Author Archives: Jackie Aim

Practical tips for pacing yourself

Hand writing on a notebook

  • Plan your day. Use diaries / timetables to balance activities with quieter times / rest to manage your symptoms.
  • Listen to your body. Watch out for, and use, warning signs to set limits (for more information please see our section on What makes you breathless). Don’t keep going with something “just to get it finished” if your body is telling you to stop.
  • Remember symptoms can vary day-to-day. Take this into account when planning your day.
  • Think about the true cost of activities. Is one task worth more to you than another?
  • Break each activity down into manageable chunks (Occupational Therapists are trained in analysing the detail of activities and can support you with this if necessary).
  • Alternate activities throughout the day.
  • Use energy saving devices. Sit down to do the ironing. Use your microwave oven to cook small portions rather than lifting and bending to get dishes out of your cooker oven.
  • Relaxation – include the things you enjoy, the ‘nice stuff’!
  • Watch out for times you feel pressured to do too much. Set limits and say “No”.
  • Let people around you know what you are doing. They can provide support and encouragement.
  • Think about your goals and make plans. “People who fail to plan, plan to fail”. For more information please see our section on Self management and how can it help you?.

The strategies of pacing


View text alternative

pacing strategies

The ‘P’s’ of Pacing =

  • Planning – Think ahead. For example, when shopping order it online, or only carry the number of items you can comfortably manage without becoming too exhausted
  • Prioritising – What do you need to be able to do? For example, is it more important that you hang the washing out or prepare your evening meal. What’s the most important thing for you at that time?
  • Positioning – What is the best way for you to manage these tasks physically? For example, are there ways for you to complete the task without you having to stand e.g sitting down to do the ironing.
  • Problem Solving – What can you do when you have a setback? For example, looking for alternative ways to do something e.g. if mornings are particularly bad for you, you may want to postpone doing tasks until your inhalers have taken effect.
  • Practice – The more you are familiar with a task, the easier it becomes. For example, practising your relaxation will allow you to control your breathing making everyday tasks easier.
  • Perseverance – Don’t be hard on yourself. It will need more than a few attempts. For example, if you’re finding it difficult to stick to a healthier diet or give up smoking.
  • Patience – Give yourself time to get pacing right. For example, pacing is a skill you need to learn, it doesn’t come naturally to everybody, there are people who can help you with this, and you can also try some of the tips on this website.

Pacing

An elderly woman in the kitchen of her home. Preparing a meal, stirring the contents of a pot on the stove.

© Crown copyright 2009

Pacing should avoid the high peaks and low troughs and even out your energy level for the day. Notice how you can complete more tasks than before over a longer time. You should still be able to gradually build up exercise and activity into your day using pacing.

  • Use of pacing helps you manage the symptoms you experience related to having COPD, and other long term health conditions.
  • Pacing is an important way to manage both your physical and emotional well being, and overall sense of control over your symptoms.
  • It is important to consider the activities you undertake in a day, how they impact on your symptoms, and think about pacing.
  • The essence of Pacing is about ‘listening to your body’. Slow down if necessary or take short breaks if needed to stay in control and manage breathlessness or any other of your symptoms on a day-to-day basis.
  • Remember a certain level of breathlessness is good for you. For more information on this please see our section on: Pulmonary Rehabilitation.

Here are a couple of practical examples of pacing


Pacing is maybe linked to time. How long can you spend out of the house?

  • One hour then come home so you still have energy for the rest of the day.
  • Stay out for four hours and you maybe exhausted for the rest of the day.
  • ……and the following day you wonder why you still feel exhausted.


“I love  to dance and now I  get too breathless.”

  • Pick a slower dance and join in half way through the dance so you can make it to the end.
  • Sometimes you have to accept doing smaller chunks of things.

The cycle of boom and bust

View text alternative

  • Life demands – this can be any normal but demanding task from getting up in the morning to looking after your children or grandchildren
  • Risk of doing too much – There may be tasks which you enjoy but which can make you tired before you realise you have overdone things
  • Trigger symptoms – You start to notice the tell tale signs that your breathing is getting more difficult, your fatigue is getting worse, pain is increasing and you are worrying that you won’t have enough energy left for anything else
  • Rest to recover – You have to rest to get back to a steady breathing pattern , wait for pain to be controlled or until your fatigue has improved again when life demands come round again. Recognising when to rest is an essential skill.
  • Loss of fitness – The less you do, the less you are able to do physically. The more you worry about this, the more apprehensive and scared you are of attempting the same task again
  • At risk of unhelpful actions – Negative thoughts, feelings and consequences feel overwhelming and you are even less likely to attempt the task in future. You convince yourself that you will never be able to do this when life demands come round again

Peak and trough / Over activity and underactivity

day_peaks_graph_LRG
You can see that sometimes you are feeling well and can do a lot of tasks. Represented by the upward lines to each peak (over activity).

