2 / Body and pacing
Pacing and energy: planning around fatigue and flare-ups
Pacing means matching activity to the energy you have. Here is what the NHS and CDC say about it, and where the sources are cautious.
Many people with long-term conditions describe fatigue that does not match how much they did. That makes outdoor days hard to plan, since a good morning can be followed by a bad week. Pacing, sometimes called activity management or energy management, is one approach health services describe. This page reports what the National Health Service (NHS) in England and the US Centers for Disease Control and Prevention (CDC) publish about it, and says where the picture is uncertain.
What pacing means
The CDC defines the goal of pacing, in its page on managing myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), as learning to balance activity and rest to avoid flare-ups of post-exertional malaise (PEM). To pace, the CDC says, a person finds their individual limits for mental and physical activity and plans activity and rest to stay within them. Some patients and doctors call this staying inside the "energy envelope."
The NHS describes energy management in similar terms. It says the treatment aims to teach a person to make the best use of their energy in daily life without making symptoms worse. As part of it, a person may be asked to monitor daily activities with a diary or a phone app.
The good-day trap
The CDC notes that on a good day people with ME/CFS may be tempted to "push," meaning to do more than they normally would, often to make up for lost time. According to the CDC, this can lead to a "crash," a worsening of symptoms. The NHS says setbacks or relapses are a common part of ME/CFS and can be triggered by an infection or an unplanned activity, though sometimes there is no clear cause.
For outdoor planning, that suggests treating the whole outing as one unit of effort, including the trip there, waiting, and the way home. The trip-planning checklist lists the practical pieces, and adaptive hiking describes how distance and grade are reported for people with limited stamina. Neither page tells you your own limit, because the sources say that limit is individual.
Rest and breaks
The NHS says it is likely that a person with ME/CFS will need to rest during the day and that a doctor should advise on how. As an example it says a doctor may suggest limiting each rest period to 30 minutes and teach relaxation techniques. It also states that there is limited or no evidence to recommend resting completely, and that having too much sleep does not usually improve symptoms. After a setback, it says clinicians can help by building in more breaks within current activity levels.
Where the evidence is mixed
The two sources are cautious about exercise in ME/CFS. The NHS reports that some people found exercise programmes made symptoms better, some found no difference, and some found symptoms got worse. It says graded exercise therapy, which aims to increase activity gradually, is not recommended for people with ME/CFS. It also says vigorous unsupervised exercise, such as the gym or a run, may worsen symptoms. If someone thinks more exercise would help, the NHS says they should be offered a personalised plan with support from a professional experienced with ME/CFS, such as a physiotherapist.
The CDC takes a similar line. It says people with ME/CFS do not tolerate vigorous aerobic exercise routines, that standard exercise recommendations for healthy people can be harmful for them, and that it is still important to undertake activities they can tolerate.
Both sources concern ME/CFS specifically. The pages used here do not report trial results for pacing, and they do not address other long-term conditions, which have their own guidance and their own debates. The general CDC advice for adults with chronic conditions or disabilities is "some physical activity is better than none" and to be as active as you are able, with a health care professional consulted about types and amounts. Weather is another factor in how a day goes, and it is covered on heat, cold and weather. The amounts in public guidelines are on the guidelines page.
The short version
Pacing, as the NHS and CDC describe it, is balancing activity and rest within personal limits and avoiding pushing on good days. The sources are cautious and specific to ME/CFS, and the details of any plan belong with a clinician who knows the condition.