Pacing: An essential strategy for living better with chronic illness

What is pacing?

Borrowed from the sports world, the term “pacing” refers to managing rhythms or adapting activity levels and is now widely used in healthcare and rehabilitation.

Pacing helps better manage symptoms by promoting regular, appropriate activity. It’s often integrated into therapeutic approaches such as pain management programs, cognitive-behavioural therapy (CBT), and acceptance and commitment therapy (ACT).

Unlike simply reducing effort or responding reactively to symptoms, pacing takes a proactive stance aimed at improving overall quality of life. It’s an energy management approach that balances activity and rest periods to reduce symptom flare-ups in people with chronic illnesses and promote recovery.

This method encourages conscious self-regulation of effort to maintain physical and cognitive stability. To successfully implement pacing, chronic illness patients must understand and adapt to their capabilities. This involves recognizing limits, taking action when possible, and respecting the need for rest. Setting priorities also helps patients focus on what truly matters to them.

How does pacing work?

Pacing relies on a few simple principles:

• Scheduled total rest periods throughout the day, involving no stimulation, in a calm, lying-down position.
• Planning energy-demanding activities ahead of time.
• Breaking up activities into smaller tasks with regular breaks.
• Choosing activities that match available energy, respecting safe durations and intensity.
• Prioritizing essential tasks.

Pacing is used to manage various chronic illnesses, such as Charcot-Marie-Tooth disease (CMT), HIV, chronic obstructive pulmonary disease (COPD), rheumatoid arthritis (RA), fibromyalgia, Ehlers-Danlos syndrome (EDS), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and long COVID.

Physical exercise can also be part of pacing, depending on the patient’s health. The guiding principle is to align activities with the patient’s functional capacity, avoiding symptom flare-ups. Pacing contrasts with programs that set predefined goals or progressively increase activity, which may trigger setbacks.

What are the benefits of pacing for chronic illness?

Reduces fatigue

By incorporating rest, pacing helps many patients alleviate chronic fatigue symptoms, gradually increasing their capacity.

Improves quality of life

Managing energy more thoughtfully allows patients to engage in meaningful activities without worsening their condition. Whether it’s spending time with loved ones, pursuing hobbies, or managing daily tasks, pacing restores a sense of control over life.

Prevents symptom flare-ups

By identifying and modifying high-energy activities, patients can avoid post-exertional malaise (PEM), which is a common issue in conditions like ME/CFS and long COVID. PEM refers to prolonged worsening of symptoms following even minor exertion, often delayed by a day or two. This can hinder recovery and lead to long periods of inactivity. By carefully managing effort, patients can stabilize and potentially improve their health over time.

How to integrate pacing into daily life?

Pacing involves adjusting activities based on personal capacity to prevent burnout. Everything counts as activity, except sleep and total rest.

Schedule total rest periods

Regular full-body and mind rest is key. This means lying down, in silence, free from stimulation (no screens, noise, or bright lights). Let thoughts pass without engaging with them. Rest duration varies depending on illness severity and comfort, typically lasting 10 to 30 minutes several times a day. The more severe the condition, the longer the total rest periods should be. Some people may find silence distressing, so gentle ambient sounds can help ease this transition.

Listen to your body

Pay attention to signals of fatigue or pain. By adjusting activity intensity and duration, patients can avoid crossing their limits. Recognizing early warning signs (such as fatigue or discomfort) helps establish safe activity thresholds. For instance, if symptoms arise after 20 minutes of activity, reducing it by 30% (to about 14 minutes) can help conserve energy and prevent worsening symptoms.

Break up and alternate activities

Divide tasks into smaller segments and take regular breaks. Alternate between physical activities (e.g., housework, walking) and cognitive tasks (e.g., reading, computer work) to maintain energy levels without depleting reserves.

Plan energy-demanding activities

Identify activities that drain the most energy, like household chores, shopping, appointments, or social visits. Avoid scheduling two high-energy activities on the same day or back-to-back. Plan rest periods before and after these activities to prevent symptom flare-ups.

Use recovery techniques

Incorporate relaxation techniques, breathing exercises, gentle stretching, yoga, or meditation. These practices promote recovery and reduce stress. Caution is advised for those with psychological conditions—seek guidance from a healthcare professional when necessary. Recovery techniques should be tailored to the patient’s condition to avoid discomfort.

Track energy levels

Keeping a journal or using energy-tracking apps can help identify patterns, warning signs, and triggers. This record helps patients fine-tune their pacing, especially during symptom flare-ups. Tracking can be periodic (such as for one week each month) to avoid over-focusing on the illness while still monitoring progress.

Adjust pacing as health evolves

Pacing requirements shift with illness progression. Activity duration, frequency, and rest periods may need to be modified daily. Ideally, pacing should be guided by a trained professional, though such expertise may currently be limited. In some cases, pacing is mistakenly equated with gradual reconditioning programs, which can conflict with its principles by enforcing activity increases.

Key takeaways

Pacing isn’t simply about rest or doing less, it’s a strategic method to optimize energy use and prevent symptom flare-ups from overexertion. It balances rest and activity to avoid deconditioning, with the guiding mantra: “Do as much as possible, but rest as soon as needed.”

Recognizing personal limits and respecting them is crucial. Even when health improves, stabilizing progress before cautiously increasing activity is essential.

With pacing, many chronic illness patients regain energy control, participate in meaningful activities, and enhance their well-being. Tailoring the method to individual needs and seeking professional guidance can further enhance its effectiveness.

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