Key 5: Pace Yourself
By Bruce Campbell
(Note: From the series Ten Keys to Successful Coping: 2005.)
The push and crash cycle described in the Key 4 article can be demoralizing. It's easy to feel frustrated and depressed by the thought that you are caught in a closed loop, cycling helplessly between overactivity and rest.
But there is another way to live with chronic illness. You can lead a more stable and predictable life by pacing yourself.
Pacing means finding the right balance of activity and rest for your unique situation. With pacing, you can learn to live your life according to a plan rather than in response to symptoms, so you have a sense of managing the illness rather than the illness controlling you.
Pacing offers an alternative to the repeated cycles of push and crash, a way to flatten out the chronic illness roller coaster.
Scheduled Rest
You are probably familiar with using rest as a way to recover from overactivity. But rest can be used in another way as well, as a preventive measure and a way to help you gain control. By taking planned rests on a regular basis, you can make your life more predictable. We call taking scheduled rests on a regular basis pre-emptive resting.
By rest I mean lying down with your eyes closed in a quiet place. The point is to cut out all activity to give your body a chance to re-charge its batteries without distractions such as TV or talking on the phone.
Pre-emptive resting is most helpful when you do it on a regular basis, regardless of how you feel and especially when you feel good. If you skip the rest when your symptoms are low, you risk returning to push and crash.
I believe that my daily scheduled rests were perhaps the single most helpful strategy I used in my recovery. I was amazed at what a difference short morning and afternoon rests made to stabilizing my life, increasing my stamina and reducing my symptom level.
Resting everyday according to a fixed schedule, not just when I felt sick or tired, was one part of a shift from living in response to symptoms to living a planned life.
Scheduled rests have been one of the most frequently used strategies among people who have taken our course. Although the length of rest varies from person to person, for most people pre-emptive rests means taking one or two rest breaks a day of 15 minutes to half an hour.
One woman, who had severe symptoms, reduced her total rest time dramatically by having several small rests each day. Prior to the course, she took two naps of three hours each. Because of the class, she decided to break up her day into one- and two-hour blocks, and to take a 10 to 15 minute rest during each block.
By doing so, she reduced her total rest time from six hours a day to three. By resting in small blocks, she added three hours of activity to her day without increasing her symptoms.
Activity Scheduling
Another pacing strategy is activity scheduling. Just as you may be helped by scheduled rests, you may be able to accomplish more without intensifying your symptoms by planning your activities. Here are several techniques our students have found useful.
Short Activity Periods: Two short periods of work with a break in between can produce more and leave you feeling less symptomatic than the same amount of time expended in one block.
The same principle can be applied over longer periods of time. You may find that your overall symptom level is lower if you spread out activities through the week, rather than trying to do many things in one or two days.
Activity Shifting: Another strategy for getting more done is to move from one type of activity to another. If you get tired working on the computer, for example, you may be able to call someone or prepare part of dinner.
Some patients divide their activities into different categories of difficulty: light, moderate and heavy. They schedule only a certain number of the most taxing activities a day and make sure to switch frequently among the three different types.
Time of Day: Many patients find they have better and worse times of the day. You may be able to increase the amount you get done without spending more time or intensifying symptoms by experimenting with when you do things.
Planning
Over time, you can extend pacing from individual activities to your whole lifestyle, by living your life according to a schedule of activity and rest. To implement this approach involves planning in advance what you are going to do for a day and a week, and then sticking to it as much as possible.
The goal is to move over time toward consistency in both activity and rest: doing a similar amount of activity each day and also taking similar amounts of rest.
To the extent you can live according to your plans rather than in response to symptoms, you will achieve a more predictable life, gain an increasing sense of control over your illness, and may be able to expand your energy envelope.
You might start by planning a day at a time. This involves setting priorities. Priorities give you a way to decide what to do when you can't do it all. In the morning or, even better, the night before, list possible activities for the day. Then evaluate your list, asking whether you will be able to do everything on it without intensifying your symptoms.
For those items that you can't do or can't do in the same way as before, try thinking in terms of delegating, simplifying and eliminating. Delegating means finding someone else to do a task that you used to do.
For example, family members might share in meal preparation or grocery shopping, or a cleaning service could take over housecleaning. Simplifying means continuing to do something but in a less elaborate or complete way.
For example, you might clean house less often or cook less elaborate meals. Finally, you may decide to eliminate some activities or relationships. Perhaps you can suspend your volunteer work or drop some friendships.
I recommend that you set your activity level ahead of time, rather than waiting until your body tells you with higher symptoms that you have done too much. Often the body gives misleading signals. You may feel fine even after you have gone outside your envelope.
The effects of overexertion are often delayed, so that you cannot rely on your body telling you when to stop. If you find your limits through experimentation, you can avoid crashing by being active for a length of time you have found to be safe.
Special Events
Non-routine times like vacations and the holidays can threaten your attempts to pace yourself. How can you handle special events in a way that allows you to enjoy them, but without paying too heavy a price? Here are some strategies.
Take Extra Rest: Store up energy by taking extra rest before the trip or event; limit symptoms by taking extra rest during; and take whatever extra rest is needed after.
Set Limits with Others: After you have decided your level of participation, communicate with others so they know what to expect from you.
Delegate: One way to enjoy a special event is by passing tasks on to others. If you are accustomed to doing all the cooking for a holiday celebration, for example, ask family members to each bring a dish. While traveling, allow others to drive.
Adjust Your Expectations: Replace resentment about not being able to do all that you want by focusing on what you can do. One student said: "I have benefited from the idea that half a loaf is better than nothing."
Achieving Consistency
The idea of pacing is easy to agree with, but pacing can be hard to practice. What can you do to increase your chances of living consistently within your energy envelope, if you believe pacing is desirable but have trouble doing it consistently? When we ask people who have been successful at pacing, they report using the following strategies.
Visualize Consequences: When you are tempted to go outside your envelope, visualize how you would feel afterwards. One person said: "Feeling the fatigue and brain fog provides a counterweight to the immediate pleasure I anticipate from doing something that takes me beyond my limit."
Use Schedule and Routine: Having a regular daily schedule eliminates a lot of decision making. One student said: "Instead of having to ask whether something is or is not within my envelope, I stick to a schedule I know is safe."
Keep Records: Having written proof of the effects of your actions can help you to hold yourself accountable for your actions. Also, you can use your health log as a positive motivator, providing proof that staying inside your limits pays.
In Summary
Pacing offers an alternative to repeated cycles of push and crash, a way to control symptoms and bring stability to your life. With pacing, you can live your life according to a plan, instead of living in response to symptoms.
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