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

Pace yourself with Visible

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

See if you qualify

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

Pacing research

Filter by energy‑limiting condition

All Long Covid [More coming soon

ME/CFS](/content/pacing-3#w-tabs-0-data-w-pane-2/index.html)

• Appelman et al. (2024), Muscle abnormalities worsen after post-exertional malaise in long COVID
  We show that skeletal muscle structure is associated with a lower exercise capacity in patients, and local and systemic metabolic disturbances, severe exercise-induced myopathy and tissue infiltration of amyloid-containing deposits in skeletal muscles of patients with long COVID worsen after induction of post-exertional malaise. Read more

• Wright et al (2023), The relationship between physical activity and long COVID: a cross-sectional study.
  Long Covid causes drastic reductions in the ability to be physically active and to complete activities of daily living independently, which could be explained by the observation that Long Covid symptoms worsen with increased Physical Activity. Read more

• 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. Read more

• 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. Read more

• 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. Read more

• 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. Read more

• 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. Read more

• 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. Read more