Ten Keys to Successful Coping 

3: Pace Yourself

By Bruce Campbell

The push and crash cycle described in the last article can be demoralizing. We can easily feel frustrated and depressed by the thought that we are caught in a closed loop, cycling helplessly between overactivity and rest. But there is another way to live with chronic illness. You can lead a more stable and predictable life by pacing yourself.

Pacing means finding the right balance of activity and rest for your unique situation. With pacing, you can learn to live your life according to a plan rather than in response to symptoms, so you have a sense of managing the illness rather than the illness controlling you. Pacing offers a way to flatten out the chronic illness roller coaster.

Finding Activity Limits 

Part of pacing is finding your activity limits: knowing how much and what kinds of activity you can do without intensifying your symptoms. To get a general idea of whether your current activity level is appropriate, spend a few minutes a day for a week keeping an Envelope Log. Rate yourself from 1 to 10 on three measures: activity level, energy level and symptoms. Most students who have used this log have found that their activity level is more than their body can tolerate. 

Another technique for determining your activity limits is to establish your limits one activity at a time.  You may know that you get tired if you spend too long fixing meals, for example, or after doing errands or housework, or after talking to people.  But you may not know when "too much" arrives.  A way to answer the question is to focus on one activity at a time by keeping a simple record.  For example, you may believe you can stand in the kitchen for 10 minutes while fixing meals. To test this idea, note your starting and ending time while preparing food, and how you feel during and after. If you find you are worse, 10 minutes is too much.  If you feel OK, you may be able to extend the time. 

Record Keeping

A good strategy for determining your overall activity limits is through record keeping or logging.  Logging gives you a way to record what you do from day to day and to see the consequences.  It helps you recognize linkages between activity level and symptoms. We’ll discuss logging more fully in a later article. For now, I’d like to make some general comments. 

Record keeping can help you in various ways. Logs can show you how many hours of activity and what types of activity you can do safely in a day. They can help you determine whether the effects of your activity are cumulative over several days or a week, and whether there is a delay between when you do something and the time you feel the effects.  Also, records can help you determine whether some activities are more tiring than others. Some patients, for example, have difficulty with exercise, while others become nauseous after a short time on the computer, and still others become ill if they drive more than short distances.

Self-observation can also help you become aware of the effects of mental and emotional events, as well as physical activities. Many patients find themselves easily tired by activities that require concentration, like balancing a check book, reading or working on the computer.  Emotional events can be especially tiring.  One student described how he became aware of to the effects of emotional events after watching a football game on TV.  Even though his team won, he found himself drained for hours afterwards, probably because of the effects of adrenaline.

The Value of Routine

Pacing means planning, deciding in advance what you are going to do for a day and a week, and then sticking to it to the degree possible. Using pacing you move gradually toward a life which is consistent and controlled: doing a similar amount of activity each day and also taking similar amounts of rest. To the extent that you know your limits and can live according to a plan rather than in response to symptoms, you can lead a more predictable life, gaining an increasing sense of control. Having a routine is a great stress reducer, because routine reduces the unpredictability of life.

In planning your day or week, it is important to schedule rest as well as activity. Instead of resting in response to symptoms, plan to rest for set amounts of time at selected times during the day. Such scheduled rests, typically one or two periods of 15 to 20 minutes each per day, have been a very popular strategy used by people who have taken our course. Most have reported having more energy, lower symptom levels and an increased sense of control. I believe so strongly in the value of scheduled rests that it will be the topic of the next article.

Also, remember to be consistent, changing your schedule only slowly. It can be tempting to do more than you had planned on a day you feel good. But if you do more than your body can tolerate, you can easily slip back into the push and crash cycle. The key is to decide ahead of time how much activity is safe and to stick to it, expanding your activity level gradually.

Expanding the Energy Envelope 

Finally, you can use pacing to expand safely how much you do. Below you’ll find several suggestions for one approach to such expansion: limiting needless loss of energy. 

Relax to Limit Adrenaline: Many patients are acutely sensitive to adrenaline. By relaxing, you may be able to limit the production of adrenaline and thus free energy for other uses. One student reported that she became very tired and cranky after an hour while hosting a birthday party. She decided her symptoms were due to worrying too much about whether people were enjoying themselves. A year later at a similar party, she created different expectations for herself by imagining that she was a queen who was observing the party. Freed from her self-imposed expectation, she found herself with good energy for more than two hours.  By relaxing, she reduced her worry and extended her energy. 

Limit Standing: Many patients are sensitive to standing.  An energy saving technique is to sit down to prepare meals and while showering. 

Limit Sensory Input: Many patients have an increased sensitivity to light and sound, and find that their concentration is affected greatly by having too much sensory information.  You may be able to get more done and experience a lower symptom level if you focus on one thing and simplify your environment. For example, you may be able to understand what you read better if you turn off the TV. Or you may function well in a group of one or two, but feel overwhelmed by a group of ten.

Use Devices: You may be able to get more done with some mechanical assistance.  Some patients whose tolerance for standing is low, who are sensitive to sensory input or both find shopping easier if they use a wheelchair or motorized cart.  Many large stores have such devices they make available for free. 

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