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  • Dr. Kelly Ashbeck

Chronic Fatigue Syndrome-Pacing


Why: With Chronic Fatigue Syndrome, our body is not producing enough energy to perform our daily activities.  Thus, we need to respect what our body is telling us and must pace our day accordingly.    


How: Despite the goal of eventual aerobic exercise, when you first begin a pacing program, we avoid this type of workload.  If we “blow through our barriers,” we will continue to feel exhausted and potentially ill (post-exertional malaise).  Instead, we will focus on activity modification and monitoring of symptoms.  


What: By following the recovery stages below, you will begin to gain a grasp of your symptoms and allow your body to regain its ability to produce energy.  Pacing will be one of the most important things you can do for yourself as you work back to the activities that are most important to you.


Rules:  What must be understood first is the following.  If we use a money analogy, those without Chronic Fatigue Syndrome will have $1000 to spend on energy.  Those with Chronic Fatigue Syndrome will only have $200 to spend on energy.  So if we are constantly borrowing tomorrow’s money, we likely will suffer from flare-ups in symptoms (exhaustion, pain, dizziness, etc) and simply be left with no energy.  By paying attention to subtleties in your symptoms, you can begin to grasp what activities you can participate in with the amount of energy you have for the day.  

  • Rest throughout the day: When we talk rest, we mean REST.  Lying flat will take workload off of the heart, which allows you to recover from your previous activities more efficiently.  Also, as best as you can, you should be resting throughout the day.

  • Prioritize your activities:  Some activities are unavoidable.  Parents will continue performing their most important role in life.  Think about your activities throughout the day and what must get done?  What activities can be spread out over time (i.e. meal prepping, house cleaning, etc)?  What activities can you modify all together (.i.e using a shower bench, parking close to the front of a parking lot)?  And what activities can you ask for help (.i.e online shopping, lawn care, snow removal)?


Understand the following stages to know that your body is in fact recovering.


Stage 1: Feeling good during short windows of time throughout the day.  Remember, this does not mean we can start to blow through our barriers, but these are the times we do just that.


Stage 2: Feeling good while doing nothing.  This may not be a daily occurrence but something you definitely notice on your good days.  Despite this stage clearly falling short of your goals, it is always a window into how you can feel in the future.  It also gives your nervous system and immune system a break.  This is then an important stage as it is the stage when your body is starting to more efficiently ration energy.


Stage 3: Feeling good doing nothing every day.  Life will not allow you to do nothing everyday, however when you rest and feel good on a regular basis, you know you have reached this stage.  


Stage 4: Graded activity begins.  The above stages should have been achieved before we begin grading our activity.  By increasing your workload, this may be physical or mental.  Feeling tired at the end of the day is okay.  Experiencing a flare-up the following day should be avoided.  In this stage, you must be willing to pull back your activity as difficult as that may seem.  


Stage 5: Initiate an exercise program.  Stage four must be well established before we begin stage 5.  To begin building back your body’s ability to produce energy, you must work muscle groups to fatigue and allow them to rest for a week.  You are able to work different muscle groups each day but once a muscle group has been worked, it must be allowed to rest.  Each body region should be done slowly and with body weight up to 90 seconds.  You should feel fatigued and a good muscle burn to know that you produced lactic acid.  This will build muscle strength over time but will also increase your body’s ability to produce energy.


Stage 6: Laying back from the program and beginning to live your life as you choose.  Diet changes, supplements, and lifestyle modifications will continue to ensure you are living a healthy life.


References: Diagnosis and Treatment of Chronic Fatigue Syndrome and Myalgic Encephalitis - It’s Mitochondria, not Hypochondria_Dr Sarah Myhill

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