What is pacing?
In medicine, pacing is a therapeutic concept for chronic fatigue syndrome (also: myalgic encephalomyelitis/chronic fatigue syndrome, ME/CFS), but also for long Covid. Severely affected people are no longer able to cope with everyday life, and even those who are less severely affected experience a drop in performance.
Pacing aims to conserve the energy resources of those affected and avoid overload of all kinds: physical, mental and emotional.
Pacing for long Covid
ME/CFS is primarily known as a result of viral infections such as mononucleosis. The main symptom of fatigue is currently occurring more frequently worldwide, as it is one of the most serious secondary disorders of Long Covid. The most likely cause is an impaired immune response, which leads to a disruption of the autonomic nervous system, vascular regulation and energy metabolism.
Stress intolerance
People with fatigue often suffer from the phenomenon of exercise intolerance. Even minor exertion can overtax them. The result is so-called post-exertional malaise, also known as “crash”. This is accompanied by a drastic worsening of symptoms and even a complete inability to act. It can also permanently worsen the condition of the person affected.
Pacing: avoid a crash by taking it easy
Chronic fatigue can be compared to the condition of a defective battery that can no longer be fully charged. It is important not to use up the energy reserves completely. Each complete “discharge” damages the defective battery further. If those affected rest, they recharge the battery.
Pacing as therapy
Pacing helps those affected to find their personal balance between rest and activation and can thus reduce the number and severity of crashes. Pacing can stabilize patients and thus prevent further deterioration of their condition.
If pacing is used as early and consistently as possible, there is a greater chance that the condition will improve or even heal completely.
Pacing also allows those affected to regain a certain amount of control over their condition. This strengthens their mental state and helps them to accept the current situation.
Strategies that can be helpful with other fatigue phenomena and that motivate patients to be more active are highly risky with fatigue: they can cause the patient’s condition to deteriorate not just in the short term, but permanently. This has a massive impact on performance and quality of life.
How does pacing work?
Recognize limits: In order not to overload themselves, those affected need to develop a sense of their current limits. These relate to four areas: physical, mental/cognitive, social and emotional activity.
The central message of pacing is to listen to your own body. If you notice a deterioration after an activity, you should avoid it in future. If you already feel exhausted during the activity, you should interrupt it. This also applies to emotionally stressful situations!
Take rest breaks, plan buffers: People with CFS have to manage their energy levels. Rest breaks are very important for you. You need to recharge your batteries from time to time. Therefore, plan regular breaks into your daily routine and stick to them consistently. In this way, you build up energy resources that act as a buffer and prevent overload. If you are planning special activities, rest before and after. Also watch out for signs of exhaustion and counteract them with spontaneous recovery breaks.
Ride at half power: An effective strategy in the context of pacing is to take on less than your own strength would currently allow. Many sufferers report that they are most stable when they only do 50 percent of what they are actually capable of. In this way, the battery is never completely empty.
Relax in a targeted manner: Relaxation techniques such as autogenic training or meditation can provide mental relief. Practitioners find deep relaxation. It can therefore be very helpful for people with CFS to learn an appropriate technique.
Accept current limitations: CFS robs those affected of the life they are used to. Some are no longer able to pursue their profession or are severely restricted in their performance. Many things that you used to enjoy doing, such as hobbies, meeting up with friends, family activities or sport, are no longer possible or only possible to a limited extent. Accepting this loss is not easy, but it is necessary (at least for the time being) in order to organize your life in the best possible way within the new framework.
Communicate boundaries: Inform those around you about your situation. Explain why you can no longer be as active as you used to be, why you sometimes have to cancel appointments at short notice and that pulling yourself together and becoming active against your instincts makes your condition worse. This is the only way your fellow human beings can develop the necessary understanding and support you.
Delegate and accept help: Try to use your reduced strength for important things and for things that are good for you. To do this, hand over as many tasks as possible: housework, tax returns, errands.
Monitoring the heart rate as part of pacing
During pacing, patients need to develop a very good feeling for their personal exercise limit. Many find this difficult, especially at the beginning.
Fitness watches with an integrated heart rate monitor can help with this. These continuously register the pulse and can help CFS sufferers to recognize higher stress levels in good time. Choose a device that offers a warning function when certain heart rate ranges are exceeded.
Doctors recommend two approaches for determining the reference value:
- Based on age, the formula (220 – age) x 0.6 = reference value in heartbeats per minute (bpm) applies. For a 40-year-old person, this means a maximum of (220 – 40) x 0.6 = 108 bpm.
- Based on the average resting heart rate, measured over seven days while lying down: resting heart rate + 15. With a resting heart rate of 70, the guideline value would therefore be 85 bpm.
The latter in particular is a very low value. However, the aim is to gradually widen the pulse range. If the patient does not experience any worsening of symptoms over a period of seven consecutive days and no further symptoms occur, the specified maximum heart rate can be gradually and slowly increased.
What is post-exertional malaise?
Post-exertional malaise is not comparable to the normal exhaustion experienced by healthy people after physical or mental stress. In the case of post-exertional malaise, the symptoms of those affected worsen dramatically.
The stress limits of patients vary greatly from person to person. While one person can cope with a walk, a conversation or brushing their teeth is too much for severely affected patients and provokes a crash. It is therefore essential to sound out individual personal limits.
