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Why is pacing important?
A chronic illness can change normality. Physical, cognitive and emotional stress limits can also shift. Situations that did not cause any problems before the illness are not manageable with the illness.
Chronic diseases such as ME/CFS and Long Covid are often accompanied by energy limitations that shift stress limits. If these limits are exceeded, symptoms such as severe exhaustion (fatigue), muscle pain and cognitive problems can occur. ME/CFS sufferers are also referred to as post-exertional malaise (also known as PEM or crashes).
Crashes lead to a rapid worsening of symptoms and can be accompanied by severe limitations in cognitive and physical performance. Every crash is associated with an increased risk of the disease becoming chronic.
Medical experts and the German Society for ME/CFS recommend the pacing strategy. This helps to prevent crashes and thus reduce the risk of chronification.
How does pacing work?
Pacing is an active self-management strategy that aims to utilise available energy reserves in the best possible way without exceeding stress limits. In contrast to simply resting, pacing involves actively planning and structuring phases of activity and rest - taking individual energy limits into account [1].
1. Getting to know your limits
If energy reserves and energy requirements change with an illness, these must be re-learnt. Here it is important to be lenient with yourself and consciously pay attention to how strenuous an activity is perceived to be.
Going to the toilet, having a simple conversation or using a smartphone can trigger PEM in many sufferers. For others, simply sitting upright is enough. However, cognitive stimuli such as light or noise can also trigger the symptoms of PEM and thus cause a reduction in the level of function.
When the overload threshold is reached varies from person to person. Stress thresholds can also fluctuate during the course of the day and from day to day, which makes it difficult to identify stress thresholds.
Nevertheless, as part of the pacing process, each patient must find out for themselves which activities are possible and when. This includes the activity itself, but also the intensity and length of the physical, cognitive and/or emotional exertion.
Due to the time lag of post-exertional malaise, it can be very difficult to accurately identify activity triggers. Using an activity and symptom diary can help you to gather information and identify exactly these activity triggers.
2. Planning activities and rest periods
In addition to recognising stress limits and triggering factors, it is important to actively plan activity and rest cycles in order to keep stress and rest phases in balance. The following considerations can help you to participate in everyday life as consciously as possible:
Prioritise: What can I do later and which tasks can I leave out? For example, you can set yourself a goal for each day that you want to complete. The important tasks are scheduled at the beginning of the week and less important tasks at the end of the week.
Delegating: Do you really have to do everything yourself? There are always tasks that you can hand over to your nearest and dearest without feeling guilty.
Change: Can I change regular tasks so that they are easier for me? Slight changes can already have an effect: e.g. cooking or folding laundry while sitting instead of standing
Alternation: Can I spread an activity over two days? Alternate between physical and cognitive exertion.
Listen: How does my body feel, in my feet, legs, stomach, arms and head?
Sometimes your body signals that a crash is imminent with mild symptoms such as a sore throat. Listen to what your body is telling you and take active rest breaks. Even if you sometimes find it difficult, stop what you are doing as soon as your body signals that a crash is imminent.
