Pacing is an activity management technique for managing a long-term health condition or disability, aiming to maximize what a person can do while reducing, or at least controlling, any symptoms that restrict activity. Patients with varying fatigue-causing conditions such as Multiple Sclerosis, Lupus, and Rheumatoid Arthritis can benefit from exercise with pacing Pacing is commonly used to help manage conditions that cause

chronic pain Chronic pain is pain that persists or recurs for longer than 3 months.https://icd.who.int/browse/2025-01/mms/en#1581976053 It is also known as gradual burning pain, electrical pain, throbbing pain, and nauseating pain. This type of pain is in cont ...

or chronic fatigue.

Aims of pacing

Pacing aims to manage symptoms and allow people with chronic energy-limiting conditions to be able to be as active as possible by avoiding the "boom and bust" cycle that is common among people exceeding their current, limited capacities. This often leads to being forced to stop their activities as a result of pain, fatigue, or other symptoms, and then requiring a large amount of rest before being able to resume their activity. The cycle then repeats. One goal of pacing for people with energy-limiting conditions is to prevent or limit

post-exertional malaise Post-exertional malaise (PEM), sometimes referred to as post-exertional symptom exacerbation (PESE) or post-exertional neuroimmune exhaustion (PENE), is a worsening of symptoms that occurs after minimal exertion. It is the hallmark symptom of m ...

(PEM) or crash by conserving energy by balancing activity and rest. PEM is an atypical response to mental or physical activity in which symptoms of an energy-limiting or chronic pain condition are exacerbated in the day or two following mental or physical exhaustion that can last up to and sometimes over a week.

Elements of pacing

There is no consensus regarding what elements are part of pacing. Pacing typically involves: * planning activities in advance * taking regular rest breaks * choosing activities based on available energy * prioritizing activities

Uses

Pacing has been used to help manage a wide variety of different illnesses and disabilities, including neuromuscular diseases like Charcot-Marie-Tooth disease (CMT), rheumatoid or immune-mediated diseases like

rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects synovial joint, joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and h ...

juvenile arthritis Childhood arthritis (juvenile arthritis or pediatric rheumatic disease) is an umbrella term used to describe any rheumatic disease or chronic arthritis-related condition which affects individuals under the age of 16. There are several subtypes tha ...

and

fibromyalgia Fibromyalgia (FM) is a functional somatic syndrome with symptoms of widespread chronic pain, accompanied by fatigue, sleep disturbance including awakening unrefreshed, and Cognitive deficit, cognitive symptoms. Other symptoms can include he ...

ME/CFS Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a disabling Chronic condition, chronic illness. People with ME/CFS experience profound fatigue that does not go away with rest, as well as sleep issues and problems with memory ...

, Ehlers–Danlos syndromes (EDS), and

Long COVID Long may refer to: Measurement * Long, characteristic of something of great duration * Long, characteristic of something of great length * Longitude (abbreviation: long.), a geographic coordinate * Longa (music), note value in early music mens ...

Methods of pacing

Pacing can be done using natural methods without therapeutic intervention and protocols or in more clinical and therapeutic settings including wearing trackers such as Apple Watches, Fitbits
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and other health trackers that have heart rate parameter tracking. Heart rate tracking can be an effective tool when used in a pacing protocol to detect variations in the autonomic balance for ME/CSF patients. Therapeutic interventions of pacing include using tools such as an RPE

Rating of perceived exertion In sports, health, and exercise testing, the rating of perceived exertion (RPE), as measured by the Borg rating of perceived exertion scale, is a quantitative measure of perceived exertion during physical activity. In medicine, this is used to do ...

scale or a CR-10 scale. The RPE scale can be modified for certain disabilities or illnesses including dyspnea There are typically two types of pacing interventions which are energy conservation and conditioning. The energy conservation approach is based on creating an energy bank or storage by conserving energy and only participating in activities that are within the energy allotment for the time period while the conditioning approach is geared towards participating in graduated activities to build an energy tolerance and ultimately decrease disability.

Outcomes of pacing

Pacing has been shown to reduce post-exertional symptom exacerbation in people with

long COVID Long may refer to: Measurement * Long, characteristic of something of great duration * Long, characteristic of something of great length * Longitude (abbreviation: long.), a geographic coordinate * Longa (music), note value in early music mens ...

. In many health conditions, there are no clinical trials to establish the effectiveness of pacing.

References