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Living with M.E.

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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.

Some clinicians consider pacing to be about carefully managing activity and other stressors to avoid post-exertional malaise. Others would consider it a way to first stabilise then gradually build up increases in activity, sometimes called pacing up; it might also be referred to as activity management. Pacing can be self-managed, with or without the support of a healthcare professional.

Because everyone’s manageable level of activity is different, it’s essential that any health professional who may be supporting you with pacing understands the limitations imposed by M.E., and that many people with M.E. are not able to work towards agreed goals, however carefully and gradually they try.

Fully revised and updated for 2020, our detailed Pacing for people with M.E. resource is based on the expertise and experience of people with M.E. and Pete Gladwell, Clinical Specialist Physiotherapist, Bristol NHS M.E./CFS Service, plus data from our 2019 Big Survey. It explains pacing as part of self-management, with a step-by-step pacing guide including daily and weekly planning, pacing versus real life, explaining M.E. and pacing to others, and managing stumbling blocks.

The NICE guideline for M.E./CFS (currently under review) says:

“In this guideline, pacing is defined as energy management, with the aim of maximising cognitive and physical activity, while avoiding setbacks/relapses due to overexertion. The keys to pacing are knowing when to stop and rest by listening to and understanding one’s own body, taking a flexible approach and staying within one’s limits; different people use different techniques to do this. However, in practice, the term pacing is used differently by different groups of people. One understanding of its meaning is as adaptive pacing therapy [see below], which is facilitated by healthcare professionals, in which people with CFS/ME use an energy management strategy to monitor and plan their activity, with the aim of balancing rest and activity to avoid exacerbations of fatigue and other symptoms. Another understanding is that pacing is a self-management strategy [see below], without specific intervention from a healthcare professional.”

Our 2014 M.E. time to deliver survey of more than 2,000 people with M.E. found that 67% of respondents used pacing to help them manage M.E. Of these, 85% said it was helpful or very helpful (12% said it made no difference, and 4% said it made them a bit or much worse).

In the same survey, 67% used rest, including bed rest. Of these, 89% of people this was helpful or very helpful (10% said it made no difference, and 1% said it made them a bit or much worse).

Pacing as self-management

Self-management includes taking control of the balance of activity and rest, and learning how to communicate to other people about the balance that usually works best for you. This balancing out of activity and rest is called pacing.

It’s very important to note that “activity” does not just mean physical activity. Mental activity such as reading a book, watching television, having a conversation in person or by phone, also counts – as does emotional activity. Orthostatic intolerance and sensory overload (when one or more of the body's senses experiences over-stimulation) may also affect symptoms. For some, activity may be very minimal (especially for those who are severely affected) yet still cause considerable impact on energy and symptoms.

Pacing as self-management is focused on learning to listen to your body. It should not be seen as a treatment but more as a way of coping with the impact of M.E. Pacing gives you awareness of your own sustainable activity levels which enables you to better plan the way that you use your energy, maximising what you can do with it.

The three key elements of pacing are:

  1. Activity analysis. In pacing terms, activity incorporates any action that uses any energy, whether physical, mental, emotional or sensory. Activity analysis involves learning how demanding each of these activities are for you at present.
  2. Establishing sustainable baselines. A baseline is a level of an activity that you can sustain even on a bad day. Your baseline level will be below your “personal best” that you can manage on a better day. If you know what your baseline level is, you can choose to stop an activity at a point that supports you to be less likely to have a bad day the next day.
  3. Using rest and relaxation, which are central to pacing. For maximum benefit, it helps to learn how to fully relax and properly rest your body and brain. This may call for a new perspective on what you consider to be relaxation. Before you became ill you might have used mental activities to relax, like reading or watching television, or you might have enjoyed physical exercise. For healing rest, you may now find you have to be quiet and still, both physically and mentally – but don’t feel guilty if you do still find TV relaxing. It is highly individual.

You can find out more in our booklet, Pacing for people with M.E. Please note this booklet is being reviewed and updated, with a new edition expected to be published by the end of 2019.