Energy Pacing for Fibromyalgia Fatigue Management

For people with fibromyalgia and other conditions that cause extreme fatigue, it’s frustrating to feel like you don’t have the same energy levels that you used to. The simplest things can wear you out so quickly — raise your hand if you ever felt like you needed to nap after taking a shower. Yet, you still have a need to get errands done, complete your work, and participate in your family and social life.

Pacing your energy and activity level is one way of addressing fatigue from chronic illness. Although “energy pacing” or “activity pacing” doesn’t work for everyone, it may help you to better manage and cope with extreme tiredness.

“I haven’t got the stamina I used to have, but being taught how to pace myself was a gamechanger for me,” Sophie R. told us on Facebook.

Read on to find out more about how to incorporate energy pacing into your daily life (in conjunction with other physical, medical, and psychological therapies).

What Is Energy Pacing?

“Energy pacing is a fatigue management technique to help conserve energy for those with fibromyalgia or chronic fatigue issues — basically, it’s allowing a short time of physical activity with a rest period, so you don’t overexert yourself,” says Irvin Sulapas, MD, an assistant professor of sports medicine at Baylor College of Medicine in Houston, who has worked with patients on these issues.

“People with fibromyalgia or chronic fatigue can expend all their energy quickly, and they are essentially ‘done for the day.’ Pacing helps conserve the energy so tasks can be done [throughout the day],” he adds.

Energy pacing generally works like this: Think of your energy level for the day as a fixed amount. Then for any activity you need to do, you figure out how much energy it will take so you can make sure you don’t exceed the total amount of energy you have in any given day.

“I always let my patients know that human beings have a finite amount of energy,” says Carole Dodge, OTR, an occupational therapist in the University of Michigan Health System and a spokesperson for the American Occupational Therapy Association. “I help them develop strategies to accomplish what is needed to be done in their lives in a manner that is less physically stressful, so that they have energy left to enjoy things they want to do.”

Energy pacing also involves psychological techniques for reframing your thinking about perceived limitations. Remember that even athletes have to pace themselves.

“Think about a long-distance marathon runner who must figure out how to spread out her energy in order to stay in the race,” says Shilagh A. Mirgain, PhD, a psychologist in the department of Orthopedics and Rehabilitation at the University of Wisconsin Research Park Clinic. “The runner listens to body signals — breathing, posture, speed, tension, fatigue — mental attitude or thoughts, and makes appropriate changes.”

Does Energy Pacing Work? What Studies Say

“The research is mixed — there are papers out there that say that activity or energy pacing is helpful for patients with fibromyalgia or chronic fatigue. Others show that it may help, but that other modalities such as cognitive behavior therapy and graded exercise therapy [exercise that starts very slowly] can be helpful as well,” Dr. Sulapas says.

Energy pacing may also help for symptoms such as pain rather than fatigue. “I tried pacing for fatigue management over six months and it didn’t work,” Katharine T. says. “For pain levels I find it more helpful.”

But with your doctor’s OK, it generally can’t hurt to try. “Energy pacing is one of the most well-received techniques to help with chronic fatigue,” Dr. Sulapas says. “It’s a safe technique to help conserve energy during the day and not wear oneself out.”

How to Use Energy Pacing for Fatigue Management in Your Daily Life

Activity pacing sounds good in theory, but how do you put it into practice? An occupational therapist and/or a pain management psychologist can help you tailor your activity pacing based on your individual needs. “I always listen to patients and ask them where they find the greatest challenges,” Dodge says. “Then we break down the tasks one by one together to develop solutions to try out.” Dodge has patients work on one or two things between visits so as to not overwhelm with too much to do at once.

Here are some specific fatigue management techniques you can try:

Plan ahead

“Plan your day and what needs to be done before it starts,” Dodge says. “Plan more difficult tasks at the time of day you have the most energy.”

“I do have to plan out my day/week,” Lindsey S. told us on Facebook. “If it’s cleaning day that’s all I’m doing, and it takes all day with rest in between. Laundry day is all I do that day.”

