What is balancing/pacing?
Balancing is all about managing activity and rest to bring about improvements in the way you feel. The word ‘activity’ is used in a broad sense, to include mental and emotional activity, as well as the more obvious physical sort. Taking a balanced steady approach to activity counteracts the common tendency to overdo things. It avoids the inevitable ill effects that follow. Pacing gives you awareness of your own limitations which enables you positively to plan the way that you use your energy, maximising what you can do with it. Over time, when your condition stabilises, you can very gradually increase your activities to work towards recovery.
To understand pacing it can help to think of your available energy as being like a mobile phone battery. If you completely drain the battery you have to wait to recharge it before you can use the phone again. If you usesome of the battery and make regular top ups, then your phone will always be ready to use. Managing your energy through planned periods of activity and rest will mean that you are more likely to be able to do the activities that you want to do.
It can be as important to understand early on what pacing is not about. It does not give you a free hand to push through activities, banking on rest and recuperation afterwards. Pacing takes an altogether smoother approach. If you are prone to trying to cram in as much activity as you can in the morning, then have to sleep during the afternoon or the next day to recover, pacing helps you to break this habit. Similarly it discourages you from gathering energy through the day and then attempting a burst of activity later in the afternoon or evening.
Understanding the basics
If you only associate activity with quite physical, active pastimes then pacing requires you to take a fresh look. In pacing terms activity incorporates any action that uses energy, whether this is a physical, mental or emotional demand. So everyday activities might range from getting up or having a shower, to watching tv, to worrying or feeling angry. In fact, many people with chronic fatigue find that it is emotional activity that is the most draining, and also the hardest to measure or control.
The types of activities that you will be pacing will depend on how the illness affects you, your circumstances and preferences. For some people it will be the basic tasks of daily living, for others it will be the physical exercise or brain activities, or work and family activities.
For me, activity means listening, talking, laughing, concentrating, making eye contact, watching TV, coping with light and noise, lifting a magazine…
Short, regular rest periods throughout the day are essential to give you time to recharge your batteries. Rest and relaxation are as central to pacing as activity, although the amount of rest that you need will vary at different stages of the illness.
For your mind and body to get real benefit you need to be fully relaxed and properly resting your brain. This may call for a new perspective on what you consider to be relaxation. Before you became ill you might have used mental activities to relax, like reading or watching TV, or you might have enjoyed physical exercise. For healing rest, aim to be quiet and still, both physically and mentally.
In general, it is better to avoid sleeping during the day, as this may disrupt your night time sleep cycle. However, sometimes, it may be a necessary and useful way of ‘recharging the batteries’.
A baseline is a level of activity that you can comfortably manage on a regular basis without making your symptoms significantly sores. Activity must be sustainable. In other words, you must be able to do the same amount of activity whether you are having a good or bad day. In this way you won’t be tempted to do more on a good day, or forced to do less on a bad day. Once a sustainable baseline has been established you can find that your symptoms ease and your energy levels increase.
People usually find that their starting baseline is considerably lower than their current level of activity. Your illness has probably forced you to give up lots of things but you may still be trying to hang on to doing too much.
As natural recovery occurs you should find that you are able to increase your activity. Any increases should be very gradual and the process should be initiated and controlled by you.
Pacing in practice
When you are doing a specific task, such a preparing a meal, it’s very tempting to try to complete it in one burst of activity. Instead, split the activity into a series of small stages, with periods of rest and relaxation in between. Only attempt one activity at a time.
As well as being able to class activity as physical, mental or emotional, you can also rate an activity according to how much energy it uses. Activities will be low, medium or high consumers of energy. You need to consider this when you are planning your day.
Look at whether there is anything you can do to make an activity easier and less taxing. Eg. If you are washing up, can you sit rather than stand? Try soaking dishes first so that they are easier to clean, then leave them to dry on the draining board. In this way you might be able to modify a high-energy activity into a medium-energy activity.
Its particularly important to take this approach with demanding activities that may be taxing in a number of different way. Eg. Shopping will include travelling, sitting, walking, carrying and coping with busy environment with bright lights and noise.
Don’t just do things the way you have always done them. Only stick to old routines if they are manageable. Eg. If you get up in the morning and have breakfast, build in a rest before you get dressed. Activities that you may have previously carried out automatically, such as showering, drying your hair etc now need to be included in your plan.
It can help to keep a simple diary of activity and rest. This will help you to understand what is going on and enable you to reflect on your own particular circumstances. The effects of ‘overdoing it’ may not show up for a day or two but your diary will help you to identify what triggered your symptoms. After a while you should be able to recognise peaks and troughs in your activity levels.
You will need to keep your diary until you are able to spot patterns or are able to apply the pacing and planning principles in your head, or build them into your routines. A diary may also need to be temporarily restarted during a setback or relapse and can also be helpful when attempting to start a significant activity change, eg. Returning to work or study, or starting to drive a car again.
Finding a baseline and stabilising activity
To find the amount of activity that you can confidently manage on a day to day basis, you first need to have a good awareness of your current activity patterns and their impact on your symptoms and how you feel. How do your symptoms change and fluctuate in relation to what you have been doing? Remember to consider not just physical activity but also mental and emotional activities.
Calculate your baseline
There are several ways to work out the length of time you can do a particular activity, and you may need to experiment to find the best one to suit your situation. This can take some time.
