Achieving Stability Through Pacing
By Bruce Campbell
(From the series What Works for Managing ME/CFS and Fibromyalgia)
Pacing is often recommended as a strategy for gaining control of symptoms and bringing stability. But how can you do it? This article contains ideas on pacing from students in our self-help course, plus their thoughts on how to use record keeping as a complement to pacing.
Pacing
Pacing means both finding an overall activity level that the body can tolerate and determining how much rest the body requires.
Specific pacing techniques include being careful about overall activity level, taking scheduled rests, living by a schedule of activity and rest, limiting the length of an activity, scheduling activities for "good" times of the day and avoiding "bad" times, and breaking tasks down into small steps with rest between each step.
Here are student descriptions of some of the most common pacing strategies.
Routine
It has helped me immensely to live by a schedule. Soon after getting sick, I recognized what a big toll stress took on me and saw that anything new or unpredictable was stressful. So I have tried to organize my life so that I know what's coming. This has reduced my stress level greatly.
Rest
Since I've been forcing myself to rest every day, I have found I have more stamina, despite having had secondary illnesses for the last month. And I've noticed the graph of my days doesn't dip and rise so steeply.
I have been resting in between activities, sometimes only for 5 minutes. When I started, I thought that my overall hours of resting would be a lot longer, but even on my less than good days the most I have rested, including planned rests, is an hour and a half. For the first time in the four and a half years that I have been ill, I feel that it is possible to manage my symptoms and have some predictability in my life.
I try to rest eyes, mind and body after 15 minutes on the computer. I get up and have a drink of water or lie down for five minutes eyes closed. Every hour I take a 15- minute break from what I'm doing and lie down. Also, I close my eyes during the ads on TV. And I rest between 11:30 and 2 pm.
Short Activity Periods
I do better with short periods of lots of different activities (including rest) throughout the day rather than large blocks of time devoted to a single activity. That's so different from how I used to work. I would get involved with a project and not come up for food or air until it was done and be surprised I'd missed meals and the sun had set.
Even though I have reduced the amount of time that I allow myself to do a task (kitchen 10 minutes, computer/reading 15-30 minutes), I am amazed at the end of the day how much I have actually done.
Task Switching
I find that switching tasks helps, like from physical to mental, even if it is only after a few minutes. Breaking things down into easy steps helps and so does doing them in installments. It sometimes takes me three runs at the washing up to finish, but I don't tire myself out nearly so much.
I divide activities into light, moderate and heavy, then plan my day to alternate activities in the different categories. By pacing myself in this way, I can do more and minimize my symptoms. In fact, I'm amazed at all I can now do in a day. A couple years ago I would have thought I was crazy to think I could do all that!
I have learned to rotate activities. I tend to fall into black holes pretty easily, where I can spend hours doing one activity without coming up for air. I pay for it later. Areas where I find it hard to limit my activity time are talking on the phone, cleaning, crafts, and computer work. Lately I've been more conscientious when it's time to switch activity.
Prioritizing
I learned to prioritize what was important and what wasn't. My therapist had me make lists of needs, wants, and shoulds. Needs were things I absolutely had to do. Wants were things I would like to do if I had the time and energy. Shoulds were things other people wanted me to do usually, or I told myself I should do, because of the expectations of others. That helped me a lot.
Every evening I list my appointments and possible other activities for the following day. By doing this, I can recognize activities that I really don't have to do, but that can be postponed. This frees up my days for my targeted rest time.
Honoring Time of Day
If I walk in the evening, I can make it around two blocks, but three has me collapsing. Early in the day, I can do three or more. I seem to have this window between 8 and 11 in the morning that is best for most activity, both mental and physical.
Applying Pacing at Work
With the job I have, I've allowed myself to be driven at an unreasonable pace. I realize now how critical it is to pace myself. So I've brainstormed some adjustments I might make: telecommuting one day per week; putting a limit on night meetings; coming in at noon the day of night meeting days; taking rest breaks during the day; leaving work early when I've had to work through lunch; leaving work on time; not working on weekends.
Pacing in Driving
I recently applied pacing to a long drive to my sister's. I took an extra hour for the drive, stopping every hour for ten to 15 minutes. I used the time to do some leisurely stretching, drink some water or read my map. And I practiced deep breathing while driving. I arrived calm and rested. Pacing works!
Logging
Some students find keeping records helps them understand their illness better. Here are descriptions of several ways they have put logging to good use.
Identifying Patterns
Keeping records showed me how to pace myself. I learned to rate my activities as light, moderate or heavy, based on how much each activity takes out of me or increases my symptoms. As a result, I now plan my day so I alternate light activities with moderate and heavy ones. I can do more now and have lower symptoms.
I rate my day and then transfer the rating to a line graph. The chart has been the most useful tool of all as it shows highs and lows. I also record ‘stressors' and ‘helpers' on this chart, so it gives a record of things that work and things that hurt.
Looking back at my journals, I realized that every September my symptoms worsen. That's when I return to teaching, thus an increase in activity and stress. Now that I realize that pattern, I will be able to plan ahead for it next year.
In the past I used logs to track chemical and food allergies and physical limits. But now I realize how much energy mental activities, emotions, watching TV and standing can take, so I'm going to log these too to define my limits more fully.
Holding Up a Mirror
Logging brings home to me the reality of my illness. Before logging, I didn't realize that most of my time is spent on or below about 35% functionality. This false perception that I was better than I am led me to overdo things, but now I am less ambitious.
I keep in Activity Log. At the end of each week, I look at the log and write a short summary at the bottom of the page, commenting on good experiences, symptoms I had that were not my fault, and symptoms I had which I could have had some control over.
Motivating
Charting gave me visual proof that staying inside my energy envelope worked. I could see that the number of good days a month increased over time. Because it's so hard to stay within my limits, I had to show myself that it was worth it.
I have been keeping records on small notepads by my bed, my computer, in the living room, and in the kitchen. I've been amazed how just by having those notepads there I am so much more aware of how much time I spend doing something. The awareness motivates me to stop as soon as symptoms appear.
Keeping Exercise on Track
I have used logging to pace myself with exercise. Since my body reacts quite strongly to increased levels of exercise, I have learned that I must raise that level very slowly. Logging has proved quite useful in keeping track of the pace at which I am working.
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