Anonymous
Not logged in
Talk
Contributions
Create account
Log in
Search
Editing
Pacing
(section)
From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history
Namespaces
Page
Discussion
More
More
Page actions
Read
Edit
Edit source
History
Warning:
You are not logged in. Your IP address will be publicly visible if you make any edits. If you
log in
or
create an account
, your edits will be attributed to your username, along with other benefits.
Anti-spam check. Do
not
fill this in!
== The principles of pacing == === Stop before you overdo it === The aim of pacing in ME/CFS is to remain as active as possible while avoiding the relapses resulting from overexertion.<ref name=":0">{{Cite journal|last = Goudsmit | first = EM | authorlink = Ellen Goudsmit | last2 =Howes | first2 =S|url = http://www.axfordsabode.org.uk/me/pacing.htm| title = Pacing: a strategy to improve energy management in chronic fatigue syndrome|journal =Health Psychol Update | date = 2008|volume =17|pages =46–52}}</ref> This requires an understanding of the relationship between symptoms and exertion. Patients have to learn to recognize symptoms of [[post-exertional malaise]] and reduce their activities in time, in order to avoid relapses. This can mean that activities have to be limited and structured per day such as washing one day and cooking the next. It also means activities have to be stopped (sometimes abruptly) before they are completed, which can be frustrating and difficult to master. === No plans or targets but internal cues === In contrast to graded exercise therapy, pacing does not rely on plans, targets or goals, but on how patients feel. As one writer poetically described it: “pacing is not a static decision but necessarily fluctuates with the monitoring of the physiological imperative.”<ref>Wiener CL. The burden of rheumatoid arthritis. In: Straus AL, Corbin J, Fagerhaugh S, Glaser BG, Maines D, Suczek B, Wiener CL, editors. Chronic illness and the quality of life. 2nd ed. St. Louis: The CV Mosby Company; 1984. p 94.</ref> Rest is advised at the first signs of muscle weakness. According to [[Ellen Goudsmit|Goudsmit]] & [[Sandra Howes|Howes]] cognitive tasks form the major exception where a time-contingent approach might be more helpful.<ref name=":0" /> Because cognitive activities such as reading provide few internal cues to detect overexertion, it might be useful to use a timer to restrict energy expenditure. === Switching === A component that has been added to pacing is called switching. This refers to changing activities in order to avoid tiring specific muscles.<ref name=":9" /> As Goudsmit explains: <blockquote>“For instance, if you've been reading for a while, stop before your eye muscles get tired and do something which involves a different muscle group, e.g. walking, washing clothes, eating, talking. Do that for a while (stop before you reach your limit), and then switch again (you can even go back to reading).”<ref name=":1">[http://www.wames.org.uk/pacingweb.pdf Pacing for ME and CFS: a guide for patients by Dr Ellen Goudsmit]. Wames. May 2005. </ref></blockquote>Rest periods can be inserted between each change of activity. === Use of a diary or activity tracker === Another advice that is often part of pacing is to keep a diary where information about activity levels, stressful events and symptom flare-ups can be recorded. This might help patients to understand the relation between overexertion and symptoms. Abbreviations and scoring systems can be used to limit the energy needed to fill in the diary. Other patients find it helpful to use an activity tracker<ref>{{Cite web|url=http://cfsrecovery.blogspot.com/2013/01/me-cfs-cfids-and-activity-monitoring.html| title = Come with M.E. on a journey: ME CFS CFIDS and activity monitoring | last = Beauts| date = 2013-01-05 | website = Come with M.E. on a journey|access-date=2018-08-19}}</ref> to obtain more reliable information on the amount of energy they’ve spent each day and how this corresponds with their state of health. === Increase activity when you are ready === Pacing is about figuring out how much one can do without triggering a relapse. If patients feel their health has stabilized or improved and they no longer experience setbacks, it might be helpful to gradually increase activities to see how it goes. In a consensus document about pacing, [[Ellen Goudsmit|Goudsmit]] & [[Leonard Jason|Jason]] wrote: <blockquote>“If increases in activity do not result in symptom flare-ups for three months and patients feel that they are close to about 60 to 70% of their former functioning, they may wish to change to a gentle form of graded exercise therapy (GET), starting at a low level and increasing incrementally in duration and intensity to further increase their fitness and tolerance thresholds.”<ref name=":8" /></blockquote>One of the other authors of this consensus document, Karen Wallman, tested a symptom-contingent form of graded exercise in a randomized controlled trial in 2004. Patients were allowed to stop or do less if their symptoms became worse while increases in exercise were only advised if patients felt they were coping with the current activity level. After 12 weeks of 'graded exercise with pacing', patients showed improvement on objective outcome measures such as blood lactate production and performance on a Stroop colour word test.<ref>{{Cite journal | last = Wallman | first = Karen E. | last2 = Morton | first2 = Alan R. | last3 = Goodman | first3 = Carmel | last4 = Grove | first4 = Robert | last5 = Guilfoyle | first5 = Andrew M. | date = 2004-05-03| title = Randomised controlled trial of graded exercise in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/15115421|journal=The Medical Journal of Australia|volume=180|issue=9 | pages = 444–448|issn=0025-729X|pmid=15115421}}</ref> === Not a Therapy === Pacing often is a helpful coping strategy for patients with ME/CFS, but it is not a therapy. It does not claim to alleviate the many symptoms of ME/CFS such as sore throat or light sensitivity. Pacing is not so much a treatment as a way of energy management for patients with ME/CFS. It is usually one component of a multidisciplinary program for ME/CFS patients that may also include information about the disease, emotional support or advice on nutrition. Because pacing does not require specialist training, its basic principles can be counseled by a GP or nurse.<ref name=":8" />
Summary:
Please make sure your edits are consistent with
MEpedia's guidelines
.
By saving changes, you agree to the
Terms of use
, and you irrevocably agree to release your contribution under the
CC BY-SA 3.0 License
and the
GFDL
. You agree that a hyperlink or URL is sufficient attribution under the Creative Commons license.
Cancel
Editing help
(opens in new window)
Navigation
Navigation
Skip to content
Main page
Browse
Become an editor
Random page
Popular pages
Abbreviations
Glossary
About MEpedia
Links for editors
Contents
Guidelines
Recent changes
Pages in need
Search
Help
Wiki tools
Wiki tools
Special pages
Page tools
Page tools
User page tools
More
What links here
Related changes
Page information
Page logs