Prioritize tasks

“I usually recommend prioritizing what you need to get done in a day, whether it’s laundry, yard work, grocery shopping, or computer work, and do that first,” Dr. Sulapas says. “Knowing oneself is important too — if you know how much physical and mental exertion a certain task will need, you can prioritize what needs to be done first.”

Work smarter

Energy pacing is not necessarily about doing less, but about restructuring your workload, being more efficient, and breaking tasks into more manageable pieces. “We work on strategies that assist in accomplishing daily tasks in a more efficient manner, by combining or eliminating steps, doing activities at a slower pace, and/or spreading the activity over several days,” Dodge says. “Working at a slow, steady pace is more effective than overworking.”

Deb G. explained how to do this on Facebook: “I pace myself by doing one ‘major’ a day. That would be: kitchen one day, vacuum another, bathroom another. So goes my life, or I would be destroyed!” Here’s more advice on how to manage chores with chronic illness.

Reduce unnecessary energy use

Don’t waste your energy on things you don’t really need to be doing at that moment. “The goal is to minimize your energy output if it is not important or not a priority, and use your energy appropriately if it is something you need to do or really want to do,” says Dr. Mirgain.

Schedule breaks

If you take time out throughout the day, you may actually be able to get more done. “For those with chronic fatigue, expending a lot of energy on one task without rest gets them tired for the rest of the day,” Dr. Sulapas says. “It’s important to schedule breaks to get tasks done.” Think of breaks not as a weakness, but as a smart way to build up stamina, Dr. Mirgain says.

Don’t push yourself

“Frequently, people with chronic pain choose to be very active and try to ‘battle through the pain.’ Although this approach feels like it is helping you to become more effective, it is actually counterproductive,” Dr. Mirgain says. “People often push themselves too hard, end up in more pain, and are laid low for several hours or days following overexertion. This is often referred to as the roller coaster pattern, which can contribute to increased pain over time.”


If you share with others what you’re going through, they’ll be more understanding and may offer to help. “Learn to delegate and get rid of the unnecessary clutter in your life — simplify!” Dodge says. You don’t have to suffer in silence, even if it may be hard for people to understand what you’re going through. “My husband is a major help on managing chores and doing all the heavy work,” Robin K. told us on Facebook.

Although kids can be a major energy-suck, get them involved more so you’re not doing everything for them, especially if they’re older. “I have two teenagers who clean their own rooms,” Lindsey says on FB. Even a 6-year-old can help with cleaning up toys, setting and clearing the table, and loading the dishwasher.

Consider mental energy

“Mental and emotional energy needs to be paced as well,” Dr. Mirgain says. If you are employed, it can seem like you’re not doing anything while sitting at a computer — but the mental stress of work can take its toll on your energy level. “I know if I work [at my job] I am not doing anything afterward,” Lindsey told us on Facebook. “When I work the day is a wash!”

The same fatigue management techniques apply to a workday: Take breaks, pace yourself, and don’t overdo it. You may want to talk to your human resources representative about any accommodations you may need.

Listen to your body

Lindsey also told us, “the number-one thing that I have learned is if your body is telling you that you need to rest or nap, it’s best to listen because if you push too much you pay for it for days afterward.”

Nana C. gave similar advice on FB: “Get to know your body and do not ignore the signals of impending deep fatigue coming on, regardless of the causes.”

Keep your routine consistent

Interestingly, Dr. Mirgain says energy pacing should not be based on how you’re feeling on any given day; rather, you should try to keep your routines consistent from day to day in order to develop a steady and predictable level of activity.

“Pacing is meant to give you more control over your day-to-day activities, such that how much you do should not vary dramatically according to your pain or energy that day,” she says. “This strategy allows you to do the same on good and bad days, while also leading to improved tolerance and achievements. It also helps you avoid the long periods of inactivity that can be so much more difficult to recover from.”

Keep practicing and tinkering

For tasks on which you are having difficulty pacing, Dr. Mirgain advises to think about how long you can do the activity without fatigue (your “active time”) and how long you will need to rest before becoming active again (your “rest time”). With those set time limits, practice! Once you’ve mastered a task, you can consider slowly increasing the activity time and decreasing rest time.

