Learning to pace is essential for managing ME/CFS and is recommended by the CDC and Nice Guidelines. The idea is that you learn what your new energy limits are and how to stay within them. If you exceed your limits, you will experience a crash where all your symptoms worsen for a temporary period of time. This is often referred to as PEM (post exertional malaise). To stabilise your health and have a chance of improvement you need to crash as rarely as possible. 

Although the concept is simple, implementing it can be very challenging!

Below is a list of answers to common questions related to pacing and crashing. Hopefully these will help you master the art of pacing.

Your baseline is the amount of activity you can do without triggering a crash. It is normally significantly lower than you expect it to be. To find it reduce your activity level to tasks you know you can do easily without any negative consequences. Staying at this level for a few days to a few weeks should mean you stop crashing and your energy levels regain some stability.

Once stable it’s time to start increasing your activity to figure out where your limits are. This is a process of trial and error which means there will be times you get it wrong, do too much and you crash. It sucks but don’t beat yourself up about it. It’s part of learning. If an activity causes you to crash you’ve learnt that it is too much and you need to modify it next time.

General advice is to operate at 50-70% of your capacity, with your baseline representing 100%. By keeping well within your limits you give yourself a buffer zone. 

For example, say the longest you can walk without causing PEM is 10 minutes. You can safely do 5 minutes without risking a crash. If you accidentally walk further and do 7 minutes that shouldn’t cause a crash either.

By not pushing yourself to maximum capacity you ensure you always have some energy in reserve. Think of it like building up savings in your “energy bank account”. Overtime these savings should give you more stability and hopefully improvement in your health.

If you are not sure how to calculate what 50% looks like, ask yourself “Could I do this twice?” This is also a good way to help figure out your baseline.

It is very important increases are small so that if the new level of activity turns out to be too much it shouldn’t cause a major crash. Physiotherapist Dr Meg Anderson advises to increase by no more than 10% to 20%. So if you can do something for 10 minutes try increasing it to 11 minutes. 

It terms of how often to increase your activity, Dr Meg recommends that you need to have done the activity on at least three days in a seven day period without it triggering a worsening of symptoms before you attempt to increase it.

In the rush to improve it is easy to increase activity too quickly, leading to repeated crashes and setbacks. It is much better to stay at one level longer than you think is necessary than to push ahead before your body is ready. 

This is a very common problem so don’t feel bad. It’s understandable you have lost confidence in your body. My advice would be to shift your focus from increasing activity to increasing confidence in your ability. 

Make your increases in activity so ridiculously small it is barely an increase at all. For example, if you can walk for 5 minutes, try walking for 5 minutes 5 seconds. When you become confident at doing that increase to 5 minutes 10 seconds. It doesn’t matter that you’re not walking that much farther, what matters is you’re doing it without symptoms. This will help you rebuild trust in your body.

I would also pick an activity you enjoy and are keen to do, not something you are dreading or would avoid doing even if you were healthy.

While people think activity is purely physical it can be anything – physical, emotional, cognitive or sensory. Everything you do uses up some of your energy.

Daily tasks like washing, dressing, talking, thinking, reading, using screens, even exposure to light and noise all count as activity. Emotions, both stress and excitement, also consume your energy and are perhaps the hardest elements to regulate when you are trying to pace.

When starting out timers can be helpful. TThey are particularly good if you get engrossed in doing your activity, such as reading a book. I’ve also found them helpful when socialising. You can pre-warn your social companion that when the timer goes off you need to stop and have a rest.

In the fullness of time, you’ll develop a sense of what your limits are and probably find you do not need to rely on a timer to tell you when to stop.

There are various devices that can help monitor your heart rate, stress level and symptoms. Some people find them very helpful when learning to pace, some pacing strategies even encourage you to continually monitor your heart rate to keep it within a specific range. However, other people find this approach a hinderance, making them focus too much on the data and their symptoms.

I have had ME/CFS since 2007, before smart phones were invented! I learnt to pace without using any of this fancy tech, so it is definitely possible. Don’t feel you need to spend lots of money if you don’t have the budget. That said they can be a helpful tool when trying to find your baseline, as well as providing data which validates your symptoms and exhaustion. You can show people just how crazy your heart rate is!

I’ve used Garmin and Visible (the free version). The data they gave me was interesting but didn’t always fit with how I was feeling. This is an issue I often see people mention in forums. Being old school, I prefer to listen to my body and use the technology as a guide rather than an absolute.

I would recommend resting on a schedule. Whether this is at set times of the day, before and after activities, or both. Resting is a preventative measure. If you are pacing well and resting regularly you should not keep getting symptom flare ups from overexertion.

PEM means you have pushed yourself beyond your baseline. The aim of pacing is to stay well within your baseline to avoid worsening symptoms. If you wait until you feel symptoms before you rest you risk of falling into the push/crash cycle.  

It is inevitable that things will happen which means your carefully crafted pacing schedule is thrown out the window. Sometimes these events will be expected and sometimes they will come out of nowhere.

