Tabletop gaming, I don't generally use it cause there's plenty of grit and complexity already.
In roll20.net games (and similar online & highly automated venues, the effect is easier to track and I use it there.
As for Vigour, if the combat ends and the person can rest for 5 to 10 minutes, I don't have the fatigue carry forward, saying that the fatigue was cancelled out in the scene. If no rest is available prior to the scene ending, then the fatigue gets to 'catch up and get real'. (Strictly a house rule, but the OP did ask how people dealt with it, and that's how I do).
And you're correct about Tire being effective. Especially combined with Smother effects and combat accrual. You can easily just run outta go juice in a very short while.
