Since early 2020, the COVID-19 pandemic has profoundly impacted global health, leaving millions to cope with its lasting effects. While healthcare systems worldwide have adapted significantly to address the immediate challenges of the pandemic, the journey to recovery remains ongoing for many individuals. Those living with Long COVID, also known as Post-COVID Syndrome, continue to face lingering symptoms that can disrupt daily life. Despite ongoing research efforts, Long COVID remains a relatively new condition, and its long-term impacts are still not fully understood.

Currently, there is no definite cure for Long COVID. While some individuals experience gradual improvement and recovery, others continue to endure persistent, debilitating symptoms that come in waves, significantly impacting their quality of life.

Interestingly, Long COVID shares notable similarities with Myalgic Encephalomyelitis, also known as ME/CFS (formerly referred to as Chronic Fatigue Syndrome). Many patients present with similar symptoms and, particularly, there are many parallels with regards to how these symptoms fluctuate and affect daily functioning. These similarities have prompted health care professionals to draw insights from ME/CFS experts and research to better support those living with Long COVID. One of the most effective strategies for managing ME/CFS - and now increasingly recognized for Long COVID - is a technique called "pacing”. This approach offers a structured way to manage energy levels and minimize symptom flare-ups, empowering patients to navigate their recovery journey more effectively.

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What is Pacing?

Specifically, pacing is a strategy designed to help patients manage their energy levels effectively, reducing the likelihood of a "crash" - a period of severe fatigue and symptom exacerbation that can last for days or weeks. By practicing pacing, individuals learn to align their activities with their body’s current capabilities, striking a balance between rest and activity to maintain the best possible quality of life under their circumstances.

Since the symptoms of Long COVID and each person’s tolerance for physical and mental exertion can vary widely, pacing therapy must be personalized to the individual’s unique condition recovery stage. This tailored approach ensures that the strategy addresses the patient’s specific needs, recognizing that there is no universal method that works for everyone.

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What is Post-Exertional Malaise?

Post-exertional malaise (PEM) is a hallmark symptom experienced by many people with ME/CFS and is increasingly recognized in Long COVID patients as well. PEM refers to the severe and disproportionate worsening of symptoms, including debilitating fatigue that occurs after physical or mental exertion beyond an individual’s current tolerance. Unlike ordinary tiredness, PEM symptoms are profound and can leave individuals unable to perform even basic daily tasks. Symptoms may last for a few hours or stretch into several days.  

It's crucial to understand that PEM is not caused by physical deconditioning. This distinction is essential, as the misconception that fatigue stems from inactivity often can lead well-meaning healthcare providers to recommend more exercise and activity. Unfortunately, such approaches can exacerbate symptoms, making the condition worse rather than better.

One of the challenges with PEM is its delayed onset. Individuals might not feel the impact of overexertion immediately, making it difficult to recognize when they have exceeded their limits. The delayed reaction complicates the process of interpreting symptoms and adjusting activities, highlighting the need for a structured and carefully monitored approach to treatment. By understanding and respecting their energy boundaries, patients can work towards better managing their symptoms and avoiding the debilitating effects of PEM.

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What Does Pacing Do?

Pacing is a practical strategy that helps patients to manage their physical and mental activities to prevent symptom worsening and avoid the debilitating effects of a crash. It encourages patients to find a sustainable balance between activity and rest, enabling them to maintain their current abilities without overexerting themselves. Through pacing, patients learn to interpret their symptoms as signals of their limits. This awareness helps them adjust their activities according to their body's needs while avoiding complete inactivity, which, if prolonged, could lead to severe deconditioning and a decline in overall health.

In some cases, temporary cessation of activities may be necessary to allow the body to recover during periods of heightened symptoms. However, the goal of pacing is not to stop activity altogether but to maintain a level of engagement that aligns with the patient's current energy capacity, promoting steadier progress in recovery.

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How Do I Start Pacing?

Beginning pacing therapy involves a bit of trial and error to find the right balance that works for you. The goal is to establish a baseline level of activity that you can manage without triggering symptom flare-ups.

Track your symptoms and activities can be a helpful tool for identifying patterns and understanding how different tasks affect your energy levels.

Here are some strategies that help you get started:

• Prioritize Your Activities
  
  • Make a list of everything you currently do.
  • Sort these tasks into three categories: what you MUST to do (e.g., eating, bathing), what you SHOULD do, and what you WANT to do.
  • If your symptoms are severe or not well-controlled, focus on the MUST category to establish a stable baseline.
• Take Regular Breaks  
  
  • Schedule frequent breaks throughout your day.
  • Rest before you feel symptoms start to worsen.
  • During breaks, rest both physically and mentally - mental effort can be just as draining as physical activity.
• Adapt Your Tasks
  
  • Look for ways to make tasks easier, such as sitting while preparing meals or using tools to reduce effort.
  • Modify your environment to lower energy demands where possible.
• Alternate Activities
  
  • Break up longer tasks into smaller, more manageable chunks.
  • Alternate between more and less demanding activities to conserve energy.
• Monitor and Adjust  
  
  • Keep a symptom and activity diary to track how you’re feeling and which activities are manageable.
  • Adjust your daily routine as needed to avoid overexertion.
• Increase Activity Gradually
• If you are ready to increase your daily activity level, do so in very small, gradual increments.
• Wait a few days to assess how the change affects your symptoms before making additional increases.

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Digital Support

Pacing is a strategy that is increasingly being integrated into digital therapy tools, such as the nyra therapy app. The app’s daily schedules are designed to allow you to complete small chunks of therapy, enabling you to decide whether to pause or continue. This approach helps you become more attuned to your daily energy expenditure while engaging in evidence-based exercises in the nyra therapy app. Advanced algorithms within the app learn and adapt alongside you, automatically adjusting to provide the optimal level of cognitive training tailored to your needs.

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The nyra health website does not provide medical or legal advice. nyra health blog articles are not scientific articles, but are intended for informational purposes only. Medical or health-related information on the nyra health website is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always consult a physician or health care provider with any questions regarding a medical condition.