With an energy-limiting chronic illness like ME/CFS, a key to being as well as possible is to make sure you don’t use more energy than you readily have available to you (sometimes called your “energy envelope”). When you push past your limits, your cells have to use a different method to produce energy, and this emergency energy production always leads to a substantial worsening of symptoms, also known as post-exertional malaise (PEM)––one of the key symptoms of chronic fatigue syndrome.
So what is pacing? Simply speaking, pacing is a way of taking care with how you use your energy so that it doesn’t run out. Although it sounds simple, it involves learning many new skills that were never needed before ME/CFS and unlearning old ways of being that no longer work for us.
Pacing is a word that inspires a mixed reaction in me. It brings feelings of not being able to do what I want and lack of spontaneity. It also brings the irritation of having to be disciplined in order to pull it off. Pacing for ME/CFS involves all of the practice and self-denial involved in mastering any kind of complex skill set. But ultimately, I know I have a much better life because of it, and it gives me a very important (if not fragile) sense of control over my well-being.
Another thing I get from pacing, is a sense of achievement. When ME/CFS robbed me of the ability to achieve in ways that I did when I was healthy, I decided that I would set my sights on mastering illness management skills. I now get to feel really good about pacing well, because let’s face it, no matter how big the benefits may be, it really doesn’t come naturally; doing it well is a huge achievement!
7 Tips to Pacing for ME/CFS
Here are my tips on seven different aspects involved in mastering pacing:
1. Know your baseline
The starting point for good pacing is getting a good idea of what you can do on an average day, without going beyond your energy envelope. I found it helpful to record my activities and wellness over a couple of weeks, and look for how my wellness changed at different levels of activities as well as what levels of activities meant that I could keep it stable. I then created a routine around my baseline to keep my energy expenditure safe. If I was doing anything out of the ordinary, I knew I would have to take back the energy from somewhere else I my routine. I also knew that if I was having a worse day than usual, I needed to cut back on what I would do.
2. Keep everything to short bursts
For me, another important principle of pacing is trying to make sure that none of my cells go into emergency energy production. It seems to make a lot of sense to me that if I keep any kind of activity to very short bursts, each set of cells I’m using will have a better chance of the mitochondria recycling my ATP. Keeping in mind my overall energy levels, I chop and change my activities sometimes using a different kind of activity to pace, rather than just rest. For example, I might pace my thinking time with a bit of washing up, as well as with a bit of rest. Using the timer on my phone as well as an app on my computer has been invaluable to helping me keep each activity to a short burst. Although It took a while to adapt to the lack of flow involved in chopping and changing activities, I found that in the end it was far more productive because it kept my energy safer.
3. Approach everything with mindful relaxed effortlessness
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An absolute key to being able to pace well has been to practice mindfulness. Becoming more mindful has made it possible for me to notice when my body is tiring and take appropriate action. It has also been instrumental in being able to overcome old autopilot habits that get in the way of good pacing. I also found that if I approached everything with an attitude of relaxed effortlessness, I used less energy for each thing I did.
4. Make certain rest is non-negotiable
I know that in order to function as well as possible I need a certain amount of rest at particular times in the day. I make these rests non-negotiable. I know they have to happen in order for me to stay well. If something unusual is happening that means they can’t happen at the time they normally would with my routine, I do my best to take them early or at least I try to fit them into my day somewhere. If I can’t take them at all, I aim to add them to the day before and the day after to make sure that over a few days I’m not losing the rest I need.
5. Take stimulation breaks and relax
For me pacing isn’t just about activity, it’s about using my energy efficiently. I’ve found that if I let my nervous system stimulation levels get high, I tend to rush more and hold more tension in my body, using my energy less effectively. It’s also much harder to notice when you’re tiring if you’ve switched into fight or flight mode. Keeping my stimulation levels down involves taking regular stimulation breaks (a few minutes of quiet time in a low stimulation environment). It’s also about noticing when the tension is rising in my body and practising breathing and relaxation techniques to bring my nervous system activity down. Including tai chi, meditation and yoga in my daily routine also helps to keep my stimulation levels lower and my energy use more efficient.
6. Learn not to rush
In pre-illness days, being efficient often meant being fast, and rushing developed into a kind of habit. When we rush, we are approaching life as though we’re under pressure. This may have been a very productive way of being when energy wasn’t limited, but with chronic illness, it just causes harmful tension in our bodies and keeps nervous system stimulation levels high. For me, learning not to rush meant consciously choosing to slow down, almost to the point of aiming to do everything in slow motion. I found that going slow;y meant I could notice the tension in my body and choose to let it go. I would also notice earlier when I was tiring and could choose to stop in good time.
7. Unlearn the completion compulsion
One of the most common autopilot behaviours that is extremely harmful once our energy is limited is the drive to finish a task once you’ve started. Unlearning this compulsion to complete things in order to be able to stop when we need to is absolutely key to good pacing. First, we have to become aware that we are pushing to complete something; then it helps to remind ourselves that pushing no longer serves us, so we can choose to stop. Finally, we need to pay attention to the evidence that stopping when we need to keeps us healthier and is just as productive in the long run.
There is so much involved in learning to pace well, make sure you give it the attention it deserves. You also need to congratulate yourself for what a great achievement it is when you learn to do it well!
Julie Holliday, ProHealth’s Inspirational Editor, is a holistic life coach and writer committed to helping people take back control from energy-limiting chronic illness to live a more relaxed, balanced and fulfilling life. Julie loves spending time in nature, growing her own vegetables and spends as much of her day as possible in a comfortable pair of yoga pants. Writing as the ME/CFS Self-Help Guru, Julie shares tips on her weekly blog. You can also follow her on Twitter, Facebook and Google+ or join her Facebook group focusing on finding purpose despite chronic illness.