ME/CFS Society of WA: Pacing

Post-exertional malaise/fatigue and worsening of symptoms is a hallmark symptom of ME/CFS and betrays the deep metabolic dysfunction that lies at the heart of the disease. In practice this means that when those affected by ME/CFS exceed the cumulative limit of exertion imposed by the disease they experience a ‘crash’ or worsening of their symptoms and deterioration in health that can last for days, weeks or even months. Exertion is defined as physical, mental or emotional activity all of which can be stressful upon the body.

Avoiding Over Exertion

Severity of ME/CFS varies markedly from one person to another and with it an individual’s overall ability to tolerate exertion. This means that the more severely an individual is affected the less activity they will be able to tolerate and potentially the worse their ‘crash’ if they exceed this limit. Often though there is no warning or indication that an individual has reached their limit –this may come as much as 48 hours later when the damage has already been done and they’ve ‘crashed’.

A well informed physician empowers the patient by respecting their experiences....and helps them achieve optimal exercise and activity levels within their limits..."
-Canadian ME/CFS Guidelines 2003

The aim of pacing is to remain as active as possible while avoiding the relapses and worsening of symptoms that occur with over exertion. Individuals should avoid an endless ‘push-crash’ cycle in which they do too much, ‘crash’, rest, start to feel a little better, do too much again, ‘crash’, and so on. If possible, which it may not be in the most severely affected, individuals should try not to avoid activity altogether as this leads to progressive deconditioning which causes its own problems.

Listening To The Body

Listening carefully to the body and heeding what it is saying is the key to pacing. Individuals may benefit from keeping a daily diary of their cumulative activity (physical, mental and emotional) and matching this to their symptoms. This will help lead to the early realisation of a base line of activity that does not exacerbate their symptoms. By staying within this limit they are then able to avoid ‘crashes’ while staying as active as their illness allows.

Individuals should plan adequate rest to recover from exertion or in preparation for days when exceeding known limits is unavoidable. Doing less on days when symptoms are relatively worse and only increasing activities gradually is also sensible. Exercise programs that do not respect how an individual feels or the relative severity of their symptoms may be harmful and should be avoided. Pacing is fundamental to managing ME/CFS and listening to the body is key to successful pacing.