If you know these events are coming, for example a birthday party or medical appointment, plan at least one day of rest before the event and another day of rest after the event. This may not stop PEM from occurring, but it should hopefully lessen the intensity.

If the event is unexpected, rest as soon as you can afterwards for as long as you need. Although frustrating, one over exertion is unlikely to set your health back in the long term so try not to stress about it too much.

You need to significantly reduce your activity and rest as much as possible. Trying to push through won’t work, you will make things worse. Delegate or delay as many tasks ask you can. 

Be kind to yourself. It can be easy to slip into a downward spiral of negative self talk, blaming yourself for over exerting. But honestly, crashing is part and parcel of having ME/CFS. Don’t beat yourself up about it, that won’t achieve anything. Instead reflect on why you crashed and what you could do differently next time.

I will write a more in-depth article about how to deal with a crash but these are two key strategies you can use right now.

There are two likely causes for this. Either you are continually pushing beyond your baseline or you aren’t giving yourself enough time to recover after an activity.

Reflect on the activities that caused the crashes. Can you honestly say they were within your capability? Were you knowingly over exerting yourself when you did them? Your baseline can change over time. I found mine will decrease when I’m under stress so I have to reduce my activities to avoid crashing. It could be that you need to reevaluate your baseline and reduce your activity level.

Alternatively, you may be pacing your activity correctly but not allowing yourself enough time to rest and recover between activities. It might be that you can manage a five minute walk, but not if you come home and start making dinner straight afterwards. Try sandwiching larger rest periods between activities. Even if you don’t feel tired, it’s important to give yourself some downtime.

If you are really struggling there are medications which can help reduce PEM. They don’t take away the need to pace but may reduce the severity and frequency of your crashes.

In my experience there are four possible reasons for this. The first, and most likely, is you’re doing too much. Even if you have reduced your activity level, you probably haven’t reduced it enough to allow your body to recover. Unless you are lying in silence in a dark room, there is always room to reduce your activity level.

Second – the over exertion that triggered the crash was significantly bigger than your average over exertion, consequently the crash lasts longer. For example, when my ME/CFS was moderate a normal trip out to my local town would take me 1-2 days to recover from. However when I travelled abroad it took me anything from two weeks to two months to recover – a bigger activity equals longer recovery time.

The third is that you are under stress. Emotional stress counts as activity. Unfortunately it is an activity which is very difficult to stop or have a break from. If this is what is perpetuating your crash, you may have to make significant life changes to ease the pressure before your health stabilises.

Lastly, the crash isn’t being caused by your typical over exertion. Something else is placing a stress on your system. Have you had a medicine change recently? Have you started eating any new foods? Have you developed a damp or mould problem in your house? Could you have any underlying infections? 

When my ME became severe I became intolerant to many foods I had previously been able to eat without an issue. Figuring out what foods these were and removing them from my diet, alongside improving my gut health stopped the deterioration in my health.

Personally, I would say yes. I rest when I’m not tired as a preventative measure. Before and after every activity I build in a rest period. I won’t necessarily be tired, particularly if I’ve paced well and stayed within my 50–70% capacity, however my body has experienced exertion during the activity, so I need to give it some recovery time.

Resting when you’re not tired feels unnatural at first but once I started doing it my energy level was more stable.

If you want in-depth guidance on when to rest, fatigue specialist Pamela Rose explains her top resting strategies that help stabilise energy and reduce crashes.

Figuring out how much rest you need is a bit like figuring out your baseline level of activity. It will vary significantly depending on the severity of your illness and the activities you are doing.

Use trial and error to find what works for you. If you crash frequently, it may be that you’re not giving yourself enough time to rest between activities. Alternatively, if you find yourself bored when resting, maybe you don’t need to rest so much. Try reducing your rest periods and see what happens.

If you are struggling to find the right balance between rest and activity occupational therapist Wendy Bryant has a simple pacing strategy that can help.

Recognise your limits are caused by your illness, not your lack of effort. Rather than seeing rest as “doing nothing“ view it as part of your treatment. It is what doctors advise you to do. Much like after an operation or an injury, people are advised to rest to allow their bodies time to heal. 

Planning regular rest into your day helps your body recover from activities. This reduces the chance of crashing and needing longer periods of rest and inactivity in the future, which would likely make you feel even more guilty.

It can also help to shift your mindset – instead of viewing success (or failure) by how much you can do, measure it with symptom stability.

Hopefully this article has helped you feel more confident about pacing and how to implement it in your daily life.  Learning to pace can be challenging and does involve some trial and error, but with time and patience, many people find they become more in tune with their limits and develop strategies that work for their individual situation.

If you would like to work with someone who can give you more personalised support check out this free guide I created which lists a selection of courses and 1:1 options.

Organisations such as ME Action, the ME Association and the NHS also provide in-depth information on pacing.

• 3 resting strategies to stabilise your energy
• 4 gentle exercise videos for CFS
• How to balance rest and activity