You will need to work out a baseline for each different activity you undertake.
- The 75% rule. If you think that you can carry out an activity for 20 minutes, try reducing your activity time by 5 minutes to 15 minutes (75% of 20 minutes). The aim would then be to maintain 15-minute blocks of activity interspersed with rest/relaxation periods throughout the day.
- An even simpler way is to set your baseline at about 50% of what you think you can do on an average day.
- Split each activity up with 5-10 minute rest breaks.
When setting a baseline, the golden rule is to remember that all activities must be set at a level than can be maintained on both a good and a bad day.
It can be very disappointing to find that your baseline is lower than you expected but remember that you are taking a step back in order to go forward!
‘Know your limits. Set a small target for the day and if you complete it, congratulate yourself. Don’t think, “I’ve done this so I can do more”, there’s always tomorrow. You should be pleased with the smallest of tasks. Keep positive.’
Stabilising your activity
When you have set your baseline you need to give your body time to settle into the level. How long this takes will vary from person to person but it can take weeks. You will be ready to gradually increase your activities when you feel your body has acclimatised to the level and you can confidently sustain it.
Rest and relaxation
Good quality rest and relaxation is an essential part of a successful pacing programme and you need to build this into your day. The amount of rest that is needed varies from person to person. Some people need a lot of rest while others find that if they are getting good quality rest they can cope with frequent but short ‘mini rests’, perhaps lasting as little as five to ten minutes.
Relaxation is about achieving complete rest of the body and mind. If you feel that your brain or body is being stimulated, you are not achieving true relaxation. It can take some time to learn to ‘switch off’ both physically and mentally. Some people find it very difficult to relax properly and feel guilty if they’re not busy or doing something ‘useful’.
There are several techniques or skills that you can learn to help achieve a state of relaxation:
Make room for relaxation
Set aside a time and place to relax. You don’t need to go to bed to relax and in fact it can be best to save your bed for night time sleep. Where you choose will depend on your home circumstances but you need to find a place where you won’t be disturbed. Switch off the phone and let those around you know that you don’t want to be interrupted. Get yourself really comfortable, either lying down on a mat, or sitting in a chair with your neck, feet and arms well supported. Make sure you are warm enough.
Learning techniques for good breathing, and remembering to put them into practice, is important. When you are feeling stressed, anxious or worried, your breathing can be shallow and quick. This is called hyperventilation. When you hyperventilate you use on the upper part of your chest, whereas good breathing uses your whole chest and lung area. A lot of people are unaware that they are hyperventilating and it can become a habit. It alters the blood chemistry and causes symptoms such as pins and needles, dizziness, palpitations, breathlessness and chest pain, and heightens anxiety and panic. Naturally these symptoms can cause further worry and anxiety and a vicious circle is created.
- Place one hand on the top of your chest and the other hand at the bottom of your rib cage/abdominal area. Breathe in slowly through your nose and into the ‘bottom’ of your lungs. You should feel your abdominal area rise while your chest should only move slightly.
- When you take a breath in, pause for a moment and then breathe out slowly either through your nose or mouth. Make sure you breathe out fully. Repeat this slowly 10 times. You might need to build up to this number.
It’s a good idea to practice breathing like this on a regular basis.
There are a number of different techniques to help tackle tension so you will need to find out what works best for you. Some people find that focusing on a pleasant or relaxing image can help to calm the mind and body. Another method is to consciously relax tension in your muscles. Your aim is to recognise when your muscles are tense, then to relax them in response to this. One way of doing this is to clench a fist for a few moments and then unclench. Note how tense and uncomfortable it felt when clenched and how good it feels when fully relaxed. Try this with other muscles in the body, eg. You neck, shoulders and back. Focus on whichever area you think might be tense. Clench for a few moments and then unclench. Some people find it helpful to systematically work their way around the body from head to toe. As you get better at the technique, it’s possible to bypass the clenching and just ‘let go’ of each muscle group in turn. This can also be used alongside deep, slow breathing as a ‘first aid’ measure in stressful situations.
Deep relaxation takes practice, and relaxation tapes or CDs can be a good guide. Gentle music can be helpful if you find that your mind starts to race. Some people benefit from practising meditation and yoga. Complementary therapies such as reflexology, aromatherapy and massage can also help.
The important thing is to find a way of resting that works for you.
Taking on too much
It can be hard to let of things that might be preventing you from pacing effectively. There are likely to be demands and pressures from other people and you may also be battling with your own expectations. If you have standards that are getting in the way of pacing you will need to adapt and change them. It’s all too easy to push yourself to finish a task you have started, or to feel bad about ‘letting somebody down’. It’s important to learn to let go and to make fewer demands on yourself. It just isn’t possible to do all the things you did before you were ill.
You may have people in your life who drain you emotionally, or you may be the sort of person who is always available in a crisis. Do you always put other people first, regardless of how you are feeling? Remember that emotions are far harder to account for when learning to pace. If you are struggling with delegating, saying ‘no’ or dealing with other people’s reactions and attitudes, counselling or cognitive behavioural therapy (CBT) can be useful.
‘I consider my own needs first. I was a people pleaser, always saying “yes” and then suffering the consequences. Now I do what I can, in my own time, without overspending precious energy’.