Aids to Pacing, Part 2

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By Bruce Campbell

Note: Second of two articles.

In addition to having personal rules and guidelines (see first article), you can use timers, pedometers and other devices to improve your success in pacing.

Timers

Timers are often used to enforce activity limits. For example, a person may have found that to avoid intensifying pain they have to limit chopping vegetables to 10 minutes followed by a five minute rest. Or they know that 15 minutes is the longest they can be on the computer without getting fatigued or brain fogged.

Using a kitchen timer or the timing function on a watch or cell phone, a person then sets the timer to sound at the end of the "safe" period. You can use this technique wherever you have limits: kitchen work, time on the computer, housecleaning, folding laundry, standing, talking on the phone, etc.

Pedometers

A second tool for staying within activity limits is the pedometer or step counter. Our friend Dr. Lapp believes that between 1,000 and 5,000 steps a day is a good range for many people with CFS and FM.

If someone takes fewer than 500 steps a day, Dr. Lapp usually suggests they gradually increase their steps. If someone is over 5,000 steps a day, Dr. Lapp finds they are usually too active and he advises that them to cut back.

His guidelines imply that 10,000 steps a day, an exercise target often suggested for healthy people, will be inappropriate for most people with CFS and FM.

The first goal with a pedometer is to use it to determine your current activity level and its effects on your symptoms. If you wear a pedometer for several days, you should get a good idea of how many steps you are now taking per day and can correlate that with your symptom level and compare it to Dr. Lapp's guidelines.

A number of people in our program have told us that their initial finding was that they were too active. Some people are surprised at how many steps they take, even without an exercise program. One wrote, "What astonished me was that even on days when I didn't go out [of the house], I was still recording 1,500 to 2,000 steps."

Once you have found your current limits (which may be fewer steps than you normally take), you can use the pedometer to help you stay within them and escape the cycle of push and crash. Over time, it may be possible to expand the number of steps without increasing your symptoms.

There are two keys to safely increasing steps per day. The first is to increase gradually, which might mean no more than 5% at a time. (For example, from 1,000 to 1,050 steps per day.) The second is to increase only as tolerated by the body. This means that you monitor the consequences of any increase and return to your previous level if symptoms are intensified.

For more, see the article Pedometers: A Tool for Pacing.

Heart Rate Monitors

Another device that can help you stay within your limits is a heart rate monitor. You can use this device to avoid post-exertional malaise, the intensificaiton of symptoms that results from doing too much. A heart monitor warns when you are over the anaerobic threshold (AT) or the heart rate beyond which we attempt to draw on energy reserves we don't have.

You can find your AT through experimentation or by going through a test. The AT is often around about 60% of a person's maximum heart rate, which is 220 minus your age. So, for a person who is 50 years old, AT would be calculated as (220 - 50) x .6 = 102 beats per minute.

Once you know your threshold, you can monitor yourself to discover when you are beyond your AT. Some people measure their heart rate by counting the beats in their wrist or neck, but other people use a heart rate monitor, an inexpensive machine available for $30 and up.

The alarm feature of a heart rate monitor tells you when you're about to go outside your limits and alerts you to the need to take a break. One person says, "We set my monitor to alarm when I reached a bit below my anaerobic threshold. That audible heart rate alarm was the best training tool I could have had."

Awareness of hitherto unknown limits can suggest how to change. One person in our program reported using a monitor showed her that just going up a flight of stairs pushed her heart rate beyond her threshold. Her solution was to take a rest break at the halfway point. Another person says that lifting her daughter used to push her over the edge. Her solution was to sit down and have the child climb into her lap.

The monitor can also educate others about limits and elicit their help. As one person said, "Using the monitor helped my family to understand and they helped me to stop when it went off."

In summary of the benefits of awareness of heart rate, here are the thoughts of one person who has used a heart rate monitor: "I've made a lot of progress in the past year, mostly thanks to heart rate monitoring, which trained me to reduce my activity to a level my body can handle. By forcing myself to stay within my limits, I have slowly achieved an increase in what I am able to do without going anaerobic."

For more see the article Pacing by Numbers: Using Your Heart Rate To Stay Inside the Energy Envelope.

Other Gadgets & Aids: Chairs, Stools, Scooters, Etc.

You may be able to get more done, reduce symptoms or both by using other gadgets and aids to help you. These may include:

Kitchen stool on rollers
Plastic chair or bench in the shower
Grab bars in the bath or shower
Grabbers
Wheelchair
Scooter
Cane
Handicap parking tag

One person in our program reported dramatic results from using a motorized cart or scooter for grocery shopping. Her tolerance for standing is low and she is vulnerable to the sensory input of stores, particularly noise and fluorescent light. Before starting to use the cart, she would be so tired from her weekly grocery shopping that she would lie down for two hours as soon as she returned from the store. Using the cart, she doesn't need any rest at all after grocery shopping, freeing two hours for other activity.