If you have done too much too soon you can run out of energy and the effort makes you tired and fatigued. This is represented by the downward lines to the trough (under activity).

For example peak 1 is getting dressed in the morning. You rush to get ready to go out and energy drops in to the trough so you are forced to rest.

Peak 2 Is your morning walk. After a rest you feel better but you are behind schedule so you walk a little faster. You still feel fine until you start to get past your peak and energy drops in to the trough again, needing another rest. Your energy level does not get back to where it was earlier. You are gradually getting more fatigued.

Peak 3 Making lunch. By now you are feeling tired but need to keep going. You think if you do lunch quickly you can rest after. By the time you start to hit the next trough you feel too bad to enjoy the lunch you spent so much effort making.

This peak and trough goes on for the rest of the day until by peak and trough 6 you are finding  short tasks are difficult when you have less energy left.

By learning to pace yourself you can reduce these peaks and troughs and use your energy in the best way. The is represented by straight arrowed line.

People like you living with COPD can experience these peaks and troughs at different times. For example you may feel low in the mornings until you have had your first medications and inhalers then feel better and stronger as the day goes on. Some people describe their own COPD as a roller coaster, especially after an exacerbation. This is when pacing can really help.

For more information on managing fatigue see page 36 :

Moving on Together (MoT): A self-management workbook by NHS Ayrshire & Arran.

Peak and trough

Graph showing wavy line with peaks and troughs, x-axis is labellled time, the y-axis is labelled activity

  • Peak: feeling good and being able to do tasks. If you do not pace yourself or if you do too much this peak feeling will not last and you will start to feel tired and head down to the trough. Pacing helps you to maintain your peak for longer.
  • Trough: the effect of doing too much and afterwards becoming tired or not feeling well. If this pattern continues or repeats you may start to feel unable to attempt tasks because you anticipate that you will only be able to cope for a short time. You may start to avoid some tasks.

These terms are often used to describe the behaviour pattern many people living with a long term health condition find themselves caught in as they try to manage and maintain routines.

Still trying to juggle various life demands? You can find yourself trying to keep going as you have always done without taking into account the symptoms you are now living with on a day-to-day basis. Symptoms can vary from one day to the next. The demands of our daily lives do not always fit seamlessly with the peaks and troughs of the condition and compromise and negotiation are essential skills.

Your habits, routines, and ways of doing things can be a struggle to change. This is the challenge of putting pacing into practice.

Remember

Pacing is about bringing in changes that help you stay in control of your physical symptoms and emotional well being.

If we don’t pace what happens?

Words you might use: Words healthcare professionals use:
  • I am exhausted
  • Get really breathless
  • Not worth anything later in the day
  • I panic… Get worried about how breathless I am
  • Fed up and frustrated
  • Annoyed, on edge
  • I stay away from / stop trying to do the thing that makes me breathless
  • Fatigue
  • Increased breathlessness or dyspnoea
  • Variable fatigue
  • Anxiety / panic / stress / worry
  • Impacts on mood, motivation and interests
  • Irritable
  • Disrupts daily plans and routines

Not pacing can lead you to believe your condition is worse than it actually is. Part of pacing is accepting going at a slower pace. Build up gradually while being in control of your breathing and activity level.

For more information on managing fatigue see page 35 :

Moving on Together (MoT): A self-management workbook by NHS Ayrshire & Arran.

Pacing and you

Q. Which of the following statements apply to you? Select yes or no for each one.
1.
I rush to get things done quickly
2.
I push and push myself until I am forced to stop
3.
I do things to please other people
4.
I do certain things in a certain way just because I have always done them that way
Reset
Finish

Pacing… what is it?

Lady shopping for groceries

© Crown Copyright 2009

Pacing yourself is all about managing the balance of all the tasks you need to do and some you want to do without rushing, tiring yourself out or making you feel worse.

  • Pacing is important when you are living with COPD. You may find you have good days and bad days when you are more troubled by your symptoms.
  • Pacing will help you stay more in control of your symptoms. If you feel your symptoms control what you do on a daily basis ,pacing helps you make active choices and decisions based on what your body is telling you that day.
  • Activity if paced correctly will not make your COPD worse.
  • The principles of pacing are practical and really quite straightforward, its often putting pacing into practice that can be the challenge.
  • Pacing is a combination of balance, rest and activity depending on your energy needs.

Review of medication

Close up of a healthcare professional or pharmacist with their face hidden holding an NHS prescription bag.

© Crown copyright 2009

At your annual medical review your doctor may discuss the following;

  • How you are taking your medication.
  • The dose of your medication.
  • Any changes to your medication.
  • If you have had a hospital admission or exacerbation you may be offered “stand by” or “rescue medication” to keep at home and take at the first sign of another exacerbation.
  • Any new symptoms or any symptoms which are getting worse.