​Pacing is the term given to the strategy of managing fatigue and other symptoms in chronic conditions including post-viral fatigue, Long Covid, fibromyalgia, chronic fatigue syndrome (ME/CFS) and many others.
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What this looks like can be slightly different for everyone, but it essentially means being strategic about how you coordinate your life scheduling rest around activities and listening to your body, stopping before your body reaches tipping point. This requires understanding your baseline (which can unfortunately fluctuate), recognising your triggers and structuring your day, week and even month accordingly.

The idea with pacing is to be one step ahead of your body to avoid flares and reduce the severity of post-exertional malaise otherwise known as PEM. PEM is a delayed exacerbation of symptoms (especially fatigue) that occurs in response to mental or physical exertion. For example, having to go out to a doctor’s appointment and doing a load of washing in one day could lead to a significant worsening of symptoms in the days following before returning to baseline. Some of you will know this pattern all too well! 

So, how can you get the most out of pacing?
Here are my 3 top tips for effective pacing.

Dysautonomia is the inability of the autonomic nervous system to regulate itself and is a common feature of Chronic Fatigue Syndrome (MECFS), Postural Orthostatic Tachycardia (POTS), Fibromyalgia and Long COVID.
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The autonomic nervous system consists of the parasympathetic (relaxation) and sympathetic nervous system and controls involuntary actions in the body including heart rate, blood pressure, digestive and bladder function. When the autonomic nervous system is constantly out of balance it can leave people with some debility symptoms which severely impact quality of life.

With the recent pandemic it is estimated that up to one third of people who test positive for the spicy cough will experience ongoing symptoms for months and sometimes years after their acute infection. Unrelenting fatigue is by far the most common.
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Chronic fatigue can occur after any infection however there are some viruses that have earned a reputation for this. Glandular fever (Epstein Barr Virus), Ross River virus, influenza viruses and of course our new favourite SARS-CoV19 are all common culprits. The biological impact of viruses on our human health is complex and there is still much to learn however there are few things we do know about why we might feel such extreme ongoing fatigue after infection.

MITOCHONDRIAL DAMAGE
Viruses can alter the internal workings of the mitochondria to allow them to replicate more efficiently. This can cause damage to the mitochondria resulting in a reduction of ATP (energy) production, increased oxidative stress (free radicals) and increased cell death. When mitochondria are impaired by viral damage our capacity to produce energy is significantly reduced.

CHRONIC LOW-GRADE INFLAMMATION
The invasion of a virus triggers the release of several pro-inflammatory cytokines (chemicals that promote inflammation). This response can continue some time past infection and higher levels of certain inflammatory chemicals have been observed in patients with post-infectious chronic fatigue syndrome (ME/CFS) and long COVID. When the inflammatory process doesn’t resolve the way it should, ongoing chronic inflammation can result and this is thought to play a role in ongoing post-viral symptoms.
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The following is my summary of the guidelines on how to approach a return to exercise after COVID-19 infection. This information should not replace appropriate medical advice.
I will begin with my key, take-away, messages from having read through the material and will then present some material in further detail.
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Key Messages:

• Be kind to yourself in the early stages following COVID-19 diagnosis. Even if you have very minor to no symptoms, the recommendations are to prioritise rest and recovery and not to exercise during this period. Focus on nutrition, hydration and rest.
  
  
• In some circumstances it is strongly encouraged to seek medical advice prior to returning to exercise. The most notable of these are: any cardiac (heart) symptoms, moderate-severe symptoms in initial infection phase and onset of particular symptoms during activity.
  
  
• Monitor your mental health. Both the initial illness period and the recovery process can be difficult to deal with at times and if you notice yourself struggling then seek out assistance.
  
  

In the vast majority of circumstances the full return to activity should be managed slowly and may well take weeks to months to properly recover. This will require patience.