Post-exertional malaise
Post-exertional malaise (PEM) is an exacerbation of symptoms due to over-exertion. This is experienced on a spectrum, with some Long Haulers experiencing profound exacerbation of symptoms after even the most modest of activity like taking a shower or climbing the stairs, where others it might be from going on a long walk or doing the shopping.
Pacing
Pacing is one of the most important skills in your Long Covid Survival guide. Pacing can help you avoid crashes and even out the up and down nature of Long Covid. Pacing also applies to physical, emotional and mental exertion. Over-exerting in any 3 of these areas can increase fatigue
Doing less:
It can be tempting to push ourselves when we feel we have energy, or try to push through when we’re feeling bad. But the result is often a crash that can last from days to weeks depending on just how much we have over-exerted ourselves.
Finding the maximum amount of activity that we can do without causing a crash, let’s call this our activity threshold, and keeping below this, can help us understand what we can achieve in a day without negatively affecting our quality of life. You can try to find you threshold by keeping track of your activity each day, making a list of what you plan to do in the morning and then ticking off each activity can help you keep tabs on how much energy you’re using. You can also print off and use this work sheet to help with pacing: https://world.physio/sites/default/files/2021-06/WPTD2021-ActivityTracker-Final-v1.pdf?fbclid=IwAR3Kghinr68mVVNvqz5X1dvdbr4yUCHMQVGaThyyalryAs9VoGwywmZt99w
Breaking it up:
Try breaking up a task into more manageable chunks. Whether this doing the dishes or answering emails. Try working in shorter time blocks and taking breaks in between.
Working more slowly:
Finding a way to perform a task more slowly can reduce the amount of effort needed. Whether that’s showering or walking the dog. Can you move slower and be mindful of how the activity is affecting your body.
Spoon theory
Spoon theory uses spoons as a visual representation of how much energy someone has throughout their day. We start each day with a limited number of spoons. People with Long Covid will have limited spoons. Each activity undertaken during the day will cost a certain amount of spoons, the greater the effort required, the more spoons utilised. Once all the spoons are used up for that day, that’s its, all energy is used up.
Example - Let’s say Gill has 10 spoons of energy for today. Gill will not wake every day with 10 spoons. Gill may have had poor sleep (-1 spoon) or woken in pain (-1 spoon). Gill may have slept badly the night before so may 30 have only started the day with 8 spoons.
High-tech:
Every smartphone now tracks steps. You can use your steps as a way to help keep track of how much physical activity you’re performing in a day.
Wearables: These can be useful tools in pacing. Apple watch, Android, Whoop etc will all allow you to monitor the same metrics. If you have one, you can use it to monitor your sleep and steps which are a great start to understand rest and pacing.
Apps:
Visible is an app that allows you to keep tabs on your symptoms but also understand your Heart Rate Variability, which can be a good metric to allow you to understand how fatigued your body is.
Further reading: