Research | Pacing as a strategy to improve energy management | May 2012

From Disability and Rehabilitation, May 2012

Pacing as a strategy to improve energy management in myalgic encephalomyelitis/chronic fatigue syndrome: a consensus document

Ellen M. Goudsmit(1), Jo Nijs(2,3,4), Leonard A. Jason(5), Karen E. Wallman(6)
(1) School of Psychology, University of East London, Stratford, London, E15 4LZ, UK
(2) Department of Human Physiology, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium
(3) Division of Musculoskeletal Physiotherapy, Department of Health Care, Artesis University College Antwerp, Belgium
(4) Department of Rehabilitation and Physiotherapy, University Hospital Brussels, Belgium
(5) Center for Community Research, DePaul University, Chicago, IL, USA
(6) School of Sport Science, Exercise and Health, The University of Western Australia
Correspondence: Dr. Ellen Goudsmit, 23 Melbourne Road, Teddington, Middlesex, TW11 9QX, UK. E-mail:


PURPOSE: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating condition characterized by a number of symptoms which typically worsen following minimal exertion. Various strategies to manage the limited energy levels have been proposed. Of these, pacing has been consistently rated as one of the most helpful in surveys conducted by patient groups. This review is a response to the paucity of the information on pacing in the scientific literature

METHOD: We describe the principle of pacing and how this can be adapted to meet individual abilities and preferences. A critical evaluation of the research was conducted to ascertain the benefits and limitations of this strategy

RESULTS: Based on various studies, it is proposed that pacing can help to stabilize the condition and avoid post-exertional malaise.

CONCLUSION: Pacing offers practitioners an additional therapeutic option which is acceptable to the majority of patients and can reduce the severity of the exertion-related symptoms of ME/CFS.

Implications for Rehabilitation

* Pacing is a strategy which helps patients with ME/CFS limit exertion-related increases in symptomatology.

* Pacing is appropriate for those who operating near or at their maximum level of functioning, and for individuals with neurological and immunological abnormalities.

* Pacing may be offered as part of an individualized, multi-component management programme.