Post-exertional malaise (PEM) is a key symptom of ME/CFS and is also common in long COVID. PEM means that symptoms get worse after using energy.
This can happen after physical, mental, or emotional activity. Even small things, like having a shower, going for a short walk, or reading, can make symptoms worse.
PEM happens because the body does not make or use energy the same way as a healthy body. It is like a battery that never fully recharges and runs out faster than normal. When the battery gets low, symptoms increase and the body needs more time to recover.
The best way to manage your condition is to slow down so your energy does not run out too quickly. This can help reduce symptoms and help you use the energy you do have more wisely. This approach is called Stop, Rest, Pace.
Stop
Stop what you are doing before symptoms start, or as soon as you notice symptoms getting worse.
Rest
Take regular rest breaks during the day and while doing activities.
Pace
Break activities into smaller parts and rest in between. This helps your energy “battery” recharge. Everyone is different, so take time to learn how much you can do and how much rest you need.
Some questions to consider:
- How much rest do you need to rechare? Are you getting enough?
- Are you constantly draining your battery without taking time to charge?
- Do you need to build in more rest time?
Free online pacing education
Self-paced education modules are designed to help you understand the basics of ME/CFS, post-exertional malaise (PEM), energy management and pacing.
Exercise as treatment for ME/CFS and long COVID
Clinical trials show that graded exercise therapy is not effective, and carries a risk of harm to people living with ME/CFS or long COVID. Exercise of any form should be managed by an ME/CFS specilist who understand this.
Pacing Overview
The goal of pacing is to finish an activity with some energy left in your battery. This makes it easier for your battery to recharge and can help manage symptom severity.
Pacing means doing less than you feel capable of in a day. It also means breaking activities into small steps, with rest in between.
For example, instead of showering, brushing your teeth, and combing your hair all at once, you might take a shower and then rest until you feel ready to do the next task.
One suggestion trying to do no more than 50–60% of what you feel you can manage, especially if you experience PEM.
Pacing is a skill. Like any skill, it takes practice. It often becomes easier over time.
Be realistic
In an ideal world, pacing would always prevent PEM. In real life, this is not always possible. Work, family responsibilities, or living alone can mean you sometimes go beyond your energy limits.
There may also be activities that are important for your wellbeing and enjoyment, even though they use more energy.
Pacing is a tool to help you manage your condition. It is not a cure, and it will not work perfectly every time. Try to be flexible and realistic, and build pacing into everyday life.
Remember, your energy battery is not the same as it was before you became unwell. Even with good rest and pacing, you will likely be able to do less in a day than you could when you were healthy.
Rest looks different for everyone
There are many ways to rest. The best kind of rest is what works for you.
For some people, rest means very little activity. This may include no TV, social media, reading, or music.
For others, rest may mean listening to a guided meditation or sitting quietly in nature.
Some people find that being completely still is not restful. Gentle activities, like playing a simple game on a phone or doing an easy puzzle, may help the body and mind rest.
You may need to try different types of rest to find what works best for you.
Important facts should I know about ME/CFS and Pacing?
There are many important facts about what it’s like to live with ME/CFS and how to manage your symptoms. There are also many misconceptions about ME/CFS that cause stigma and harm to those who live with the condition.
- To help break down the stigma, click here to learn more about important myths and facts.