Pacing - Managing everyday with a chronic condition

Many people with a Neurological disorder or Chronic health condition, find that they can no longer do all the activities in a day that they wish.  When working with clients we get them to appreciate that they need to pace their activities (Something that over my rehab period I have also had to do). 

What is Pacing?
“a way of increasing your activity level without stirring up your fatigue/pain or other symptoms such as dizziness too much”

Aim: to maintain an even level of activity throughout the day instead of doing as much as possible in the morning and then resting all afternoon.
When we don't do this we can get in to a cycle which is unproductive which we call the BOOM/BUST cycle. 

  How to use Pacing
1  Work out what you can manage now:

• Decide on your baseline – how much of your activity can you do on a good day and a bad day
•  This may take a couple of attempts to get right
• DO NOT compare yourself to others or what you think you ought to be able to do

2 Decide on a realistic build-up rate:

• Too much will make you overdo things 
• Build up the task slowly and at a steady rate regardless of your fatigue
• With exercise it may be better to break it into smaller sections as it is better to be more active over the course of one day rather than one big amount of exercise at once. 

3 Write your plan down and record your progress

• Write down your plan and your daily progress (maybe in a diary) but don't fixate on what you didn't do well. 
• This will allow you to easily notice your progress or if you’re slipping back.
• On a daily basis it is also difficult to remember things or how you were. 

Applying Pacing to a Task – The Rule of the 3 P’s
Prioritise 
Do you need to do the entire task today / in one go?
Can you get someone else to help?
Does the task need to be done at all?

Plan
Can you break the job/task into different stages?
What do you need to carry out the job?
What basic activities does each stage involve? (e.g. walking, sitting, standing)

Pace
See Pacing Techniques outlined below Pacing Techniques

There are 3 main aspects to pacing:
1. Breaking tasks down into smaller bits – Part of prioritising
2. Take frequent short breaks
      a. Do something for a set time
​      b. This breaks the overactivity / underactivity cycle
      c. Helps to even out your activity over the course of a day
      d. ‘Taking a break’ does not mean stopping completely
      e. Change your position/activity or do something else for a short while
3. Gradually increase the amount you do
     a. You may seem like you are going backwards and activities can take longer
     b. Gradually build up the amount you do
    c. ‘Pace up’ by a set amount
    d. Do not be tempted to try to do more on a ‘good day’ stick to pacing levels

Additional hints for using pacing

• Start on activities that are easier
• For activities that you cannot leave, it is most important that you still try to pace yourself as much as possible
• Try to change your position regularly
• It is ok to ask for help with specific tasks
• Keep to your targets and plans if possible If you understand and put into practice the concept of pacing, you should have fewer flare-ups of pain or episodes of fatigue and gradually do more and more. Setback or flare-ups
• Fatigue and setbacks are normal and everyone has them, It does NOT mean you are back to square one
•  How much pain or fatigue you experience will depend on how you react
• It is important to remember that pacing has worked for you before and can still continue to work for you

Tips for changing habits:

1. Write a list of your plans and stick it on the fridge
2. Start off with a small change and build on this
3. Make a list of why you want to change
4. Explain to others why you are changing a habit, get support and help from others if needed
5. Reward yourself with a treat
6. Do not worry if you fall back into your old habits, everyone does when they try to change, look at your plan and start afresh
7. Find a new way of doing something with pacing rather than stopping it altogether
   

Remember - be positive about what you can do rather than what you can not do.