What is Pacing Activity?
Terry Stewart
Pacing is a self-management strategy used in pain management to balance activity and rest, helping individuals to maintain a steady level of physical activity without causing significant flare-ups of pain. It involves breaking tasks into smaller, manageable parts, taking regular breaks, and gradually increasing activity levels in a graded and controlled manner. This approach promotes confidence during movement and minimises increased sensitivity in the nervous system and protect by pain responses by the brain (Jamieson-Lega et al, 2013) (Antcliff et al, 2021).
Why is Pacing Important in Chronic Pain?
1. Prevents Flare-Ups – Many individuals living with chronic pain often perform a “boom-and-bust” cycle of activity, where they engage in excessive activity on good days, leading to flare-ups and increased pain that requires prolonged rest to recover. Implementing effective pacing can help prevent these negative cycles and mitigate the brain’s protect by pain responses.
2. Improves Function & Endurance – By dividing activity into achievable chunks throughout the day, individuals can gradually build tolerance and maintain a more consistent level of function. This approach assists achieving success rather than failure during movement tasks.
3. Reduces Fear-Avoidance Behaviour – In chronic pain states, individuals often avoid movement due to fear that it will worsen their pain or the belief that pain always indicates injury. It’s critical to recognise that fear avoidance is a psychological issue; therefore, management plans should include interventions to challenge irrational beliefs and foster positive cognitive attitudes.
4. Enhances Quality of Life – Maintaining a balanced approach to activity enables individuals to remain engaged in work, interact socially, and participate in hobbies without being controlled by pain. Accepting that life has changed and adopting a new approach is essential for successfully applying pacing and avoiding “boom-bust” cycles.
5. Supports Energy Conservation – Individuals living with chronic pain often experience fatigue, which is influenced by many factors. Pacing can help manage energy levels by preventing over-exertion and reducing the load on the body’s systems, allowing for a more balanced and sustainable approach to daily activities.
6. Encourages Self-Efficacy – Learning to control activity levels rather than being controlled by pain empowers individuals to take charge of their lives. Success through effective self-management of activity and pain creates positive progressive change and less reliance of passive approaches to recovery.
Practical Strategies for Implementing Pacing in Chronic Pain Management?
Pacing involves balancing activity and rest to maintain a steady level of function without aggravating pain. Here are some key strategies and examples to help implement pacing effectively:
1. Set a Baseline for Activity
- Determine a manageable amount of activity that can be done without increasing pain.
- This should be a level where you can complete the task comfortably and repeatedly without triggering a flare-up.
Example: If walking for 20 minutes worsens your pain, start with 10-minute walks and gradually increase over time.
2. Use the 50% Rule
- If you’re unsure how much activity is “safe,” start with half of what you think you can do comfortably.
- Slowly increase by 10% each week if tolerated.
Example: If you think you can stand for 30 minutes, start with 15 minutes and gradually increase as tolerated.
3. Take Regular Breaks (time-based vs. symptom-based)
- Time-Based Pacing: Schedule breaks before the pain increases (proactive).
- Symptom-Based Pacing: Limit the activity once you notice an increase in symptoms (reactive).
Example: Instead of waiting until your pain spikes while cleaning, take a 5-minute break every 10 minutes.
4. Use the Traffic Light System
Green (Safe Zone) – Low-level activity with no increase in pain. Continue as planned.
Yellow (Caution Zone) – Mild increase in pain. Reduce intensity or take a short break.
Red (Stop Zone) – Significant pain increase. Stop, rest, and reassess before continuing.
5. Prioritise & Plan Activities (activity scheduling)
- Spread tasks throughout the day instead of completing everything at once.
- Alternate high- and low-energy activities to avoid overexertion.
Example: If grocery shopping is exhausting, schedule it on a different day than cleaning or exercising.
6. Break Tasks Into Smaller Steps
- Large tasks can be overwhelming and lead to overexertion.
- Divide them into smaller steps with built-in rest periods.
Example: Instead of vacuuming the whole house in one go, clean one room at a time with rest breaks in between.
7. Gradually Increase Activity (graded exposure)
- Slowly increase activity levels over time to improve endurance.
- Keep increases small and consistent to prevent setbacks.
Example: If sitting for 30 minutes increases pain, start with 15 minutes and increase by 1-2 minutes weekly.
8. Listen to Your Body, Not Just Your Pain
- Pain doesn’t always mean tissue damage; learn to differentiate between hurt and harm.
- Staying consistent with gentler/safer movement can help improve long-term function.
Example: Mild discomfort during movement is okay, but if pain lasts hours after an activity, you may need to reduce intensity or duration.
9. Use Assistive Tools & Ergonomics
- Tools like ergonomic chairs, walking aids, or voice-to-text software can help reduce strain.
Example: Use a stool while cooking instead of standing for long periods.
10. Track Your Progress & Adjust as Needed
- Keep a pacing diary to monitor activity levels, symptoms, and improvements.
- Adjust based on your findings.
Example: Record how long you walk, sit, or stand before pain increases and gradually extend the time.
Final Thoughts
Pacing is a long-term strategy, not an instant fix. It helps create a sustainable balance between activity and rest, reducing pain flare-ups while improving function.
Seek the advice of an Accredited Exercise Physiologist to create and monitor a structured, paced and graded movement plan.
(Jamieson-Lega et al, 2013) (Antcliff et al, 2021).
- Jamieson-Lega, K., Berry, R., Brown, C.A. 2013. Pacing: A concept analysis of a chronic pain intervention. Pain Res Manag Vol 18 No4 July August 2013.
Antcliff, D., Keenan, A., Keeley, P., Woby, S., McGowan, L. Testing a newly developed activity pacing framework for chronic pain/fatigue: a feasibility study. BMJ Open, Vol 11, 2021.
