What is Pacing/Energy Conservation?

• Pacing is a term that most sufferers of chronic conditions have heard. "Pace yourself" you are told, yet while you nod your head, you are thinking, " I already have too much to do; how can I pace myself?" There is a misunderstanding that pacing strictly means doing less. Pacing, generally means learning how to do daily activities in such a way as to avoid causing unnecessary pain and fatigue. Without increased pain and fatigue, there is less "down time," and therefore in the long run more may be achieved rather than less. Pacing will allow you to achieve a better balance between lifestyle components of work, rest, and play.

Why is Pacing so Important And Why Should I do it?

1. It will increase the number of "active" hours available to you in a day and across the week.
   • minimizes/eliminates "crashing" from over-doing.
   • minimizes/eliminates bad days after you have gone "gung-ho" on your good days.
   • it is time consuming to apply pacing concepts, however overall it will increase the amount of time available for you to accomplish things.
2. It will enable you to control symptoms of pain and fatigue at a manageable level.
   • this manageable level is not the same as no pain/fatigue; it is a level somewhere between no pain/fatigue and worst pain/fatigue. The goal is to try and obtain the lowest level of pain/fatigue possible.
   • everyone's manageable level is different.
3. It will maximize your endurance and energy level.
   • saves energy for the times when you want to participate in a planned event that you enjoy.
   • improves your ability to participate in homemaking/work responsibilities.
   • allows you to better handle "surprise" visits or events that are beyond your control.
4. It empowers you to cope with your condition.
   • by controlling your symptoms, you gain control over your daily activities and life.
5. It helps you to focus on your accomplishments instead of pain and fatigue.
   
6. It breaks the activity/pain association.
   • by pacing, you can eliminate the flare of pain and fatigue associated with doing an activity; by eliminating this flare, you can slowly eliminate anticipating this flare; by eliminating anticipation you can relax your muscles more and decrease your pain/fatigue.
     

The Principles of Pacing Include:

1. Balance self-care, productivity and leisure components of your lifestyle.
   • consider what roles/values are important to you
   • set goals that are realistic and attainable;
   • develop a plan of action and communicate/share this plan with loved ones
   • a healthy/enjoyable lifestyle assists in coping with chronic pain.
     
2. Adhere to your activity tolerance level.
   • consider the length of time that you can participate in an activity before your pain/fatigue begins to increase; this is your activity tolerance level.
   • avoid over-doing/pushing to finish/continuing despite increasing pain.
   • when pain/fatigue start to increase, stop the activity and take a rest break, or a symptom control break.
3. Break down lengthy/difficult tasks into smaller/manageable ones.
   • make sure that the task is broken down enough so that you can adhere to your activity tolerance level.
   • allows you to participate in daily activity without over-doing.
   • enables you to complete smaller tasks (in control of your symptoms), providing motivation to resume more activities.
   • makes it easier to plan and schedule rest breaks/symptom control breaks.
4. Spread tasks throughout the day and across the week.
   • enables you to consistently use your muscles throughout the week.
   • allows the specific muscles used during that task to rest for the remainder of the day.
   • enables you to maintain a consistent activity level throughout the week.
5. Alternate tasks.
   • consider demands placed on certain muscle groups used during activities.
   • vary sitting/standing postures.
   • consider type of activity scheduled back to back, ie. sedentary vs. active.
6. Maintain a consistent activity level.
   • pace on both good and bad days.
   • maintain approximately the same activity level so that muscles don't have the opportunity to tighten and shorten.
   • don't schedule all your hard work in AM and sedentary work in PM.
7. Incorporate rest/symptom control breaks into your routine
   • rest break is a time away from work/housework when you do a sedentary, enjoyable activity, ie. reading, watching TV.
   • symptom control break is a time away from an activity when you perform a technique that actively relaxes your muscles, or controls your pain/fatigue level, ie. sitting to do deep breathing,lying down to do imagery,
     listening to relaxation tape
8. Practice symptom management during participation in an activity.
   • problem-solve ways to use deep breathing, imagery or relaxation while you are involved in a task.
9. Make work easier.
   • eliminate tasks that are not necessary.
   • don't over-schedule.
   • prioritize.
10. Take a gentler approach to life.
    • stress is fatiguing and can flare pain.
    • work at a comfortable, easy pace.
    • don't rush.

Why a Written Schedule?

• Written schedules are a feedback tool that you can use to stay on track, or assist in problem-solving for improvement.
• Written schedules cue your memory for pacing.
• By planning ahead, you can best use your energy level, or pain control.
• Scheduling will help you to maintain realistic expectations and avoid over-doing.
• Try different approaches to a task, or different strategies to determine which provides symptom control.

Where do I Pace?

1. Everywhere
   • at home, work or play
   • alone, with family or in social situations.
2. Some techniques can be done undetected by other people.
3. With practice/problem-solving, some techniques can be "fit" into various situations without disrupting the routine.
   

When do I do it?

1. Once your symptoms are at a manageable level, you need to practice your pacing and carry out your home exercise program to keep your symptoms under control.
2. Written schedules will need to be kept daily, initially. Because pacing is a new skill that must be learned, daily schedules will be needed to master the skill, break old habits and develop new routines. As you improve, pacing will become second nature and schedules won't be needed any more.
3. Consistency is the name of the game.
4. If a flare occurs
   • keep pacing
   • Slightly decrease activity level and increase time spent in rest/symptom control breaks.
   • remember the right mental attitude.

Keep in Mind

• Your manageable symptom level is not a perfect state, there are fluctuations above and below.
• No matter how successful you are at pacing - you will experience a flare-up. Flare-ups cannot always be avoided.
  • try to identify what caused it and correct it
  • if no causes, pace as best you can and wait it out.
• Finding out which combination of pacing principles work best for you is trial and error.
  • remember to keep analyzing and brainstorming ways to improve.
• Be Flexible
• Rest/symptom control breaks are aimed at controlling your pain/fatigue level, therefore, no napping.
• Activity tolerance levels can be improved
  • this can be done by shaping your baselines
  • as your tolerance levels improve, the number of breaks and the amount of pacing you need will decrease.