Let go of negative energy

Don’t worry about what you “should” be doing. Work on not letting worry or negative thoughts steal your energy. “Love yourself enough to pay attention and not make excuses later for how you feel,” Nana says.

Dr. Mirgain offers psychological strategies for dealing with tasks you’re having a hard time pacing: “Reflect on what is it that makes pacing difficult, such as social pressure, guilt, you don’t know another way to do it, anger, anxiety,” she says. Then, you can address how to change your attitude toward it.

Does Energy Pacing Mean Limiting Exercise?

Activity pacing does not mean not getting exercise — instead, it means conserving energy in between bouts of activity. “Studies have shown that doing exercise, either aerobic or resistance-based exercise, does improve energy levels,” Dr. Sulapas says. “It also helps establish a baseline of endurance, so doing daily tasks can be easier.”

Rest is important, but you need physical activity throughout your day. “If a person lives a sedentary lifestyle and has chronic fatigue, they are usually just running on half a tank of energy. Gentle exercise can help decrease fatigue,” Dr. Sulapas says. Dodge says exercise can help “reset” your body so all systems function optimally.

In addition, not being active can lead to psychological fear of activity, resulting in a vicious cycle, Dr. Mirgain says.

Instead, strive for balance: “Think of it as a middle ground between doing nothing and overexerting yourself,” she says. “Pacing involves spending just enough time and energy in an activity to be productive, without pushing yourself so hard that you end up in more pain and able to do less afterward.”

Talk to your doctor or therapist about what exercises are right for you.

Other Fatigue Management Remedies to Try

Activity pacing is actually part of cognitive behavioral therapy (CBT), which is a way of changing patterns of how you think and act, Dr. Mirgain says. Because the physical and the mental are so closely tied, a pain management psychologist may help you use additional CBT strategies to manage your fatigue.

With your doctor’s OK, try physical activity that has a mind/body component. “Doing yoga for a year has improved my stamina and pain,” Robin told us on Facebook. Meditation, deep breathing exercises, stress management, and progressive muscle relaxation may also help.

Getting good sleep is also important in maintaining your energy levels. This is another reason exercise is important, because it helps you sleep better, Dodge says. “Daily physical activity leads to improved sleep, which is key to better health,” she says.

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Keep Reading

Andrews NE, et al. Activity pacing, avoidance, endurance, and associations with patient functioning in chronic pain: a systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation. November 2012. doi: 10.1016/j.apmr.2012.05.029.

Antcliff D, et al. Activity Pacing is Associated With Better and Worse Symptoms for Patients With Long-term Conditions. The Clinical Journal of Pain. March 2017. doi: 10.1097/AJP.0000000000000401.

Antcliff D, et al. Exploring patients’ opinions of activity pacing and a new activity pacing questionnaire for chronic pain and/or fatigue: a qualitative study. Physiotherapy. September 2016. doi: 10.1016/

Fibromyalgia. American College of Rheumatology.

Fibromyalgia. Mayo Clinic. Published August 11, 2017.

Fibromyalgia Management and Treatment. Cleveland Clinic.

Fibromyalgia pain: options for coping. Mayo Clinic. Published November 11, 2017.

Hadzic R, et al. The Relationship Between Pacing and Avoidance in Chronic Pain: A Systematic Review and Meta-Analysis. The Journal of Pain. October 2017. doi: 10.1016/j.jpain.2017.04.008.

Interview with Carole Dodge, OT, University of Michigan and spokesperson for the American Occupational Therapy Association

Interview with Irvin Sulapas, MD, Baylor College of Medicine

Interview with Shilagh A. Mirgain, PhD, University of Wisconsin-Madison School of Medicine and Public Health

Karsdorp PA, et al. Active avoidance but not activity pacing is associated with disability in fibromyalgia. Pain. December 2009. doi: 10.1016/j.pain.2009.07.019.

Racine M, et al. Operant Learning Versus Energy Conservation Activity Pacing Treatments in a Sample of Patients With Fibromyalgia Syndrome: A Pilot Randomized Controlled Trial. The Journal of Pain. April 2019. doi: 10.1016/j.jpain.2018.09.013.

Treatment for Fibromyalgia. Stanford Health Care (SHC) – Stanford Medical Center.

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