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Boom and bust activity cycle
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[[File:Boom-and-bust-activity-cycle-animated.gif|thumb|right|After energy limits are exceeded, a dramatic increase in symptoms follows that prevents the patient from doing even minimal activity.]] The '''boom and bust cycle''' or '''over-activity and crash''' cycle is a common result when people with [[myalgic encephalomyelitis|ME]]/[[chronic fatigue syndrome|CFS]] try to [[pushing through symptoms|ignore and push through their symptoms]]. ==Post-exertional malaise == Exceeding personal [[energy limit]]s in ME/CFS results in post-exertional malaise (PEM): increased and debilitating symptoms that typically begin around 24 hours after exceeding limits, but may begin up to 3 days after. The [[delayed onset of post-exertional symptoms|delayed onset of PEM]] makes it difficult for patients to know when they are at or approaching their energy limit, which can cause the illness to feel very unpredictable. Post-exertional malaise may last days, weeks or longer, and even trivial activity may exceed someone's energy limit. {{See also|Post-exertional malaise}} ==Boom and bust == When ME/CFS patients become worse after pushing through their symptoms, people with ME/CFS then have to choose again between [[rest]] or trying again to "push through" - which causes them to deteriorate further, until eventually they physically cannot continue. Both resting and pushing through result in an "[[greatly lowered ability to do activities that were usual before the illness]]", a symptom that is required for the diagnosis of ME/CFS.<ref name="CDC-symptoms">{{Cite web |url = https://www.cdc.gov/me-cfs/symptoms-diagnosis/symptoms.html | title = Symptoms {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome | website = [[Centers for Disease Control and Prevention]] | date = Jan 27, 2021 | access-date = 2021-02-25}}</ref><ref name="niceng206">{{Cite web | url = https://www.nice.org.uk/guidance/ng206 | title = Myalgic Encephalomyelitis (or Encephalopathy)/Chronic Fatigue Syndrome:diagnosis and management. NICE guideline. | last = NICE Guideline Development Group | first = | author-link = | publisher = [[National Institute for Health and Care Excellence]] | date = 2021-10-29}}</ref> The cycle of repeatedly exceeding energy limits by doing too much activity or even [[pushing through symptoms]] followed by being forced to totally stop is called the "[boom and bust cycle", and is very widely recognized in ME/CFS, and in some patients without post-exertional malaise, including [[chronic pain]] and [[chronic fatigue]] patients.<ref name="Antcliff2021">{{Cite journal | title = “Pacing does help you get your life back”: The acceptability of a newly developed activity pacing framework for chronic pain/fatigue | url =https://onlinelibrary.wiley.com/doi/abs/10.1002/msc.1557 | journal = Musculoskeletal Care | volume = n/a | issue = n/a | last = Antcliff | first = Deborah | last2 = Keenan | first2 = Anne-Maree | last3 = Keeley | first3 = Philip | last4 = Woby | first4 = Steve | last5 = McGowan | first5 = Linda|language=en|doi=10.1002/msc.1557|issn=1557-0681}}</ref> A significant proportion of people with [[Long COVID]] report experiencing post-exertional malaise and find they have a boom and bust cycle.<ref name="Horton2010">{{Cite journal | title = Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) in adults: a qualitative study of perspectives from professional practice | date = 2010-11-15 | url = https://doi.org/10.1186/1471-2296-11-89 | journal = BMC Family Practice | volume = 11 | issue = 1 | pages = 89 | last = Horton | first = Simon MC |author-link = | last2 = Poland | first2 = Fiona | author-link2 = | last3 = Kale | first3 = Swati | author-link3 = | last4 = de Lourdes Drachler | first4 = Maria | author-link4 = | last5 = de Carvalho Leite | first5 = Jose Carlos | author-link5 = | last6 = McArthur | first6 = Maggie A. | author-link6 = | last7 = Campion | first7 = Peter D. | last8 = Pheby | first8 = Derek | author-link8 = Derek Pheby | last9 = Nacul | first9 = Luis | author-link9 = Luis Nacul |doi=10.1186/1471-2296-11-89|pmc=PMC2994803|pmid=21078171|access-date=|issn=1471-2296|quote=|via=}}</ref> ==Consequences == The [[Canadian Consensus Criteria]] for ME/CFS states that the boom and bust cycle can result in more severe illness: ::"Early warning signs of a pending '[[crash]]' must be respected. Patients can suffer severe and prolonged exacerbation of their illness if they transgress their activity boundaries too deeply or too often."