Tiredness, Fatigue, and Exhaustion as Perceived by Recreational Marathon Runners, 2018, Olsen et al

Andy

Andy

Retired committee member
Abstract
In this article, we report the results of a study that was part of a five-study concept development project. Our goal was to learn about the nature of illness by exploring variations in the manifestations of fatigue, a symptom that is prevalent in both ill (cancer, depression, chronic fatigue syndrome) and selected nonill (recreational marathon runners, shift workers) populations. In this article, we report results of our study of recreational marathon runners, obtained from unstructured interviews with 13 runners between the ages 19 and 49 years using ethnoscience as the design.

Key findings with implications for practice are the importance of planning recovery periods following large energy expenditures, the value of using dissociative strategies to manage tiredness, and the usefulness of associative strategies and support systems to manage fatigue. Future studies could explore whether these strategies would be useful for management of tiredness and fatigue in other populations.
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Paywalled at http://journals.sagepub.com/doi/abs/10.1177/1049732318785360?journalCode=qhra
 
Manifestations of fatigue
All but one participant said they experienced fatigue and described it in more detail than tiredness or exhaustion. Fatigue was common during a difficult training session or during the last half of a marathon. The first indication of progressing from tiredness to fatigue was described in terms of thinking ability. One participant said, “Your concentration starts to shift . . . you, uh, internalize more.” One participant described exclusion of surroundings to the point of almost getting hit by a car, “ . . . I wasn’t really, uh, processing what was going on around me.” Two participants talked about having difficulty doing simple math calculations while running in the fatigue phase,

. . . you try to do the math in your head, and it would take a really long time to put like eight miles into kilometers . . . something that should be a lot easier definitely took a bit more time.

Participants also described faltering form and posture in their descriptions of fatigue.

Problems with stamina and body processes became much more pronounced. Participants said their legs felt like lead, and their feet ached, to the point that they had to consciously decide to move their legs, “. . . your legs just feel like I’m done; that’s it; no more. I just don’t want to go . . . but still you’ve just got to sort of will them on.” Light headedness, semimetallic taste, and a feeling of being disconnected from surroundings were sometimes perceived to be associated with fatigue, and were seen as an indication to eat a jell pack or drink an energy drink. Many participants described a sense that their hearing was “coming and going,” and they also noted blurry vision, shortness of breath, and a pounding sensation in their heads, particularly during marathon running. While running, several participants also mentioned having difficulty performing fine motor tasks such as buttoning or unzipping something, or tying shoes.

Emotions were more pronounced in this phase, and many participants felt negative thoughts flooding their mind. One runner said,

You just become really negative, I would say. There’s more of a “this sucks, I don’t want to run anymore. Why am I doing this?” And if you’re there it’s a lot harder to push past than it is for, say, that pain that you might be having.

They wanted to stop running and were no longer happy or having fun. One participant described a point in time when this mood change happened:

. . . after about two-and-a-half, three hours, people are quiet. And it’s just sort of a mood swing. You know, everyone’s kind of elated to begin with—and then there’s sort of this realization of, “why am I out here?”

To get through the negative feelings, many participants said they used positive self-talk strategies to “stay positive while feeling negative.”

Socialization was minimal during fatigue. Participants said they tended to focus on themselves and block out others by not talking to them. Nevertheless, social support remained important during fatigue. Although there was little verbal communication, runners described “pulling strength from others.” This phenomenon typically included runners using their running companions, or spectators and family members in the crowd to mentally convince themselves to keep going. Overall, fatigue during a run was viewed as difficult to overcome, but most participants described mentally pushing themselves, so that they could reach the end of the training session or marathon.

During the recovery period following a marathon or a very difficult run, fatigue lingered much longer than tiredness. Participants described having no “pep” postrun. For some, concentration was altered for days after the run. One participant explained, “I would run into walls, and I would stub my toe all the time on corners of doors.” Sleep was also significantly affected by fatigue. Many participants described erratic sleep patterns. Immediately after a run, participants said they would often fall asleep if they sat down in the afternoon, but at night, they had difficulty sleeping. One participant said, “I found that my sleeping patterns were interrupted where you’re waking up during the night, that you’re only sleeping for two or three hours, waking up, and then having some difficulties getting back to sleep.” Another participant described having a “ . . . broken sleep, getting up 2 or 3 times in the night, waking up not rested.”
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This experience of fatigue is a cultural construct. Members of indigenous African and South American tribes have run ultra-long distances for generations and there are no systematic reports of them feeling anything like this. It's clear to me that this exercise-behavior serves as a ritual performance that allows the individual(s) to disengage from their surroundings and feel fatigue and other Conversion symptoms in a socially-sanctioned and even celebrated manner by providing a culturally-plausible excuse for their manifestation. It is a defense mechanism for the individual's psyche, allowing them to explain the Conversion symptoms non-psychogenically and thus justify abnegation of reflective self-examination which, if undertaken earnestly, would reveal the true causes of the symptoms - though at the cost of subsequent likely diminution of self-esteem due to revelation of inadequacy or neurosis due to mental weakness; and/or psychic pain caused by repressed memories of abuse.

It is suggested that these runners work through their existential issues using Graded Marathon Therapy. In the RACE Trial treatment arm, participants will be administered a combined exercise program and talk-therapy treatment that will help them to increase the number of marathons they can perform without producing Conversion symptoms. Participants will start low, at just one marathon per day, and will be administered either Cognitive Behavioral Therapy or psychoanalysis when they begin to feel Conversion symptoms. The goal will be to detach the feelings of fatigue and other Conversion symptoms from exercise-behavior, allowing the participants to address the root causes of their Conversion symptoms while enabling them to perform marathons unencumbered by bodily distress. By the end of the treatment, it is hypothesized that participants in the treatment arm will be able to perform marathons virtually constantly without experiencing Conversion symptoms.
 
Actually could be a useful study, in that it shows that clearly healthy and fit people can quite easily get similar physical sensations and problems (limitations?) after intense physical challenge, so it cannot automatically be ascribed to delusional thinking.

It may actually be a result (in ME/CFS patients) of a pathophysiology in the energy production/utilisation process.
 
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