What is pacing?

Many people with energy-limiting conditions find that too much physical, cognitive or emotional exertion can make their symptoms worse. Pacing is a way of balancing activity and rest to help reduce the risk of symptom flare-ups.

Understanding
symptom flare-ups

A response to exertion

Symptom flare-ups can happen after physical, cognitive or emotional exertion.

This can look very different from person to person, but may include severe fatigue, pain, cognitive difficulties, disrupted sleep and other symptoms.

A delayed onset of symptoms

Symptom flare-ups do not always happen straight away. They can begin 12 to 48 hours after exertion and may last for days or even weeks.

This delay can make it difficult to recognise when you have done too much, which can lead to a cycle of overexertion, symptom flare-ups and recovery.

Staying within your energy envelope

Pacing is a way of balancing activity and rest to help reduce symptom flare-ups. It involves finding a manageable level of activity that avoids both overexertion and underexertion, and that you can maintain over time.

Cycle of recovering and relapsing

Pacing

Pace yourself with Visible

Visible uses your body’s data to help you understand your energy, so you can pace with confidence.

Explore Visible

Using wearable technology

High-accuracy wearable technology can help measure exertion and rest by using heart rate and movement data. Capturing and analyzing this data in real-time may help you to find, and stay, within your energy envelope.

Find out more about Visible

Recommended by medical bodies around the world

Learn more about pacing from leading health authorities

Pacing research

Filter by energy‑limiting condition

Larun et al. (2011), Finding the right balance of physical activity: a focus group study about experiences among patients with chronic fatigue syndrome

Self-management, body awareness and physical activity of choice combined with facilitation and advice from health care professionals is essential to achieve a positive outcome.

White et al. (2010), Severity of symptom flare after moderate exercise is linked to cytokine activity in chronic fatigue syndrome.

Our research group has obtained preliminary evidence that CFS patients with and without FMS show greatly exaggerated increases in alpha-2A, beta-1, and beta-2 adrenergic receptor mRNA expression after exercise.

White et al. (2010), Severity of symptom flare after moderate exercise is linked to cytokine activity in chronic fatigue syndrome

Our research group has obtained preliminary evidence that CFS patients with and without FMS show greatly exaggerated increases in alpha-2A, beta-1, and beta-2 adrenergic receptor mRNA expression after exercise.

Mark VanNess et al. (2010), Postexertional Malaise in Women with Chronic Fatigue Syndrome

The results of this study suggest that PEM is both a real and an incapacitating condition for women with CFS and that their responses to exercise are distinctively different from those of sedentary controls.

Pagen et al. (2023), High proportions of post-exertional malaise and orthostatic intolerance in people living with post-COVID-19 condition: the PRIME post-COVID study

High proportions of PEM and OI are observed in post-COVID-19 condition.

Twomey et al. (2022), Chronic Fatigue and Postexertional Malaise in People Living With Long COVID: An Observational Study

Long COVID is characterized by chronic fatigue that is clinically relevant and at least as severe as fatigue in several other clinical conditions. PEM is a significant challenge for this patient group.

Clague-Baker et al. (2023), An international survey of experiences and attitudes towards pacing using a heart rate monitor for people with myalgic encephalomyelitis/chronic fatigue syndrome

Wilcoxon Signed-Ranks test indicated a statistically significant reduction in their severity of ME after HRM (Heart Rate Monitored) pacing.

Bond et al. (2021), Effects of Post-Exertional Malaise on Markers of Arterial Stiffness in Individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

We have shown that ME/CFS patients may experience altered vascular responses following aerobic exercise, contrary to what is seen in healthy populations.

McManimen et al. (2020), Deconstructing post-exertional malaise: An exploratory factor analysis

The results suggest that post-exertional malaise is composed of two empirically different experiences, one for generalized fatigue and one for muscle-specific fatigue.

Strussman et al. (2020), Characterization of Post–exertional Malaise in Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome patients describe post–exertional malaise as all-encompassing with symptoms affecting every part of the body, difficult to predict or manage, and requiring complete bedrest to fully or partially recover.