If you have a chronic illness, you've likely heard about pacing. This week, I'm going to discuss pacing in detail - what it is, and how you can use it to manage your activity levels if you're struggling with pain, fatigue, or getting back to normal following illness or surgery.
At the time of writing this, I'm living with someone who is recovering from an operation. They're in a lot of pain and sleeping quite a bit, but have been told to walk a little bit every day. Today, we made it to the end of the street before we had to go back - and this isn't someone who was unwell or unfit before surgery. We're all susceptible to injury, illness and being otherwise unable to do the things that we were able to do even just a few days before. When that happens, or if we have a chronic health condition that limits our energy or our activity, pacing can really help.
So what is pacing?
Pacing is a way of managing the amount of activity that you do in a day (or week, or month), taking into account anything that might limit your ability to keep going indefinitely, so that you don't end up causing yourself more difficulties down the line. It requires patience, and ways to manage frustration, but the rewards hopefully more than make up for this.
Take chronic pain, for example. If you have chronic pain, cleaning the house from top to bottom won't do you any physical harm, but it's going to increase your level of pain until you absolutely can't do any more. This is often the only way that people know of doing things, because that's usually what we do when we don't have pain or fatigue - just keep going until you've finished the task. Unfortunately, it doesn't work when you are recovering, or you have a chronic health condition. Pushing yourself to exhaustion then resting for a few days afterwards is known as "boom and bust" - the "boom" of increased activity is followed by your energy level ending up as a "bust" and you needing to rest. Over time, the rest periods sap your strength and energy even more, meaning that you can do less and less as you continue to boom and bust. Eventually, even small things require too much energy, or put your body in too much pain.
The same thing applies if you're recovering from an operation, an illness like 'flu, or even something like giving birth. Just because you feel that the worst of it should be behind you, doesn't mean you can start to behave like the experience you had never happened. You're likely to do too much and put your recovery back several days, weeks, or even months. You need to learn to pace.
When learning to pace, the first thing you need to know is what your baseline tolerance level is. A "tolerance level" is how much of an activity you can do without experiencing payback in the form of fatigue or pain. For example, you might be able to do thirty minutes of gardening, but any more might mean that you can't do anything else that day. This isn't an exact science, and might depend on lots of different factors. The key is not to push your tolerance level to breaking point ("I can do thirty minutes of gardening but I'm totally broken afterwards and I'm struggling by twenty minutes anyway, but I don't want to stop"). If you think you can ride a bike for twenty minutes, half it and start from there. This also applies to things like sitting, standing and walking - they're all things you do with your body, after all.
Once you've worked out your baseline tolerance level, you can start to work within that. It might be walking to end of the street and back then resting, or you might be able to do things for up to an hour at a time. The important thing is to factor in rest breaks, or breaks where you do something that's less fatiguing or painful, like sitting and reading, calling a friend, watching TV or listening to music. And if you're factoring in rest breaks, that means stopping when you reach your tolerance level, not when you've finished the task. Typically, this is the bit that causes all kinds of problems.
What's driving you?
Pacing itself is a pretty easy idea to get the hang of. However, most people are rubbish at it at first! That's because loads of things can interfere with you wanting to pace yourself. To really get used to the idea of pacing, you need to know what's preventing you from doing it.
Maybe you're the kind of person who's always been on the go, who everybody turns to in a crisis, who is reliable and dependable. Chronic illness, or recovery from acute illness, might mean that you don't feel so dependable any more. Guilt can set in, and then you find yourself pushing harder to help the people who have relied on you in the past, rather than explaining your current situation and working out a compromise. Or, suppose you've always used the gym to de-stress - if you can't work out in the way you used to, you may feel that you have no way of managing stress, so you push yourself to get back to lifting weights before you should.
Often, the rules we have for behaviour can interfere with pacing as well. Beliefs such as "if a job's worth doing, it's worth doing well" and "go hard or go home" can really stop us from taking on board the idea that we need to do things differently now. We don't like to slow down, but that doesn't mean that we have any choice, or that it's something we can just ignore.
Keep moving forwards
Ultimately, the point of pacing your activity today is so that you can gradually do more tomorrow (or in a week, or month). This is known as pacing up. Just because you can only walk to the end of the street today doesn't mean that's all you'll ever be able to do. But if you push it the next day and walk double that distance, you're likely to set yourself back further. The trick is to keep moving forwards in small increments - you'll be amazed at your progress in just a few weeks.
As for the person I live with, they'll be back on their feet in two weeks. But if you have a chronic health condition it's not that simple. By learning to pace your activity, and being protective of the amount of energy you have, you can start to slowly do more over time.
Does this make sense to you? Let me know in the comments.
Dr Sarah Blackshaw: Clinical Psychologist, blogger, tea drinker, interested in dinosaurs and shiny objects