<ref name="canadianconsensus-CCC"/> ==Pacing== Activity [[pacing]] or ''energy management'' is a way of planning and monitoring activity to try to avoid exceeding energy limits, in order to avoid the resulting periods of [[post-exertional malaise]], which often forced patients to spend days in bed recovering.<ref name="ICC2011primer">{{citation | last1 = Carruthers | first1 = BM | author-link1 = Bruce Carruthers | last2 = van de Sande | first2 = MI | author-link2 = Marjorie van de Sande | last3 = De Meirleir | first3 = KL | author-link3 = Kenny de Meirleir | last4 = Klimas | first4 = NG | author-link4 = Nancy Klimas | last5 = Broderick | first5 = G | author-link5 = Gordon Broderick | last6 = Mitchell | first6 = T | author-link6 = Terry Mitchell | last7 = Staines | first7 = D | author-link8 = Donald Staines | last8 = Powles | first8 = ACP | author-link8 = A C Peter Powles | last9 = Speight | first9 = N | author-link9 = Nigel Speight | last10 = Vallings | first10 = R | author-link10 = Rosamund Vallings | last11 = Bateman | first11 = L | author-link11 = Lucinda Bateman | last12 = Bell | first12 = DS | author-link12 = David Bell | last13 = Carlo-Stella | first13 = N | author-link13 = Nicoletta Carlo-Stella | last14 = Chia | first14 = J | author-link14 = John Chia | last15 = Darragh | first15 = A | author-link15 = Austin Darragh | last16 = Gerken | first16 = A | author-link16 = Anne Gerken | last17 = Jo | first17 = D | author-link17 = Daehyun Jo | last18 = Lewis | first18 = DP | author-link18 = Donald Lewis | last19 = Light | first19 = AR | author-link19 = Alan Light | last20 = Light | first20 = KC | author-link20 = Kathleen Light | last21 = Marshall-Gradisnik | first21 = S | author-link21 = Sonya Marshall-Gradisnik | last22 = McLaren-Howard | first22 = J | author-link22 = John McLaren-Howard | last23 = Mena | first23 = I | author-link23 = Ismael Mena | last24 = Miwa | first24 = K | author-link24 = Kunihisa Miwa | last25 = Murovska | first25 = M | author-link25= Modra Murovska | last26 = Stevens | first26 = SR | author-link26 = Staci Stevens | title = Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners | date = 2012| isbn = 978-0-9739335-3-6 | url = http://www.investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf}}</ref><ref name="canadianconsensus-CCC">{{Cite journal | last1 = Carruthers | first1 = Bruce M. | author-link1 = Bruce Carruthers | last2 = Jain | first2 = Anil Kumar | author-link2 = Anil Kumar Jain | last3 = De Meirleir | first3 = Kenny L. | author-link3 = Kenny De Meirleir | last4 = Peterson | first4 = Daniel L. | author-link4 = Daniel Peterson | last5 = Klimas | first5 = Nancy G. | author-link5 = Nancy Klimas | last6 = Lerner | first6 = A. Martin | author-link6 = Martin Lerner | last7 = Bested | first7 = Alison C. | author-link8 = Alison Bested | last8 = Flor-Henry | first8 = Pierre | author-link8 = Pierre Flor-Henry | last9 = Joshi | first9 = Pradip | author-link9 = Pradip Joshi | last10 = Powles | first10 = AC Peter | author-link10 = A C Peter Powles | last11 = Sherkey | first11 = Jeffrey A. | author-link11 = Jeffrey Sherkey | last12 = van de Sande | first12 = Marjorie I. | author-link12 = Marjorie van de Sande | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols| journal = Journal of Chronic Fatigue Syndrome | volume = 11 | issue = 2 | pages = 7-115 | date = 2003 | pmid = | doi = 10.1300/J092v11n01_02| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf}}</ref> Different methods of pacing include [[pacing with a heart rate monitor]], [[Energy Envelope Theory]], and [[spoon theory]]. {{See also|Pacing}} {{See also|Energy Envelope Theory}} ==See also == *[[Pushing through symptoms]] *[[Crash]] *[[Severe and very severe ME]] *[[Energy limit]] ==Learn more == ==References== [[Category:Definitions]] [[Category:Management strategies]]
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