Energy management, activity management and pacing are terms often used interchangeably to mean similar things.
Energy management is a strategy that involves managing activities to stay within available energy levels. People with ME have reported that energy management is one of the most effective forms of symptom management.
However, while physiotherapists may feel familiar with the concepts of energy management, activity management and pacing, it is important to understand that there are different types of energy management, some of which may not be appropriate for people with ME.
The aim of energy management is to reduce symptom exacerbation and maximise function and quality of life.
But physiotherapists can show a preference for using a style of pacing that aims to increase activity, often in structured amounts. One survey found 50% of physiotherapists adopt this style of pacing, and only 0.1% saw the aim of pacing was to conserve energy. Physios for ME have previously written about our concerns that physiotherapists may apply a universal style of pacing to people with ME.
Pacing for people with ME is difficult due to the nature of post exertional malaise (PEM), which is a hallmark symptom of this disease. PEM is the addition of new symptoms or exacerbation of current symptoms caused when people with ME exceed a certain activity level, and can persist for days, weeks or even months after exertion. Unfortunately PEM is usually a delayed reaction, often 24-48 hours after the triggering event, so it can be very difficult to determine what level of activity is "safe". If a person tries to push themselves beyond their energy levels, they will trigger PEM and make their symptoms worse.
There are many strategies for energy management and it is a very individual approach.
Mapping a daily schedule can be helpful, splitting activities with meaningful rest breaks and remembering that exertional tasks can be physical, cognitive, sensory and emotional
Change elements of an activity to reduce exertion, such as the position of the person (eg sit instead of stand) or chunking a large activity into smaller components
Tracking how much energy is being expended can help to remind the person when to rest, or form an assessment of which tasks are incurring the most exertion.
Heart Rate Monitoring is one way of doing this.
Activity and symptom tracking apps are being developed specifically for people with ME and Long Covid.
Adaptive Aids and Equipment
Use of adaptive equipment such as perching stools, mobility scooters, stair lifts, electronic devices (electric toothbrush, electric cooking aids) can help to minimise energy expenditure.
"Pacing as a strategy to improve energy management in myalgic encephalomyelitis/chronic fatigue syndrome: A consensus document"
"How to conserve your energy" by the Royal College of Occupational Therapists
"Energy Management and Pacing" by the ME Association
Film (15 minutes) "Activity and Energy Management - Pacing" by Dialogues for a Neglected Illness
If you are considering a change in the way you manage your activity, we would recommend doing this with guidance from a health care professional who understands ME.