Managing your symptoms

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Pacing and energy management

Pacing and energy management

The information set out on this page about pacing is not necessarily a recommendation. Instead, we aim to support you to make an informed decision about which symptom management approach you may or may not want to consider trying.

Pacing is a self-management technique that aims to balance energy and rest. Self-management is a broad description of a combination of knowledge, skills and strategies which people can use to reduce the impact of a health problem on their quality of life.

Pacing as self-management should not be seen as a treatment, but more as a way of coping with the impact of M.E. Taking a balanced, steady approach to activity counteracts any tendency to overdo things. Keeping your activity levels within your "energy envelope" can help avoid aggravating symptoms.

You also know that if the activity is within your limits, you have a realistic chance of achieving the activity as planned. Understanding and accepting what your current abilities are helps you to plan ahead with more confidence. Over time, if your condition stabilises, you can choose to try, if you feel able, to very gradually increase your activities to work towards improvement.

UK government guidelines

The October 2021 NICE guideline for M.E./CFS refers to pacing as energy management (see "A note about terminology" below). It advises health professionals as follows (section 1.11.2):

"Discuss with people with ME/CFS the principles of energy management, the potential benefits and risks and what they should expect. Explain that it:

  • is not curative
  • is a self-management strategy led by the person themselves with support from a healthcare professional in an ME/CFS specialist team
  • includes all types of activity (cognitive, physical, emotional and social) and takes into account overall level of activity
  • helps people learn to use the amount of energy they have while reducing their risk of post-exertional malaise or worsening their symptoms by exceeding their limits
  • recognises that each person has a different and fluctuating energy limit and they are experts in judging their own limits
  • can include help from a healthcare professional to recognise when they are approaching their limit (children and young people in particular may find it harder to judge their limits and can overreach them)
  • uses a flexible, tailored approach so that activity is never automatically increased but is maintained or adjusted (upwards after a period of stability or downwards when symptoms are worse)
  • is a long-term approach − it can take weeks, months or sometimes even years to reach stabilisation or to increase tolerance or activity."

Evidence and patient experience

Action for M.E.’s 2019 Big Survey of more than 4,000 people with M.E. asked them questions about a number of symptom management approaches, including pacing. We found that most respondents (88%) had tried pacing in the past five years. Of these:

  • 70% said that they use pacing to do what they feel able to within their manageable limit
  • one in five (20%) said they used pacing to successfully help gradually increase activity, while one in three (30%) said they tried to do so, but it was unmanageable.

Hear from people with M.E. and health professionals in the Dialogues for ME/CFS film about pacing.

Useful resources

Our detailed guide Pacing for people with M.E. is based on the expertise and experience of people with M.E. and Pete Gladwell, Clinical Specialist Physiotherapist, Bristol NHS M.E./CFS Service, the 2021 NICE guideline for M.E. (see above), and data and insights from our 2019 Big Survey. One respondent told us:

“It is very personal and every individual will need their own version of pacing in my opinion. It’s very relative to ‘life before’ – and we were all different then, too! Lots of different factors to consider, it’s a simple concept but application is tricky. Lots of trial and error.”

Emerge is an Australian charity we work with as part of the World ME Alliance. Some people with M.E. have told us that they find their pacing factsheet very helpful: you can download this from the Emerge website.

We have also had good feedback about the Bateman Horne Center's ME/CFS Crash Survival Guide (which can also be downloaded in different colours to suit your needs). This guide is "designed for the patient, their support network, and care team" to help them "understand M.E./CFS and its defining characteristic of post-exertional malaise (PEM); help the individual prepare in advance for a crash/PEM episode, ensuring their critical needs are met; [and] offer adaptive guidance in carrying out everyday living activities that support energy conservation with M.E./CFS

A note about terminology

Balancing out activity and rest is sometimes called “energy management,” “activity management” or simply “pacing,” which is the term Action for M.E. – and the people we support – most often use. “Energy management” is a term more often used by health professionals, as it includes more than just pacing, such as planning and prioritising and managing sleep.

It’s important to note that pacing can mean different things to different people. Some clinicians consider pacing to be about carefully managing activity and other stressors to avoid post-exertional malaise. You may also hear references to the “energy envelope” theory, which is about keeping the activities you undertake within your available energy levels.

Other clinicians consider pacing a way to first stabilise then gradually build up increases in activity, sometimes called “pacing up," which we also cover in our pacing booklet. As with any symptom management approach, pacing up, or not, is your choice. Our 2019 Big Survey (see above) found that around one in five respondents successfully increased activity through pacing up, with one in three saying that they tried gradually to do this, but found it unmanageable.