“Pacing, or activity management, is an approach to balancing activities with rest to avoid exacerbations of symptoms. Different types of pacing have been described, including quota-contingent and symptom-continent pacing, the former used to gradually increase activities”.

Symptom-contingent pacing for management of post-exertional symptom exacerbation encourages engagement in activities guided by perceived symptom levels to avoid worsening symptoms, conserve energy and enable participation in meaningful activities. Sustained stabilisation of often episodic and fluctuating symptoms could guide how activities and rest can be modified dependent on symptoms.”

“Pacing should include realistic goals, monitoring of physical, cognitive and social activities and their effects on energy levels, and avoidance of possible over-exertion which may worsen symptoms. Quality of rest, sleep, and eating patterns may also be considered within the context of activity management and symptom stabilisation. Pacing is not an activity avoidance strategy, rather it is a strategy used to minimise post-exertion symptom exacerbation. Avoiding over-exertion or remaining within a person’s “energy envelope” can avoid symptom relapses. The “energy envelope” theory suggests that by maintaining expended energy levels within the envelope of perceived available energy levels, people are able to better sustain physical and mental functioning while reducing symptom severity and frequency of relapses.”

“Fluctuations in symptom severity and delayed recovery from activities due to post-exertional symptom exacerbation, should be considered. Pacing will often be included as part of a number of energy conservation strategies termed “the three P’s Principle” which includes Prioritisation, Planning and Pacing, and can also be accompanied by others such as Posture, Positioning and Precaution. Useful resources on pacing are available on the Long COVID Physio website”