Pacing or some People prefer the term activity management

The definition of activity management/pacing is: Breaking down activities you are doing to make them more manageable.

This article is written from my experience of being trained as an Occupational Therapists (I'm now retired) with 30 plus years of experience of having to personally put this into practice.

The following are some generalized tips to explain why it is so important to manage our activities from a physical, emotional, and cognitive viewpoints. Knowledge is power and just understanding what is happening can be the first step to improving our energy.

Many of us know we need to conserve our energy levels and to use our energy in a way that will stop us crashing, which is often called 'Boom and Bust'. We can find it hard to put this into action, I sometimes boom and bust! This can be because of the pressures put on us by others and our personality types can be our greatest hindrance. Sometimes we are ‘perfectionist/carers. For example, we are not content when someone else does some work for us, they perhaps haven’t done it to the standard you would have done or/and we often put the needs of others before our own health.

It can be hard to find the energy to assertively tell others that you are not able ‘to do the washing today’ or your energy levels are so low ‘you can’t manage to go out that evening’.

Then there are choices we must make for example; do we make the beds or go to lunch with a friend.

When, for example, planning an event like the family coming to visit. One way is to assertively say you are too unwell for them to be able to visit, especially if they have no appreciation of the amount of fatigue and pain you are in and they are the type of people who drain your energy rather than give you love. Or limit the time they stay with you.

Another way to cope is to spread the work over many days, don’t aim to be the best cook and buy in food that’s easy to prepare, perhaps pre-cut vegetables or frozen meals. Perhaps share out jobs with others, without the feeling of guilt, you’re doing the best you can with your current energy levels. It's surprising how much energy the brain needs to function, it's suggested it takes 20% of the body's energy. Feelings of guilt and frustration will burn up more energy, it's time to be compassionate to yourself. The risk is if you wear yourself out preparing, you’ll have no energy left to enjoy the time with the family, the priority should be spending quality time with loved ones as that in turn will help your energy levels. A phase you could use is ‘Plan for help’.

The following suggestions are to help you manage activities and to help you be more assertive when you must ask for help. Please pick out the tips you feel ready to try.

I attended a medical professional masterclass on ‘Fatigue management’ run by Sue Pemberton, OT Director Yorkshire Fatigue Clinic. She has written an excellent book called ‘Fighting Fatigue’ which has a lot of practical tips.

When I first saw the following graph on energy patterns with chronic fatigue, which is in the book ‘Fighting Fatigue’. I was shocked when I realised this was me......

Our energy pattern can be like this:

We like to continually push ourselves until the job is complete. We often don’t like to make mistakes, and want to finish tasks to a high standard, not wanting to let people down. Keep going despite it all. I was then even more surprised when I saw the following graph showing how ‘normal’ energy levels can fluctuate during the day.

A typical energy pattern

So how can we balance our energy levels?

Are you using more energy than you have? Try to consider the energy in your cells is like a battery. Normally the cells are full of energy.

For those of us with fatigue we only have a small amount of energy.

This energy is produced in the Kreb's cycle and is called ATP (adenosine triphosphate). When we push ourselves too hard we can find ourselves with no energy. This is often called ‘crashing’ or going ‘beyond our ceiling of energy’.

It can take up to 4 days of total rest to start to gain more energy. The Alpha-Stim microcurrent device, is a device I use that has been proven to increase ATP levels. This is one way to help our energy levels.

The Kreb's cycle, in summary, if you'd like more information about this please ask to see a summary of a lecture by Dr Myhill that I wrote up for our support group. Energy is produced by 2 forms of respiration.

Aerobic respiration (using air, oxygen) and is very efficient. Aerobic respiration: 1 molecule of sugar + oxygen = 30 - 36 ATP.

Or the inefficient anaerobic respiration (without oxygen). This type of respiration takes energy by breaking down muscle and leaves us with a debt of energy. It also produces lactic acid and this causes pain when trapped in muscle tissue. Anaerobic respiration: 1 molecule of sugar = 2 ATP + lactic acid (pain)

N.B. it takes 6 ATP to rid the body of lactic acid. You can tell when you move from aerobic respiration to anaerobic respiration as the muscles feel different and can start to burn. For me it feels like my legs are walking through treacle. You may notice a change to anaerobic respiration when for example, walking or another activity when you've pushed yourself too far you can be gasping so much for air that you can't speak or whistle.

This is different from the 'good' perhaps painful, feeling after you've done some gentle exercise that has stretched muscles and the muscle is getting stronger called DOM.

It is better to always keep a little energy in reserve.

With practice we can learn when to stop and rest to gain more energy. We need to listen to our bodies, learning to be kind and compassionate to ourselves rather than feel we are 'fighting our bodies'. I've leant the signs when I’m in danger of reaching 'empty' is when my legs start to feel like jelly or I get severe tinnitus. What are your signs?

