What is Pacing?

Many people with energy-limiting conditions find that their symptoms get worse after exertion. ‘Pacing’ is a strategy to manage this by balancing rest and activity.

Understanding
Post‑Exertional Malaise

A response to exertion

Post-exertional malaise (PEM) refers to the worsening of symptoms following physical, cognitive or emotional exertion.

It isn’t just a feeling of general tiredness, but can include severe fatigue, pain, cognitive dysfunction, sleep disruption, and more.

A delayed onset of symptoms

Post-exertional malaise is characterized by a delay in the onset of symptoms, which may occur from 12 to 48 hours after exertion and can last for days or even weeks.

This delay makes it extremely difficult to recognize when over‑exertion is occurring, which can lead to a debilitating cycle of relapsing and recovering.

Staying within your energy envelope

Pacing is a strategy that balances rest and exertion to minimize post-exertional malaise. It involves finding a comfortable range of energy expenditure that avoids both over‑exertion and under-exertion, maintaining an optimal level of activity over time.

Cycle of recovering and relapsing

Pacing

Using wearable technology

High-accuracy wearable technology can help measure exertion and rest by using heart rate and movement data. By analysing this data in real-time, it can help you to find, and stay, within your energy envelope.

Find out more about Visible

Recommended by medical bodies around the world

Learn more about pacing from leading health authorities.

Pacing Research

The latest research in pacing and post-exertional malaise.

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Appelman et al. (2024), Muscle abnormalities worsen after post-exertional malaise in long COVID

We show that skeletal muscle structure is associated with a lower exercise capacity in patients, and local and systemic metabolic disturbances, severe exercise-induced myopathy and tissue infiltration of amyloid-containing deposits in skeletal muscles of patients with long COVID worsen after induction of post-exertional malaise.

Pagen et al. (2023), High proportions of post-exertional malaise and orthostatic intolerance in people living with post-COVID-19 condition: the PRIME post-COVID study

High proportions of PEM and OI are observed in post-COVID-19 condition.

Clague-Baker et al. (2023), An international survey of experiences and attitudes towards pacing using a heart rate monitor for people with myalgic encephalomyelitis/chronic fatigue syndrome

Wilcoxon Signed-Ranks test indicated a statistically significant reduction in their severity of ME after HRM (Heart Rate Monitored) pacing.

Ghali et al. (2023), The relevance of pacing strategies in managing symptoms of post-COVID-19 syndrome

‘"Our findings demonstrated that pacing is effective in the management of patients with Post-Exertional Malaise, and that high levels of adherence to pacing are associated with better outcomes."

Pagen et al. (2023), High proportions of post-exertional malaise and orthostatic intolerance in people living with post-COVID-19 condition: the PRIME post-COVID study

High proportions of PEM and OI are observed in post-COVID-19 condition.

Twomey et al. (2022), Chronic Fatigue and Postexertional Malaise in People Living With Long COVID: An Observational Study

Long COVID is characterized by chronic fatigue that is clinically relevant and at least as severe as fatigue in several other clinical conditions. PEM is a significant challenge for this patient group.

Geraghty et al. (2017), Myalgic encephalomyelitis/chronic fatigue syndrome patients’ reports of symptom changes following cognitive behavioural therapy, graded exercise therapy and pacing treatments

Pacing is the most favoured treatment with the lowest negative response rate and the highest reported benefit

Clague-Baker et al. (2023), An international survey of experiences and attitudes towards pacing using a heart rate monitor for people with myalgic encephalomyelitis/chronic fatigue syndrome

Wilcoxon Signed-Ranks test indicated a statistically significant reduction in their severity of ME after HRM (Heart Rate Monitored) pacing.

Bond et al. (2021), Effects of Post-Exertional Malaise on Markers of Arterial Stiffness in Individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

We have shown that ME/CFS patients may experience altered vascular responses following aerobic exercise, contrary to what is seen in healthy populations.

Hodges et al. (2020), The physiological time line of post-exertional malaise in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)

Subjective data demonstrated the 48-hour ME/CFS group reported significantly longer time to recover.

Strussman et al. (2020), Characterization of Post–exertional Malaise in Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome patients describe post–exertional malaise as all-encompassing with symptoms affecting every part of the body, difficult to predict or manage, and requiring complete bedrest to fully or partially recover.

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