What is PACING?

PACING is an evidence-based technique which has been proven to manage and support recovery from Post-Viral Fatigue. 

PACING, in terms of managing fatigue, means finding a balanced and achievable pattern of activity and rest in order to break the BOOM BUST cycle and to minimise PEM. It means staying within your energy envelope and current capabilities and slowing down to work at a steadier pace instead or pushing or rushing.

 
This is the pattern of a typical PACED week:

PACING will enable you to expose your body and mind to daily demands in a regular and controlled way in order to maintain a consistent and realistic daily routine and help the body stabilise itself. 

How do I PACE?

  • Use an activity diary to analyse your day-to-day activities.
  • Find your baseline (usually a mid-point between a good and bad day).
  • To being with, strip back anything that is not essential.
  • Alternate between different types of activity and exertion throughout the day.
  • Aim for a range of high, medium and low energy activities throughout the day.
  • Split up any complex or high energy activities.
  • Ensure regular rest, relaxation and re-charge after each activity. Remember to rest your mind and senses as well as your body.
  • Remember to stop before you become tired!
  • Prioritise uplifting, inspiring and enjoyable activities that provide you with a sense of achievement; help you connect with what is important to you; and boost your mood.
  • Work through high levels of fatigue very gently with the aim to minimise Post Exertional Malaise. If you continue to develop PEM you may have to continue to decrease your activity until it is no longer induced. Listen to your body.
  • Ensure a period of consistency (at least 7 days) before very slowly and gradually increasing activities and/or exercise. Start low and go slow.

When using PACING; it can also be helpful to look at PLANNING, PRIORITISING and POSITIONING:

Planning

Planning is a powerful self-management skill which puts you in control. It allows you to:

  • Plan ahead/pre-plan activities.
  • Schedule in rest breaks.
  • Identify and make time for what is important to you.
  • Minimise the frequency of activities.
  • Spread out activities or split them into more manageable stages or chunks. Does the level
    of activity exceed your current limitations?
  • Think through your activities – can they be done in a different way? Find easier ways to complete activities (short cuts) to conserve energy.
  • Schedule more difficult tasks for when you have the most energy. Everyone has a time of day when they are most alert.
  • Alternate between light and heavy tasks.
  • Alternate between cognitive and physical tasks.
  • Make time for fun.

Prioritising

Prioritising allows you to prioritise, not just what is necessary, but what is important to you.

  • What is a priority for YOU?
  • List your weekly activities in order of importance. Focus on the week ahead only – next week can wait (for now).
  • Apply the 4 Ds to your list: Do? Delay? Delegate? Drop?
  • Identify necessary tasks. Is it necessary? What’s the worst that can happen if it’s left undone?
  • Eliminate any unnecessary tasks – let go of the things you can’t do.
  • Is there anyone else who can help? Can you ask or hire someone to do some of your tasks for you?
  • Can you schedule some time for the things you enjoy every day. What else can wait?
  • How can you save energy for the things you want and need to do?

Positioning

  • Use your environment to support you… lean, sit, perch, rest where possible.
  • Avoid pulling, lifting, twisting, bending, stretching and overhead reaching.
  • Avoid prolonged standing, squatting or stooping.
  • Use gravity and momentum to decrease your workload – push and slide rather than lift.
  • Maintain a good posture, where possible.
  • Avoid prolonged gripping.
  • Bend and use leg muscles when lifting – stand close to objects.
  • Avoid lifting children – sit them in your lap instead.
  • Use feet to close doors/drawers.
  • Bring feet/knees up to put on socks/shoes to avoid over-bending.
  • Have work in front of you, not to one side to avoid twisting.
  • Don’t hold your breath during a task.
  • Inhale during the lightest part of an activity and exhale during the most strenuous part.
  • Keep your chest and open and relaxed.
  • Use breathing techniques such as pursed lip breathing; diaphragmatic breathing and ‘Blow as you Go’. Your Physiotherapist can teach you these techniques.

Your Environment

When PACING, it is useful to pay attention to your surroundings and become aware of how certain environments contribute to your fatigue.

  •  Reduce clutter – busy environments can contribute to fatigue (and both mental and physical tasks can require more energy when navigating clutter).
  • Ensure adequate room temperature – increased body temperature can increase fatigue.
    Shivering also uses energy.
  • Ensure adequate ventilation – a supply of cool, fresh air will help with fatigue.
  • Ensure adequate lighting – poorly or brightly lit rooms can strain the eyes and cause sensory overload.
  • Reduce noise/distractions – too much noise, or too many distractions can contribute to
    sensory/mental fatigue.
  • Lack of sunlight/daylight – lack of Vitamin D can cause fatigue; and lack of natural melatonin can affect sleep and contribute to fatigue – open the curtains, get outside, spend time in nature.

Energy Conservation

It is important to look at different ways to save energy. This can be achieved by:

  • Making simple adjustments to your daily routines to improve your energy efficiency.
  • Saving energy for things that are important to YOU!
  • Activity Grading (see below).

Activity Grading

Understanding the different component parts of an activity and how to break an activity down into
more achievable steps is a process known as activity grading. Learning new ways to complete
activities helps you to use your energy more wisely. By using activity grading, this can help you
to:

  •  Find the easiest way of doing a task so that you have energy left over afterwards.
  • Break down activities into smaller, more achievable stages by adding, reducing or
    eliminating steps.
  • Change your position regularly, and add in regular rest breaks.
  • Learn to use equipment and/or the environment to support you.
  • Seek assistance with activities.
  • Slow down your pace.


Your Occupational Therapist can provide further advice around Energy Conservation and Activity Grading; along with advice on and provision of equipment, aids and adaptations.

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