When you experience pain, it can affect your activity levels. You might stop doing certain activities to avoid the pain, or you might try to push through it. However, pushing too hard can cause pain flares, while avoiding activity can lead to more pain and disability. To manage your pain, it's helpful to use a "paced" approach. This means breaking up everyday activities and exercise into smaller, more manageable parts. By doing a little bit at a time, you can avoid overdoing it and reduce the risk of pain flares. Pacing can help you stay active and continue doing the things that are important to you, while also reducing pain in the long run. Plus, it can give you a greater sense of control over your life.

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Activity pacing is a method that involves managing and regulating your activity level and pace to achieve your goals. The main objective of this technique is to reach your desired goals rather than pacing to avoid activity. There are two fundamental components of activity pacing: conserving energy for activities that hold value for you and setting a graduated activity quota to enhance your ability to do activities and diminish disability. Pacing should be used as a pre-planned strategy in combination with a graded activity program aimed at increasing your activity levels. The pacing method uses a time-contingent approach to activity rather than a pain-contingent approach. This approach measures activity based on time, distance, or number of repetitions, thereby setting a target and limit for the activity. This helps build activity tolerance, which is crucial for accomplishing everyday tasks. It is essential to note that using a pain-contingent approach often leads to overdoing and underdoing activity cycles, which is associated with poorer patient outcomes. Pacing is a practical approach that can reduce pain flares and slowly increase your activities, thus helping you achieve your goals effectively and efficiently.

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How do I pace?

Decide what your goals are first: what do you value most? (see below for guidance on goal setting). Try and think about the two parts of activity pacing mentioned above.

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Step one: Set the baseline

The key is to work out how long you can do a task without a pain flare. Here it is important to remember that it is normal to expect some pain increase after an activity. This may last for 20 to 30 minutes and this is not a pain flare.

• Write the time, distance or number of times that you can do the activity or task without a pain flare

• Set your baseline based on the most limiting symptom for that activity (e.g.pain, fatigue)

• Taking 3 measures over 3 days often gives the best guide

• Take an average of these measures: add the 3 numbers together, then divide by 3. You should then reduce this number by 20% (or multiple by 0.8) to give yourself a buffer. This is your first week baseline for activity “one”. Repeat for other activities.

• You can calculate this number on your phone, calculator or computer

 

Step two: Repeat the task daily

Using your baseline number, do this activity daily for the first week using this baseline time (e.g. standing, doing dishes), distance (e.g. walk), or number (e.g. number of shirts ironed, number of book pages read, number of repetitions of a particular exercise).

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Step three: Increase by 10% per week

Slowly increase the time, distance, or number of repetitions each week by 10% (or multiply the baseline number by 1.1). This becomes your baseline for the second week. Download our pacing activity template to help you calculate and manage your paced activities.

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Step four: Build up your activity levels using SMART goals

SMART goals stand for: Sustainable, Meaningful, Achievable, Realistic, and Timed. Write your goals down to help you stay on track and remind you of those things that are important to you.

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Step five: Small bits often

Do small bits often – break activities into smaller chunks – this helps to maintain the range of your activities and your tolerance to activity. Make sure you alternate your position or posture regularly, e.g. sitting, standing, and walking. Your body will benefit in many ways from movement. Calculating and recognising your baselines (or ‘tolerance’) means you avoid pain flares.

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Step six: Take regular planned relaxation periods

Take regular planned relaxation periods – regular planned rests and relaxation breaks, even on days when you feel pretty good, are essential. Make sure you plan short rests before and after particularly stressful or demanding tasks. Practising relaxation, stretching and daily walks, even on not so good days also helps control the pain. 

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Helpful insights

• pain flares sensitise your nervous system resulting in more pain for less activity

• when pain gets in the way it is a mistake to push through it or to stop doing things completely

• using pacing to find the middle road is best
   

Helpful tips for pacing

• on a good day, do not do more than the pacing schedule allows

• have a plan and aim to change only one or two things at a time

• keep a record of what you're doing and how much you are doing - write it down

• alternate heavier tasks with lighter or less stressful ones

• do little bits often

• use one kind of task as a break from another

• change your body position/posture regularly

• build up time on a task gradually - start low and increase slowly
   

What about goal setting?

Step one: Set your goals - Plan and prioritise

It is easy to lose sight of your priorities when dealing with a difficult problem such as managing chronic pain. Pain often drives a wedge between the things that you care about and what you actually do. Give attention to those things that deserve it, the truly important things for you. Do activities every day that reflect these values. So for example, if your relationship with your partner is highly valued to you, you may plan to spend time talking with them over dinner, or arranging an activity together; if caring for your children is something you value highly you might include activities with them such as listening to them read or cook them a nutritious meal; if your health is a high priority to you, include some gentle exercise each day, eat some healthy food, make that appointment you have been meaning to do. Think ahead and plan activities so that you don’t overstretch yourself.

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Step two: Write down the things you have to do

Once they are in front of you, arrange them into order of priority. Ask yourself if each task really needs to get done, and then cross off those that are not necessary. If there is one really important thing you need to do, arrange your day around this task.

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Step three: Do little and often

For example, breaking down tasks such as cleaning or gardening into smaller amounts; carrying the groceries from the car in small amounts. This may seem more complicated at first, but it is a very helpful way to conserve energy and reduce pain flares. In this way, many activities that you might have given up (like gardening), become possible again. This means a change of emphasis and not expecting yourself to do things like you used to.

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Step four: Alternate tasks

Plan to alternate heavier tasks with lighter or less stressful ones. Plan to incorporate relaxation periods every day. Writing down a weekly plan can help you to balance out tasks and to focus on your goals.