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.

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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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Chu (2018), Deconstructing post-exertional malaise in myalgic encephalomyelitis/chronic fatigue syndrome: A patient-centered, cross-sectional survey

This study provides exact symptom and time patterns for PEM that is generated in the course of patients’ lives. PEM involves exacerbation of multiple, atypical symptoms, is occasionally delayed, and persists for extended periods.

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

O'Connor et al. (2017), Energy envelope maintenance among patients with myalgic encephalomyelitis and chronic fatigue syndrome: Implications of limited energy reserves

These results are consistent with the Energy Envelope Theory, and they suggest that overexertion was particularly impactful for individuals with higher levels of available energy.

Rowe et al. (2017), Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Diagnosis and Management in Young People: A Primer

Successful management is based on determining the optimum balance of rest and activity to help prevent post-exertional symptom worsening.

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

LaManca et al. (1998), Influence of exhaustive treadmill exercise on cognitive functioning in chronic fatigue syndrome

We conclude that after physically demanding exercise, CFS subjects demonstrated impaired cognitive processing compared with healthy individuals.

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