Pacing activities

Pacing an activity enables you to consistently carry out activities without causing extra pain. It will help to enable you to gradually increase the amount you can do and helps prevent you having bouts of over or under activity.

A common cycle for people with chronic pain involves tending to push themselves until the pain tells them to stop. This is invariably followed by a period of rest, taking painkillers and feelings of frustration and despair. In times of prolonged rest, the body starts to get out of condition, with joints becoming stiffer and muscles becoming weaker. Consequently, it is less able to cope with a higher level of activity. Over time the point at which a person has overdone it becomes less and less. Rest periods tend to become longer and activity levels, including fitness and function, tend to reduce.

The amount of activity you do is often based on how you feel: when you have a ‘good day’ you find that you want to make the most of this and get extra tasks done. This can often lead to overdoing it and feeling much worse later in the day or the following day.

There are ways to break the over/ under activity cycle and increase your activity level without stirring up the pain too much, so that you can enjoy a wide range of activities again. The idea of pacing activities and exercise is one of the most important aspects of the programme. Pacing is being able to do everyday activities without making the pain worse. If you can successfully pace everyday activities, you will find over time you will become fitter. Because you are fitter, you will be able to do even more without making the pain worse. Pacing puts you, rather than the pain, in control of your life.

There are three ways in which you can incorporate pacing into your daily activities. These include:

• Taking regular breaks – try not to complete a task for a long period of time; instead break it down. For example if you are going to hoover, do not do the whole house at once, you can hoover one room then sit down and have a break, then go back and do another room and so on. Make sure you have a rest instead of doing it all at once, and then feeling the pain later. You can use timers to schedule in your breaks.
• Change positions – Instead of sitting in one position for a long period of time, and getting stiff and achy, make sure you get up every now and again and have a stretch. The same can be applied if walking for long periods of time. Ensure you get the chance to sit down and rest.
• Gradually increase over time – complete your activities at a level that feels comfortable and then gradually increase this over time; do not push yourself too hard to begin with. For example when gardening start off with a small amount, prepare one or two pots then increase this to three or four. Then when you feel able plant some bulbs, then move on to mowing the lawn. You do not have to tackle it all at once, build it up as you feel able. Find your baseline as mentioned below, and gradually increase from this.

And don’t forget you can always delegate!

Before being able to pace yourself you need to establish a comfortable time limit for activities. This leaflet helps you to do this.

A baseline is a comfortable level of activity that you can manage on a regular basis, without experiencing an increase in symptoms. It acts as a starting point on which to build activity levels gradually.

Finding a comfortable time limit

1. Choose an activity; for example, sitting, standing or walking.
2. Record/ measure the length of time you are comfortably able to do this. Do this at least three separate times in a day and on good days and bad days. Take the average of these times, then deduct a fifth of this.

Using your new comfortable time limits

Using one of the examples above you can use these time limits when doing activities. For example if watching television you would sit for nine minutes before changing position, perhaps by standing or walking a little before sitting down again. If standing, or doing an activity while standing such as washing up, you would do this for two and a half minutes before sitting down or walking before returning to the task.

Case study for using baselines

Mrs X wants to watch a film on TV. However, if she sits on her sofa for the evening or for the length of the film, she finds it difficult to get up as she is stiff and her pain increases.

Using pacing she can get up at her baseline time and stand by the chair or walk around the room before sitting back down. Or she could use a mixture of lying on the sofa, standing and walking as well as sitting.

Breaking down tasks

Many activities may seem daunting but can be broken down into steps or stages, for example cooking a meal can be broken down into separate stages. Baselines can then be used in each stage.

1. Collecting items and ingredients required. (Walking for six minutes).
2. Preparing ingredients. (Sitting for nine minutes, or standing for two and a half minutes before changing position).
3. Cooking. (Standing for two and a half minutes before walking or sitting).
4. Laying the table. (Walking for up to six minutes).
5. Eating. (Sitting for nine minutes, standing or walking a little before returning to sitting).

Remember

Pain will have limited what you can do and how much you can do. Pain management is about changing long standing habits. Before you start, it is worth thinking about the following points:

Prioritise – what needs to be done: choose the most important activities to be done.
Plan – your week, make sure you spread your sitting, standing and walking activities out.
Pace – think ‘little and often’ remember to change your position before the pain begins to increase.

• By using a baseline for your abilities you can organise activities to time and not to pain, which will give you more control.
• You can carry out tasks that previously caused you discomfort with more ease.
• The baseline should be used on ‘good’ days and ‘bad’ days; initially you may find it hard to limit yourself on good days.
• Using a baseline leads to improved tolerances and achievement when used with goal setting.
• You may find a timer useful to start with, to remind yourself to change position.
• You can also use your pain levels as a measure of when to stop an activity. Using the pain scale by rating pain from 0 (no pain) to 10 (worst pain), rate it at the beginning of an activity. If this pain starts off from a score of 0 to five you can increase this pain by two scores before needing to stop the activity. If it starts from a score of six to 10 you can increase this pain by one score before needing to stop.

Tips for changing habits:

• write a list of your plans and stick it on the fridge
• start off with a small change and build on this
• make a list of why you want to change
• explain to others why you are changing a habit, get support and help from others if needed
• reward yourself with a treat
• do not worry if you fall back into your old habits, everyone does when they try to change, look at your plan and start afresh
• find a new way of doing something with pacing rather than stopping it altogether