Pacing Physical Activity

Physical Activity, Pacing, and Exercises

The Importance of Pacing

Activity pacing is an important tool in chronic pain self-management. It is easy to find ourselves in an “all or nothing” cycle when living with chronic pain.

  • Learning to manage your activity by scheduling planned rest periods/breaks can improve your energy and pain levels.
  • Pacing is “an active self-management strategy where you learn to balance time spent on activity and rest for the purpose of achieving increased function and participation in meaningful activities.”
    • In pacing, activities are planned so that you can space them out.
    • Pacing can help re-create a sense of control- instead of your pain dictating your schedule each day. 
    • By structuring your day, you can conserve energy and avoid flare-ups.

In this module you will learn about: 

  • How over activity and inactivity can increase pain signals
  • How pacing can positively impact pain
  • How to identify what pacing looks like for you
  • Calculations to better manage activity levels
  • How to decide on an increase in activity schedule

Over Activity

Pain levels vary from day-to-day.

  • Low pain- it can be easy to feel as though you need to take advantage of this “good” day.
    • You may try to fit in as many chores as possible or make up for lost time and spend longer doing the activities you enjoy.
  • High pain- you may try to push through the pain 
    • This over activity leads to over doing it and causes you to end the day exhausted and in pain.
    • You are then forced to stop your activity and chores and it takes longer to recover.
  • Obligations and guilt build until you repeat the cycle once again.

People living with persistent pain often find themselves repeating this “Boom and Bust” pattern. In the long run, you can lose stamina and avoiding things that are fun and make you feel good to keep from having severe pain.

Key concepts:

  • Chronic pain varies in intensity and severity on a day-to-day basis.
  • On “good” days where you pain intensity is low, it may be tempting to make up for lost time by overdoing activities of daily living.
  • Over activity can have negative consequences on persistent pain, causing you to feel exhausted, tense, and worried.
  • “Boom and bust” patterns of activity can negatively impact your stamina, cause you lose interest in activities you previously enjoyed for pain management.

Under or Inactivity

On the other end of the spectrum, you may fall into completely stopping your activities. 

  • Experiencing more pain after an activity can lead you to believe that you need to stop all activity
    • You may take extended periods of rest and avoiding activity all together.
    • You might also start avoiding chores and social outings out of fear of flares.
    • Your fitness level will decrease as a result of inactivity, leading to decreased strength.
      • Your muscles will begin to feel stiff and have less strength.
  • Ultimately, this inactivity will lead to an increase in pain levels rather than a decrease.

For example, you spend one hour raking the leaves and you experience severe pain and fatigue. You feel so bad afterwards, you vow to never rake leaves again! However, it may not be the raking itself that is ramping up your pain levels. It may be that at this point, one hour without a break is too long for you. With proper breaks scheduled, raking leaves might in fact not flare your symptoms at all.

 

We will go over how to schedule breaks in the calculation portion of this module

Key concepts:

  • Under or inactivity may result when engaging in an activity causes you to experience more pain, leading you to associate increased pain with the activity.
  • When inactivity occurs, your fitness level will decrease, your muscles will begin to feel stiffer and have less strength.
  • In the long term, chronic inactivity will lead to increased pain levels.
  • Scheduling timely breaks during activities can mitigate short-term pain increases or flares

Positive impact of pacing on pain

Pacing is learning how to balance activity and rest so you can accomplish what you want to do while managing your pain levels.

  • Inactive- this means gradually increasing your activities to normal levels.
  • Overactive- this means learning to schedule breaks, changing your body position, alternating tasks, and adopting new strategies to break the “Boom-Bust” pattern. 

 There are two major objectives behind pacing:  

  1. Preserving your energy so that you can participate in the activities that are important to you
  2. Establishing functional or activity-based goals to gradually increase your conditioning and stamina, in order to slowly improve your tolerance to these activities

Use a time-based approach for your activity (i.e., measurable in terms of time, distance, or number of repetitions)

INSTEAD OF...

A symptom-based approach (ie., stopping when your symptoms flare)

Key concepts:

  • Pacing is the process of balancing activity and rest to accomplish your daily goals while managing your pain.
  • There are two major objectives behind pacing which are: (1) preserving your energy and (2) increasing your conditioning and stamina.
  • Breaking the “Boom-Bust” pattern of activity will help you to avoid flares.
  • Pacing is more effective at managing pain when using a time-based approach (i.e., measurable in terms of time, distance, or number of repetitions).
  • Pacing is less effective at managing pain when using a symptom-based approach (i.e., stopping when your symptoms flare).
  • Effective use of pacing will help you to break progressive deconditioning associated with chronic pain.

Pacing your way

Below are strategies to help you pace out your activities.

Download the Activity Adaptation Worksheet to help you make a plan to pace your day!

