If you or your child has a form of chronic pain or chronic illness, there is a good chance you have been recommended an approach called, “activity pacing.”
But what is activity pacing?
Simply put, activity pacing is a form of treatment for chronic pain or illness that involves adapting your response to symptoms. Sometimes, individuals with chronic pain or illness may respond to their symptoms by avoiding certain activities, overactivity, or cycling between the two (“boom or bust”). Instead, activity pacing models recommend modifying activity or effort to maximize meaningful activity engagement balanced with managing symptoms. The kinds of activities can be anything, such as physical activity, homework, social activities, work, and even relaxing activities.
There are two main approaches to activity pacing:
1) Energy conservation
2) Operant activity pacing
Energy conservation pacing:
This is the approach of deliberately reducing effort or output with the goal of retaining energy for the future. This view considers energy to be finite, popularized by the “spoon theory” online.
Pros: It can feel tempting and relieving to “hold something back,” and feel more confident having some energy in reserve.
Cons: It can begin to feel demoralizing or unfulfilling to not give full energy to activities. The energy conservation approach can also affect self-image and foster an “illness identity.” It can also create fear of certain activities and further avoidance of things your or your child truly enjoy or benefit from. For example, stopping a favorite sport such as swimming every time pain or nausea arise, ultimately putting in less and less effort or time, until the athlete quits entirely.
Alternatively, students or athletes may constantly push through pain and experience burnout.
Operant activity pacing:
This approach involves strategically and systematically alternating between effort and rest. In the quota-contingency model, periods of effort and rest are determined based on time or task completion. In another model, they are based on symptoms, but that can lead to the same negative consequences as energy conservation.
Pros: This approach avoids possibilities of either avoidance or overdoing it. This approach also aligns with the fact that pain and symptoms don’t always proportionally reflect tissue damage, Instead, this approach focuses on aspects of functioning important to a particular individual, helping people achieve more than they often think they can. It can be tailored based on an individual’s baseline and priority activities.
Cons: There can be mental barriers to implementing operant activity pacing. It can be tricky to know which and how much of activities to prioritize, and what to do for rest (and how long!). Individuals who are prone to self-criticism, such as focusing on productivity or perceived “laziness,” may talk themselves out of their commitment to pause activities and rest briefly. Individuals with executive function difficulties may struggle with managing time and not getting too distracted. Support from an individual’s family, school, or work may be essential.
Which activity pacing model is right for you?
It may depend on many factors, such as what strategies have or haven’t worked for you in the past, your personal tendencies and beliefs, and constraints of your responsibilities or support system. Finding the right approach can take some experimentation and discernment. If you’re ready to explore finding the balance between activity and symptom management that’s right for you, click the get started at the top right of your screen.