers who can help you manage your energy.
Evidence for this answer
The sources the Compass team used to write this answer. Highlighted phrases in the answer above correspond to the statements below.
Statement 1 of 1. Poor sleep contributes to daytime fatigue in ALS/MND, and treating what is disrupting sleep can improve it.
Supports this. Guidelines for the physiotherapy management of MND — Irish Motor Neurone Disease Association · Clinical guideline · 2014
The MND physiotherapy guideline lists impaired sleep among the things that contribute to fatigue, and its fatigue section then works through the treatable case: night-time under-breathing is common in MND, it is thought to be a major reason sleep is poor, and non-invasive ventilation improves poor quality sleep and quality of life.
“Nocturnal hypoventilation is a common symptom of MND and is thought to contribute significantly to impaired sleep.”
Section 3.4e.2 Evidence, FFLink checked August 2026
Used across the whole answer
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You do not have to work out energy management alone. Several people can help tailor it to your life, and connect it to anything treatable.
Who can help:
- Occupational therapist (OT). Occupational therapists and physiotherapists both work on energy conservation, and which of them leads on it varies between services. OTs are experts in analysing daily activities and finding ways to do them with less effort, through pacing, technique, equipment, and adapting your home and routine. If energy is a problem, an OT assessment is well worth asking for.
- Physiotherapist. Also teaches energy conservation, and advises on movement, staying active within comfortable limits, conserving energy when moving around, and how to balance activity and rest.
- Your ALS/MND team or doctor. They can look for treatable causes of fatigue (such as night-time breathing changes, poor sleep, or other factors) so you are not just managing fatigue that could be eased (see the symptom management card).
- Dietitian. Nutrition affects energy (see the nutrition card).
- Your caregivers and family. Sharing tasks is part of energy management; coordinating help means you can save energy for what matters (see the caregiver coordination card).
How to get help:
- Ask your ALS/MND team or doctor for a referral to an OT or physiotherapist if you are not already working with them.
- Mention fatigue and energy specifically. Describe how it affects you and what you struggle to do, so support can be targeted.
- Ask the team to check for treatable causes of fatigue, rather than assuming nothing can be done.
Combine the practical and the medical: the best results often come from both practical energy management (this card) and treating any underlying causes of fatigue (symptom management card). Together they can make a real difference to how much you can do and enjoy.
The next question gives you prompts to raise about managing your energy.
Evidence for this answer
The sources the Compass team used to write this answer. Highlighted phrases in the answer above correspond to the statements below.
Statement 1 of 2. Both occupational therapists and physiotherapists work on energy conservation in ALS/MND.
Supports this. Guidelines for the physiotherapy management of MND — Irish Motor Neurone Disease Association · Clinical guideline · 2014
Covers the physiotherapy half. This is an MND guideline written for physiotherapists, and teaching energy conservation techniques sits inside its own fatigue management recommendations, as something the physiotherapist does. Advice on energy conservation also appears in its early, middle and late stage physiotherapy plans.
“Teaching energy conservation techniques may encourage patients to pace themselves and reduce levels of fatigue (4).”
Section 3.4e Fatigue Management, recommendation GGLink checked August 2026
Supports this. NEALS PT/OT guide — NEALS · Practical guide
Places energy conservation with both professions. It describes occupational therapists as the specialists who work with you on taking part in daily activities such as bathing, dressing, cooking, eating, cleaning and working, and it lists activity modification and energy conservation strategies under what a physical therapist or occupational therapist may put in a treatment plan.
Link checked August 2026
Statement 2 of 2. A clinical team can look for causes of fatigue that can be treated, including night-time breathing changes and poor sleep.
Supports this. Guidelines for the physiotherapy management of MND — Irish Motor Neurone Disease Association · Clinical guideline · 2014
Sets out both halves. It names the contributing factors worth looking for, including poor cardiopulmonary function, impaired sleep, pain, depression and medication, tells clinicians to work on those factors and to bring in other professionals where needed, and gives night-time under-breathing as the worked example, with referral for non-invasive ventilation.
“Management strategies should be directed at minimising factors known to impact on these contributing factors, referring to other health professionals as necessary.”
Section 3.4e Fatigue ManagementLink checked August 2026
Used across the whole answer
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A few questions for an occupational therapist, physiotherapist, or your ALS/MND team help you get practical, tailored support for your energy. Pick what fits you.
Getting assessed and tailored help
- Can I see an occupational therapist about managing my energy and daily activities?
- Which of my daily tasks could be made easier or less tiring, and how?
- How can I plan and pace my activities to do more of what matters?
Equipment and setup
- What equipment or aids would reduce the effort of everyday tasks? (See daily living tools.)
- How could I set up my home or routine to save energy?
Fatigue and treatable causes
- Could my fatigue have a cause that can be treated, like night-time breathing or poor sleep? (See symptom management.)
- Who should look into that?
Balancing life
- How do I balance staying active with resting and conserving energy?
- How can I keep doing the activities I enjoy with less energy cost?
- How can my family best help share the load?
Tip: before an appointment, it helps to note when you feel most and least energetic, and which tasks tire you most or stop you doing what you want. This helps an OT target their advice. Bring this with you.
Related cards cover symptom management (treatable causes of fatigue), daily living tools (equipment), physiotherapy (activity), nutrition (fuel), and caregiver coordination (sharing tasks). All of them connect with managing your energy well.
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