Our Director and specialist physiotherapist, Jessica Sands, has been working as a fatigue specialist for over 20 years and shares her views on how the fatigue landscape has changed since founding Vitality360 15 years ago.
In some ways, the world of fatigue looks very different today than it did 15 years ago, yet in others, we are still dealing with the same core issues. We have lived through a global pandemic and seen the emergence of Long Covid, while also learning much more about neurodivergence and chronic illness. We have watched healthcare change in ways few could have imagined, alongside an explosion in social media influence. While not every change has been positive, we know far more today than we did 15 years ago and can keep embracing change as we work towards improving services for those impacted.
It feels to me that there is growing recognition that those with hidden or non-visible disabilities deserve respect, validation, and compassionate care. There are now far more conversations around neurodivergence, more disabled actors playing important roles, and much greater recognition of often hidden mental health conditions. Topics that were once taboo are entering everyday conversations, allowing those experiencing distress to feel properly heard.
One way to feel heard and validated is to access information online and connect with others sharing similar experiences. At its best, social media can reduce isolation, foster connection, and offer practical support and hope. However, when people are feeling isolated, worried, and desperately seeking help, there is also much snake oil out there. Over the last 15 years, online offerings have expanded, ranging from pills, potions, and fancy devices to sympathetic AI chatbots and “guru-like” followings. Some are simply ineffective, whilst others can be expensive, damaging, or both. We have also seen a huge rise in misinformation (unintentional) and disinformation (intentional) that draw people into stressful, helpless messaging. One example is around exercise, which has become deeply misunderstood and polarised. More generally, social media algorithms actively prioritise angry or sensationalist content over nuance, moderate views, or stories of someone gently getting better over time. Many people have had their beliefs about recovery adversely influenced, spent large sums of money on ineffective remedies, and been left anxious and financially drained. While connection is vital, and I celebrate any positive relationships gained online, a key part of our role now is helping people untangle these confusing, distressing digital rabbit holes and find a clear, evidence-based direction.
One reason why people feel they need to seek so much help online is that the reality of current healthcare provision remains stark: NHS fatigue and Long Covid services are under severe pressure, highly variable, and simply have not kept pace with demand. The closure of specialist clinics and staggering waiting lists leave far too many people unsupported at their most vulnerable moments. Even where services survive (and there are a handful of wonderful services across the UK), many lack the funding to provide the comprehensive, multidisciplinary care required to treat complex, multi-system conditions. These deep structural gaps demonstrate that despite growing awareness, healthcare systems are still failing to deliver the equitable, timely care that patients urgently need.
It has been clinically very helpful to see a richer understanding of how fatigue, pain, hypermobility, mental health, autism, and ADHD can overlap, and why we need to look further than a purely biological model to explain fatigue. More people are receiving diagnoses that help explain lifelong experiences, opening the door to personalised care, insight, and an improved quality of life. Viruses can play a major role in fatigue, especially in the case of Covid or following glandular fever, but there is also a growing recognition of how genetics, trauma, housing, finances, work, and relationships all influence recovery. Perhaps we are now more open to a holistic, 360-degree view of rehabilitation (just in case anyone was wondering where the "360" in Vitality360 came from!). Identifying these wider influences helps people feel less blamed or personally responsible for their condition, encouraging a broader view of the factors both within and outside our control.
Rehabilitation has evolved too. ME/CFS, for example, is still misunderstood, but patient voices are stronger than ever before. Patients have quite rightly demanded a move away from rigid, one-size-fits-all rehabilitation towards more personalised approaches that recognise the importance of pacing, symptom fluctuation, and individual tolerance. The opportunity now is to rebuild confidence in movement through careful, nuanced programmes that listen to the patient experience and support people to get back into the activities that matter to them.
Artificial intelligence is another exciting, yet also somewhat worrying, frontier that was nowhere in sight 15 years ago. Used wisely, it has the potential to help patients organise information, find patterns in their activity or physiological data, and improve access to knowledge. However, we have also seen online programmes being sold that are largely chatbot-based, carrying significant information risks. We firmly believe AI cannot replace human contact with a specialist, and we watch with interest (and some trepidation) as healthcare technology continues to evolve.
The use of gadgets and smartwatches has also become mainstream, with extraordinary capability built into everyday devices. Years ago, we used to lend patients clunky heart rate monitors and biofeedback equipment; now, wearable technology puts valuable biological insights directly into people's hands. This gives people immediate access to the fine workings of their bodies, such as heart rate, sleep quality, and heart rate variability (HRV). These metrics can be very helpful in the early stages as people try to stabilise their activity, but they can also cause unnecessary stress and hyper-focus. We see many people abandoning these devices when they discover they feel better without worrying about the numbers on their wrist. A big part of our role now is helping people learn what works for them intuitively, using tech as a helpful stepping stone rather than a permanent crutch.
