The Principles of Pacing

In this topic, you will learn the basics of pacing and energy management.

Activity pacing has two parts to it:

1)	Conserving energy for activities you value (e.g., important tasks, playing with your kids, engaging in your favorite hobby, etc.)
2)	Setting graduated activity quotas to help you to increase your ability to do activities (tolerance) and improve your capability

Stop before you overdo it!

Pacing requires some pre-planning. It helps you manage your tasks and activities, while considering the real consequences of your pain.  

The aim of pacing is to remain active but avoid relapses due to overexertion. This requires an understanding of the relationship between your symptoms and activity. It is important to learn to recognize symptoms that follow exertion to reduce activities in time and avoid relapse/flares.

Limit and structure your activities. For example, you may divide your tasks by day, cleaning one day and cooking the next. Or, you may do 30 minutes of each activity every day. Sometimes, activities have to be stopped (abruptly) before they are done. This can be hard, frustrating, and difficult to master. As time goes on, it will become more natural.

No plans or targets but internal cues

Unlike graded exercise therapy, pacing does not fully rely on plans, targets or goals. It is also regulated by how you feel.

“Pacing is not a static decision but necessarily fluctuates with the monitoring of the physiological imperative.”

Rest is usually advised at the first signs of muscle weakness. However, tasks that rely upon thinking may require a time-restricted approach. This is because these activities (e.g., reading) have few physical cues to detect overexertion. Here, it might be useful to use a timer to restrict energy expenditure.

Switching

Switching refers to changing activities to avoid tiring specific muscles. The idea is that if you are carrying out one activity, you’ll want to stop before the muscles you’re using get tired. Switch to another activity that uses different muscles so the muscle groups have time to rest. For example, switch to walking if your eyes get tired while reading.

Insert rest periods between each change of activity

Use of a diary or activity tracker

When pacing, you might find it helpful to keep a diary where information about activity levels, stressful events, and flare-ups can be recorded. This can help you understand the relationship between overexertion and symptoms.

Please have a look at the I-Engage App Pacing Page to check out our pacing tool

Limit the energy needed to fill in the diary with abbreviations and scoring systems. Others may use a digital activity tracker to get more reliable data on the amount of energy they’ve spent and how it relates to their pain.

Increase activity when you are ready

Pacing is about figuring out how much you can do without triggering a relapse. If you feel your health has stabilized/improved, and you’re not experiencing setbacks, you might want to gradually increase your activities. You can see how it goes and adjust from there.

Pacing is contingent on time and energy, rather than pain. So, activity is regulated with a measurement (e.g., time, distance, number of repetitions, etc.) rather than pain. This measure gives you a target and a limit for the activity (e.g., 15 minutes of walking, 20 minutes of housework). It gives you a basis from which to build activity tolerance. Building tolerance will help you to do everyday tasks with practice.

The disadvantage of using your pain to regulate your activities is the boom and bust cycle. You may complete all of your activities on days where your pain is lower. Then, due to overactivity, you may be in a lot of pain later. This leads to a period of underactivity while you recover. This doesn’t help you build activity tolerance. You may even injure yourself.

Try out a time-contingent approach to activity. Current research shows that both avoidance and overactivity lead to poor outcomes for pain patients.

In a research study, participants were allowed to stop or do less if their symptoms became worse. Increases in exercise were only advised if participants felt they were coping with their current activity level. After 12 weeks of graded exercise with pacing, participants showed improvement.

Pacing is a practical approach you can do to get less pain flares, while slowly increasing your activities

Pacing is not a Therapy

Pacing is a helpful coping strategy for people with chronic pain, but it is not a therapy. It does not claim to alleviate your symptoms. Additionally, pacing is not a treatment, but a way of energy management. It is usually one component of a multidisciplinary program. These programs may also include education about the disease, emotional support, and advice on nutrition. Most support-professionals and healthcare providers can counsel about pacing because it doesn’t require specialist training.

In the next topic, you will learn how to begin pacing. To continue, select “How Do I Pace?” from the left-side menu.