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The care of patients with post-polio syndrome ought to be carried out by a multidisciplinary team of specialists, including medical professionals, specialists of rehabilitation, psychologists and social workers. Many therapeutic strategies might be employed to reduce the late effects of polio. Today, the management of post-polio syndrome is based on non-pharmacological intervention, including lifestyle modification, decrease of physical activity, rest periods during the day and an individually tailored training program.

Fatigue is one of the most common symptoms of multiple sclerosis (MS) and is associated with reduced quality of life. The fatigue syndrome is characterized by uncontrollable apathy, exhaustion, fatigability and lack of energy. The mechanisms underlying fatigue in MS are still poorly understood but studies suggest that immune and neuroendocrine factors may play a causative role in the development of fatigue. The first step in management of MS-related fatigue is identifying and eliminating any secondary causes (adverse effects of drugs, infections, sleep disorders, metabolic diseases). As the fatigue syndrome in patients with MS cannot be evaluated objectively in the routine clinical setting, a number of scales have been developed. The Fatigue Severity Scale is a general scale. Additional scales that have been tested in MS include the Fatigue Impact Scale. Therapy of fatigue syndrome consists of modafinil, amantadine, pemoline and non-pharmacological management.

Fatigue without coincident depression may accompany many neurological disorders, including multiple sclerosis, Parkinson's disease, motor neuron disease, stroke and post-polio syndrome, and is frequently reported by patients as a predominant complaint. The pathophysiology of fatigue is unknown. The role of various mechanisms has been suggested, including the effect of proinflammatory cytokines (TNF-alpha, IL-1beta and IL-6) on glutaminergic transmission, hypothalamo-pituitary-adrenal (HPA) axis dysfunction, disturbances of astroglia metabolism and decreased levels of the neurotransmitters noradrenaline and serotonin. The diagnosis of fatigue syndrome is based on exclusion of depression and additional organic conditions (anaemia, cardiovascular disorders, kidney diseases or hypothyroidism). The treatment of fatigue syndrome is complex. Physical activity, rehabilitation, psychotherapy and avoidance of factors which may increase fatigue, such as fever, anxiety, depression, pain, sleep disturbances, as well as some drugs like opioids and benzodiazepines, are important. Pharmacological treatment leads to slight improvement. Amantadine, modafinil and pemoline are administered to such patients.

Fatigue or piercing feeling of weakness, lack of strength and energy or total exhaustion is a common complaint of patients with neurological disorders. From 40 to over 90 per cent of individuals with multiple sclerosis, Parkinson disease, amyotrophic lateral sclerosis, neuroboreliosis, post polio syndrome or stroke confirm its experience. It is not infrequently numbered among most disabling complaints. A separate entity, with fatigue as a cardinal sign, is a chronic fatigue syndrome, a disorder, though controversial, more and more frequently diagnosed. Fatigue ought to be discriminated from fatigability, paresis, somnolence and, first of all depression which commonly coexists in chronic disorders. The assessment is almost entirely based on self-estimate scales filled in by a patient. Attainable results of neuroimaging, electrophysiological, polisomnographic, vegetative, psychological and biochemical surveys have not allowed yet to define the pathogenesis of fatigue. The treatment basis consists of behavioral therapy, psychotherapy and a proper treatment of the basic disease.

Fatigue is often related to cancer, and is related to its treatment. Fatigue is the most commonly reported side effect of cancer treatment. It differs from fatigue induced by other causes, because doesn't decrease after period of rest. The fatigue reported by cancer patients is usually described as an unusual, excessive, whole-body experience that is disproportionate or unrelated to activity or exertion and is not relieved by rest or sleep. Cancer related fatigue is multidimensional, subjective experience that has profoundly negative effect on patients' quality of life. Fatigue today is the most commonly reported symptom, for some patients the most unpleasant symptom, and the most distressing side-effect in connection with cancer and/or its treatment. The prevalence of fatigue in patients receiving anti-cancer treatment has been estimated to be more than 80 per cent. The fatigue can be pervasive: patients report that fatigue begins with treatment, continues during the course of chemotherapy or radiation treatment, and declines somewhat--but frequently sustains at a higher-than-baseline rate- after treatment is over. It may also persist for several years even in patients with no apparent disease. Despite of the prevalence of fatigue and its profoundly negative effect on patients quality of life, little is known about the specific mechanisms that underline fatigue in cancer patients or how to prevent it and treat it effectively.

Patients with stable heart failure show decreased exercise tolerance and consequently quality of life. The reduced physical capacity in these patients is a result of decreased strength of skeletal muscles and even their atrophy. The physical activity is limited by metabolic disorders and histological changes in myocytes. Dysfunction of respiratory muscles plays a role in the development of exertional dyspnea. Patients with stable heart failure are recommended to perform low or moderate physical training, which improves exercise tolerance. Intensive physical training in patients with reduced left ventricular ejection fraction improves maximal oxygen consumption through increased left ventricular stroke and increased arteriovenous difference. Recent studies indicate that regular physical training has a positive physiological effect on exercise tolerance, and decreases dyspnea and fatigue, in many patients with heart failure.