Pacing (activity management)

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Pacing is an activity management technique for managing a long-term health condition or disability, aiming to maximize what a person can do while reducing, or at least controlling, any symptoms that restrict activity.[ citation needed ] Pacing is commonly used to help manage conditions that cause chronic pain or chronic fatigue. [1] :134

Contents

Aims

Pacing aims to manage symptoms by avoiding the "boom and bust" cycle that is common among people exceeding their current, limited capacities. This often leads to being forced to stop their activities as a result of pain, fatigue or other symptoms, and then requiring a large amount of rest before being able to resume their activity. The cycle then repeats.[ citation needed ]

Elements of pacing

There is no consensus regarding what elements are part of pacing. [1] :135 Pacing typically involves:

Uses

Pacing has been used to help manage a wide variety of different illnesses and disabilities, including neuromuscular diseases like Charcot-Marie-Tooth disease (CMT), [3] rheumatoid or immune-mediated diseases like rheumatoid arthritis, [2] juvenile arthritis and fibromyalgia, ME/CFS, [4] Ehlers–Danlos syndromes (EDS), [1] and Long COVID. [5]

Outcomes

Pacing has been shown to reduce post-exertional symptom exacerbation in people with long COVID. [5]

In many health conditions, there are no clinical trials to establish the effectiveness of pacing. [1] :135

See also

Related Research Articles

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<span class="mw-page-title-main">Post-exertional malaise</span> Worsening of symptoms with activity

Post-exertional malaise (PEM), sometimes referred to as post-exertional symptom exacerbation (PESE), is a worsening of symptoms that occurs after minimal exertion. It is the hallmark symptom of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and common in long COVID. PEM is often severe enough to be disabling, and is triggered by ordinary activities that healthy people tolerate. Typically, it begins 12–48 hours after the activity that triggers it, and lasts for days, but this is highly variable and may persist much longer. Management of PEM is symptom-based, and patients are recommended to pace their activities to avoid triggering PEM.

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Long COVID or long-haul COVID is a group of health problems persisting or developing after an initial period of COVID-19 infection. Symptoms can last weeks, months or years and are often debilitating. The World Health Organization defines long COVID as starting three months after the initial COVID-19 infection, but other agencies define it as starting at four weeks after the initial infection.

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A 2-day CPET is a cardiopulmonary exercise test given on two successive days to measure the effect of post-exertional malaise (PEM) on a patient's ability to exercise. PEM is a cardinal symptom of myalgic encephalomyelitis/chronic fatigue syndrome and is common in long COVID as well.

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References

  1. 1 2 3 4 Hakim, Alan J.; Keer, Rosemary J.; Grahame, Rodney (2010-09-15). Hypermobility, Fibromyalgia and Chronic Pain E-Book. Elsevier Health Sciences. ISBN   978-0-7020-4993-4.
  2. 1 2 Ryan, Sarah (2020-02-17). Nursing Older People with Arthritis and other Rheumatological Conditions. Springer Nature. p. 88. ISBN   978-3-030-18012-6.
  3. 1 2 Stokes, Maria; Stack, Emma (2011-04-19). Physical Management for Neurological Conditions E-Book: [Formerly Physical Management in Neurological Rehabilitation E-Book]. Elsevier Health Sciences. ISBN   978-0-7020-4712-1.
  4. Grach, Stephanie L.; Seltzer, Jaime; Chon, Tony Y.; Ganesh, Ravindra (October 2023). "Diagnosis and Management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome". Mayo Clinic Proceedings. 98 (10): 1544–1551. doi: 10.1016/j.mayocp.2023.07.032 . PMID   37793728.
  5. 1 2 Parker, Megan; Sawant, Hannah Brady; Flannery, Thuvia; Tarrant, Rachel; Shardha, Jenna; Bannister, Rebecca; Ross, Denise; Halpin, Stephen; Greenwood, Darren C.; Sivan, Manoj (2022-12-02). "Effect of using a structured pacing protocol on post-exertional symptom exacerbation and health status in a longitudinal cohort with the post-COVID-19 syndrome". Journal of Medical Virology. 95 (1): e28373. doi:10.1002/jmv.28373. ISSN   0146-6615. PMC   9878088 . PMID   36461167.