Pacing

Pacing
Pacing is one way for those diagnosed with myalgic encephalomyelitis (ME) to balance activity and rest and may even reduce symptom severity and the frequency of relapses. Day-to-day energy levels for those with ME are often unpredictable; however, pacing allows patients to assess their perceived energy levels on a daily basis (or in smaller time increments, as needed) and use that level to gauge their energy expenditure for the day. Pacing encourages ME patients to accept their daily energy limitations and not exceed or fight them. Pacing is based on four main principles, and when practiced it can help to "support the body's natural recovery process ." The four goals to pacing are activity, rest/relaxation, establishing a baseline, and increasing activity as you are able.

Activity: Every individual has his or her own definition of what it means to be active and therefore, for some "being active" can vary from taking a shower to talking on the phone or even watching a movie. However, when practicing pacing one should consider activity anything that requires mental or physical energy.

Rest: Each person must also investigate and find out what it means to for them to rest. Rest should mean that both the body and mind are relaxed. For some, this might mean sleep and for others just laying quietly.

Establishing a sustainable baseline: A baseline is a level of activity that can be sustained whether you are having a "good" or a "bad" day.

Increasing activity as you are able: Setting a routine and prioritizing tasks is one way to steadily work up from a baseline. However, it has been suggested that one should avoid pushing his or herself past "safe stores" of energy to avoid woresning of symptoms.

The Energy Envelope Theory
The Energy Envelope Theory is the idea that those with ME should not expend more energy than they perceive that they have available. Professionals might take the concept further by recommending that those with ME do less than their perceived energy would allow, in order to have energy left over for recovery.

Under the Energy Envelope Theory, treatment programs that recommend a steady increase in daily activity are discouraged because the person with ME may exceed the amount of energy available for that day, thereby initiating post-exertional malaise or an increase in symptoms. Those that stay within their daily "envelope" of energy, have been observed to have fewer symptoms or even recover to a higher functioning level.

The concept of staying within one's "energy envelope" is a similar technique as the spoon theory.

Patient experiences with the Envelope Theory

 * The Just ME blogger, Sally Burch, has written about self-pacing and the energy envelope in a post called "Play-Up & Lay-Up" not "Boom & Bust".
 * Bruce Campbell, PhD, has included the Envelope Theory in chapter 7 of his manual, Recovery from Chronic Fatigue Syndrome: One Person's Story
 * http://www.cfidsselfhelp.org/library/how-i-use-pacing-manage-cfs

Notable studies

 * 2008, The Energy Envelope Theory and myalgic encephalomyelitis/chronic fatigue syndrome (Full text)
 * 2013, Energy Conservation/Envelope Theory Interventions to Help Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (Full Text)
 * 2016, Activity Pacing is Associated with Better and Worse Symptoms for Patients with Long-term Conditions

Learn more

 * "Play-Up & Lay-Up" not "Boom & Bust" - Sally Burch
 * Solve ME/CFS Initiative - Managing Your Energy Envelope by Bruce Campbell (pdf)
 * Health Rising - Coping vs Energy Envelope in CFS