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Controlling Long Covid Symptoms with Pacing

Written by Adam Brown BScPT MClScPT FCAMPT

What is Activity Pacing?

Pacing is a technique recommended to some patients to help control symptoms of long covid. It teaches them how to control the amount of energy they consume throughout their day to prevent worsening of their symptoms. The process of pacing matches a person’s activity level to what their body can handle at a given time while recognizing that some activity is necessary and beneficial.

Every case of long covid is a little different. While one patient may only need to decrease their energy expenditure a little, others may need to reduce substantially in order to get symptoms under control.

Post-exertional Malaise

Many long covid patients suffer from a syndrome called post-exertional malaise (PEM). This condition causes people to experience severe fatigue and a worsening of their typical symptoms between 3 hours and up to three days after undertaking too much activity. The symptoms of PEM may last a few days, or persist for weeks. People experiencing PEM are not simply ‘tired’. The symptoms brought of post-exertional malaise are severe, and can prevent patients from being able to do anything at all. PEM is not because the patient is ‘out of shape’, it is a condition that is completely independent of the patient’s physical fitness level.

It is not always clear to patients that they are ‘overdoing it’. The delayed onset of symptoms makes it difficult for individuals to correlate how they are feeling with their physical or mental activity level. This makes symptom control difficult, requiring a structured approach to treatment.

How is Pacing Done?

Pacing requires some patience and experimentation to find the activity level that keeps your symptoms under control. First, you need to find a baseline of activity that is tolerated well. This may involve a week or more of very minimal energy expenditure to establish a symptom baseline.

Keeping some record of symptoms and physical activity can be very helpful. This information can be used to interpret how your activity is impacting the symptoms you are experiencing.

Helpful Pacing Strategies:

  • Separate everything you need to do in a week into three categories. Things you NEED to do, Things you SHOULD do and lastly things you WANT to do. To get symptoms under control you may need to focus only on the things you NEED to do for a short time. You can add other items over time in their order of importance.

  • Take frequent breaks BEFORE symptoms start. While on a break it should be both physical and cognitive rest. Thinking and problem solving can be as fatiguing as physical activity.

  • Modify everything to reduce energy output. Sitting while cooking a meal can help. Look for opportunities to modify your environment to reduce your total energy required to accomplish the items in your NEED column.

  • Switch activities often. It would be wise to complete larger tasks in a few spaced out efforts.

  • Track your symptoms and adjust your activity accordingly.

  • If symptoms have been well controlled for a week, you may consider an increase in your daily activity. Increase activity by very small increments and wait several days to interpret the impact on symptoms before any further increase.

In partnership with Cornerstone Physiothreapy

 The logo of Cornerstone Physiotherapy is a vector illustration. It features a stylized representation of a corner of a building, resembling a cornerstone. The cornerstone is depicted in solid lines, with clean and angular edges. It is positioned at an angle, giving a dynamic and forward-moving appearance. The logo utilizes a color scheme consisting of earthy tones, such as warm brown and soothing green, evoking a sense of nature and wellness. The Cornerstone Physiotherapy logo represents the organization's focus on providing a solid foundation of care and support for physical well-being. The vector design conveys a sense of stability, professionalism, and growth."
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