Pacing as a strategy to improve energy management in myalgic encephalomyelitis/chronic fatigue syndrome: a consensus document

Abstract

Purpose: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating condition characterized by a number of symptoms which typically worsen following minimal exertion. Various strategies to manage the limited energy levels have been proposed. Of these, pacing has been consistently rated as one of the most helpful in surveys conducted by patient groups. This review is a response to the paucity of the information on pacing in the scientific literature. Method: We describe the principle of pacing and how this can be adapted to meet individual abilities and preferences. A critical evaluation of the research was conducted to ascertain the benefits and limitations of this strategy. Results: Based on various studies, it is proposed that pacing can help to stabilize the condition and avoid post-exertional malaise. Conclusion: Pacing offers practitioners an additional therapeutic option which is acceptable to the majority of patients and can reduce the severity of the exertion-related symptoms of ME/CFS.

Implications for Rehabilitation

• Pacing is a strategy which helps patients with ME/CFS limit exertion-related increases in symptomatology.

• Pacing is appropriate for those who operating near or at their maximum level of functioning, and for individuals with neurological and immunological abnormalities.

• Pacing may be offered as part of an individualized, multi-component management programme.

Keywords::

• Activity
• chronic fatigue syndrome
• envelope theory
• fatigue
• myalgic encephalomyelitis
• pacing

Acknowledgements

We wish to thank all the patients and our colleagues for their helpful comments on earlier drafts.

Ellen M. Goudsmit: initiating the review, designing the format and writing of the manuscript. Jo Nijs: designing the format and writing of the manuscript. Leonard A. Jason: writing of the manuscript; Karen E. Wallman: writing of the manuscript. Jo Nijs is guarantor.

Declaration of Interest: There are no competing interests to declare. This review was self-funded.