Perhaps one of the most positive shifts, particularly following the pandemic, has been the rise of flexible and hybrid working. For many people living with fatigue, greater flexibility has made employment sustainable and life far more manageable. Working from home or embracing flexible hours can be transformative for someone trying to return to or maintain employment while managing a health condition, often making the difference between holding down a job or having to stop work altogether. We watch with interest as the UK prioritises employment support through Keep Britain Working initiatives, seeking to help more people with health conditions and disabilities remain in fulfilling work.
Looking back over the last 15 years, the path for those living with persistent fatigue remains undeniably complex. Navigating confusing online spaces and struggling against under-resourced healthcare services are very real, everyday burdens. Yet amidst these systemic hurdles, we can celebrate a genuine move towards more personalised, patient-centred care, alongside the fact that non-visible conditions are finally being brought into the light. Flexible working is transforming the workplace. The challenge now is to channel this momentum into providing evidence-based care regardless of postcode, and we look forward to continuing to be part of the national conversation as we strive to make a difference for everyone living with persistent fatigue."
The world of fatigue and pain looks very different today than it did 15 years ago. We have lived through a global pandemic, seen the emergence of Long Covid, learned much more about neurodivergence and chronic illness, and watched healthcare adapt in ways few could have imagined. While not every change has been positive, we know far more today than we did 15 years ago.
Long Covid has brought fatigue into mainstream healthcare conversations and accelerated research into post-viral illness. Although it has created diagnostic uncertainty, it has also increased recognition that persistent fatigue is a serious and life-changing condition deserving of attention and investment.
We are also developing a richer understanding of how fatigue, pain, autism and ADHD can overlap. More people are receiving diagnoses that help explain lifelong experiences, opening the door to more personalised care and self-understanding.
Awareness has increased, even if access to services has not kept pace. The closure of many NHS fatigue clinics is deeply disappointing, but it also highlights the need to rebuild services that are equitable and accessible for everyone, regardless of postcode.
Rehabilitation has evolved too. We have moved away from one-size-fits-all exercise advice towards more personalised approaches that recognise pacing, symptom fluctuation and individual tolerance. The opportunity now is to rebuild confidence in safe movement rather than fear it.
ME/CFS is still misunderstood, but patients' voices are stronger than ever before. There is growing recognition that hidden disabilities deserve respect, validation and compassionate care.
The pandemic also taught us that health is shaped by far more than biology. Trauma, housing, finances, work and relationships all influence recovery, encouraging a more holistic view of rehabilitation.
Social media has transformed patient communities. It can reduce isolation, connect people with shared experiences and provide practical support, even though it also requires careful navigation to avoid misinformation.
Artificial intelligence is another exciting frontier. Used wisely, it has the potential to help patients organise information, prepare for appointments and improve access to knowledge, while reminding us that technology should complement, not replace, human care.
Perhaps one of the most positive changes has been the rise of flexible and hybrid working. For many people living with fatigue and chronic pain, greater flexibility has made employment more sustainable and life more manageable.
If there is one lesson from the last 15 years, it is that fatigue and pain are far more complex than we once believed. We still need better services, better research and better listening, but I remain optimistic. Conversations are more open, patients are being heard more often, and healthcare is slowly moving towards seeing the whole person rather than just a diagnosis. That feels like progress worth building on.
From Beverly
Reflecting on the past 15 years, I have witnessed remarkable changes in our field of expertise. For me, the major shift came as a result of the pandemic, when the reality of experiencing debilitating fatigue and associated post-viral symptoms became a matter of universal conversation. What followed was a much deeper, more widespread understanding of fatigue, recognising it as something entirely distinct from everyday tiredness that carries a profound impact on people's lives.
Since then, it has been heartening to see fatigue taken seriously across a wide spectrum of conditions: cancer, MS, rheumatological conditions, TBI, stroke, hypermobility, FND, and, increasingly over the last couple of years, neurodivergence. Individuals are openly talking about their experiences, and health professionals are actively asking about them.
This growing visibility of an invisible symptom has resulted in a much greater variety of people coming to Vitality360 for support, many of whom present with multiple diagnoses. As our understanding of fatigue continues to evolve, the maturity of our multi-disciplinary team places us exceptionally well to support this population and help them optimise their lives