 

  • Use short periods for activities

    • Using short activity periods as well as limiting your overall activity level will help to prevent flares. 
      • For example; two short periods of work with a break in the middle can be more productive and leave you feeling more energetic than completing a task in one period. 
    • The same principle can be used for activities over a longer period of time. 
    • You may find it better to spread activities throughout the week rather than try to complete them in one or two days.
  • Activity Shifting

    • Activity shifting involves changing or shifting between physical, mental and social activities frequently. 
      • For example if you are feeling tired or confused after working on the computer for a while, you might stop and call a friend or do something physical like taking a walk or preparing a meal. 
    • Another way for shifting activity is to divide your tasks into light, medium and heavy and switch activities frequently scheduling only a few heavy tasks each day.
  • Adding Activities

    • It is easy to add one more task to your day which often results in more symptoms. 
    • The solution is to think of subtraction rather than addition. 
    • If you really need to add a new task in your day, you need to defer another.
  • Time of Day

    • Many people with pain find that certain times during the day are consistently better or worse. 
    • For some the morning may be when they have the most energy. 
    • Others may find the morning challenging and perk up later in the day.
    • It is likely that you can achieve more with less adverse effects if you organize your day to use your best hours for the most important or demanding tasks. 
    • Some people with pain have an increased sensitivity to sensory information such as light and sound and find their concentration is affected by too much sensory in-put. 
    • It may be possible to get more done and experience a lower level of symptoms if you focus on one thing and simplify your environment. 
    • Try to limit exposure to large groups, read in a quiet place, and shop or go to restaurants during quieter times.
  • Using Devices

    • There are devices that can help you pace your activities such as pedometers or heart rate monitors. 
    • Pedometers can help you measure the distance or number of steps you have achieved during your activity/day. 
    • Heart rate monitors help you keep your energy levels within a targeted range. 
  • Pleasurable Activities

    • Living with a chronic condition often means ongoing discomfort and frustration. 
    • Pleasurable activates can reduce stress, frustration, and distract you from your symptoms. 
    • Plan to schedule some time each day to devote to enjoyable activities can help you accept your limits.
  • Mental Adjustments

    • Pacing involves adopting new habits and it also requires making mental adjustments based on accepting that life has changes. 
    • This knowledge leads to a different relationship with your body. 
    • One part of this shift is changing expectations to support your efforts to live well within your limits without frustration. 
  • Daily and Weekly Schedules

    • The goal of pacing is to move toward consistency, scheduling similar amounts of activity every day. 
    • Beginning with planning a daily schedule and moving toward a weekly schedule can help you achieve the desire results.

Key concepts:

  • Even if you are having a good day, stick to your scheduled breaks.
  • If you are having a bad day, be patient with yourself and try to do some of what you have planned.
  • Only change one or two things at a time in your schedule and subtract an activity if you add an activity.
  • Keep a journal and track the activity, noting how much you did and how you felt doing it.
  • Alternate between light, medium and heavy tasks.
  • Change positions frequently.
  • Start with frequent short periods and gradually increase your activity.
  • If you have a flare, return to an intensity you know you can handle and try to gradually build up again.

Create your plan

  1. Start with establishing a baseline. 
    1. Download and use the activity tracker to learn your baseline
    2. pick an activity to monitor (walking, gardening etc...)
  2. Week 2
    1. Try to increase your activity by 10% (e.g., if you started at 10 minutes, try for 11 minutes)
  3. Increase your activity by 10 % every week or so (by adding more time, or more weight, or more repetitions)
    1. If you experience a flare with the increased activity, try not to panic, return to the baseline of the previous week and gradually try to increase again.
    2. If increasing your activity level by 10% feels very comfortable, you can experiment with increasing by 20% (i.e., from 8 minutes of gardening to 10 minutes of gardening).
    3. Alternatively, if increasing by 10% is too challenging and causes you to flare, try increasing your activity by 5% instead.

Use activity tracker to help you plan rest periods during the day when you need them.  Over time you will learn to listen to cues from your body and know when to stop for a rest. The idea is to plan your day so that you change activities before the pain forces you to stop. This keeps you in control and not the pain! 

 

Key concepts:

  • Start with establishing your baseline: first way is using the amount you can accomplish on a bad day without flaring your pain, second way is to take an average of a given activity over 3-7 days and reduce it by 20 to 30%
  • Plan the rests and take them at specific times
  • Learn to listen to cues from your body telling you to take a rest
  • Change the activity before your pain forces you to stop

References

  1. Australian Pain Management Association Inc., (Updated 2015). Pacing Activity. Retrieved from
    https://www.painmanagement.org.au/2014-09-11-13-35-53/2014-09-11-13-36-47/166-pacing.html

  2. Fitzpatrick, P., (2017, July 29). Lower Back Pain Toolkit. Retrieved from http://www.lower-
    back-pain-toolkit.com/chronic-pain.html

  3. Government of Western Australia Health Department (updated 2017). Pacing and Goal Setting.
    Retrieved from https://painhealth.csse.uwa.edu.au/pain-module/pacing-and-goal-setting/

  4. HealthTalk.org. (2015, May). Pain Management Pacing and Goal Setting. Retrieved from
    http://www.healthtalk.org/peoples-experiences/long-term-conditions/chronic-pain/pain-management-pacing-and-goal-setting

  5. Jamieson-Lega, K., Berry, R., Brown, C. A., (2013, August). Pacing: A concept analysis of a chronic pain intervention. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3812193/

  6. Strong, J., Wales, C., Chronic Pain Australia Pacing. Retrieved from
    https://www.chronicpainaustralia.org.au/chronic-pain/treatments/physical-therapies/pacing

 

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