Try to keep 20% of energy back each day. Or as we sometimes say in our support group 'Don't use up all your spoons!' See the Spoon theory on this webpage: This is an excellent visualisation of why we need to conserve energy. https://butyoudontlooksick.com/articles/written-by-christine/the-spoon-theory/

There is now a new theory that is now taking over from the idea of 'Adrenal fatigue'. As above this is related to ATP (energy) that is produced by the mitochondria. It is called 'Cell danger response' developed by Dr Naviaux. The following is a very simple explanation of a complex process. When the body is working well the mitochondria are more numerous and producing plenty of energy. When the body is 'under treat' this could be from a virus, lack of sleep and/or emotional stress the mitochondria stop producing energy and go into defence mode to protect the body. This is the time to rest to regain energy.

What is rest?

Rest is essential to increase our energy levels, but what is meant by rest?

What it is not, is sitting watching the TV. Rest is relaxing both mind and body to recharge the our energy levels. That is ideally lying down in a quiet room mediating, practicing mindfulness techniques, listening to a relaxation CD or gentle music. It can be, when you have some energy, a slow gentle walk in the countryside.

Managing the energy we use in activities is vital to the success of completing the task. If we are like the hare we will complete the task but then suffer the consequences of an increase in pain and fatigue, and possibly a crash. This can be a delayed response up to hours or days later. We will achieve more with less consequences if we add in times of rest or gentle activity during times of high energy activities. For example, if I watch my timing well I can work on the computer or paint a picture for 30 minutes without consequences but only do 10 minutes doing a jigsaw puzzle before getting severe neck pain.

These timings can be increased but at your own gentle individual pace. Which might be an extra minute a week, or a month, or longer.

I've been following the advice of a pain consultant in New Zealand called Dr Jonathan Kuttner. He's written an excellent book called 'Life After Pain'. (See more about his book on the article about 'What is pain?'). In a recent talk he was discussing how to manage our activities with a different twist.

You will see above a photo of a guard dog. The guard dog - represents our over alert sympathetic nervous system (the fight and flight response).

This sleeping dog - represents the parasympathetic nervous system (that promotes rest and digest).

When we are about to do an activity or we notice we have activated our ‘fight and flight response’ we should do a 'mind-body session' of our choice that will send the dog (fight and flight response) to sleep. This could be a 30 minute mindfulness session or just 2 - 5 breaths. My favourite short session is a breath in for the count of 3 and then the breath out for the count of 6. The breath out activates the parasympathetic response. I've recently been learning about 'Buteyko breathing' where Patrick Mc Keown suggests we should preferably breath in and out through our nose, breath deep so we feel our ribs move slightly BUT keep the volume of the breath low. This helps the 'Bohr effect' releasing more oxygen to our muscles.

Visualisation before activities to calm the mind and prepare the body.

You might have observed Olympic competitors as they prepare to take their turn, such as snowboarders, visualising the course before they set off. I now add this in before I do my VERY gentle exercise or stretches.

To give you an example: This is a series of 6 very gentle exercises I've used to strengthen my body with the aim that if I have stronger back muscles, I will feel less pain and have more energy.

Before I do the exercises, I do a mind-body session to get 'the dog to go to sleep'.

Then I visualise myself doing the exercise with a feeling of ease and success.

Then I do the exercise with regular slow breaths to 'keep the dog a sleep'.

If I ‘wake the dog up’ either immediately or in a delayed response I will reduce the number of exercises the next day, or if everything is calm over a few days or a week I'll gradually increase the number of exercises.

The plan is to do this for 3 days then a day's break. By doing this regularly it will become a habit that I can incorporate into everyday activities. The more I do it the easier it will be to keep the dog asleep!

Somatic tracking

Another mindfulness technique I'm currently having good results with is 'Somatic tracking'. Alan Gordon has written an excellent book about this called 'The Way out'. Instead of just doing a mindfulness process this technique encourages you to go towards your pain and discomfort in a gentle non-judgemental way. This reduces the emotional response to your symptoms such as, fear and frustration and this in turn leaves you with more energy.

Alan has done a number of Podcasts under the title ‘Tell me about your pain’. I particularly like this one.

http://painpsychologycenter.com/audio/sue.mp3?fbclid=IwAR0KDVdwfJ8WQkLOZR1XhkGavbGWl0xYe5pZZG_jeJ4nr7LCpi10YA0EPGY

Pacing in the workplace.

When I was a member of the FMA UK medical board I edited 2 booklets for the national charity FMA UK on ‘Working with Fibromyalgia’ for employees and employers. These can be found online at:

Employee’s guide https://www.fmauk.org/1366-employee-s-guide

And Employer’s guide https://www.fmauk.org/1368-employer-s-guide

DISCLAIMER:

This article is for informational purposes only and should not be used as a substitute for the medical advice or services of your health care providers. Every effort has been made to make this publication as accurate as possible. This information is not intended for self-diagnosis, treatment, or the justification for accepting or declining any medical treatment for any health problems or diseases. Any application of the information presented in these pages is at the reader’s own discretion.