Pacing

It is important to develop a personal plan to manage your energy.

• Each person has a different relationship between activity and symptoms.
• Some people are too inactive ("sedentary"), while others have extreme ups and downs in activity. Both can lead to more pain, fatigue, or low mood.
• Understand how activity affects you: Pay attention to how your body reacts to different types and patterns of activity.
• Once you know what helps or hurts, you can make better choices.

Managing your energy throughout the day

We often think about our plans first thing in the morning—what we have to do and what we'd like to do. Here's how to manage your energy throughout the day:

• List your daily activities. Things you must do, like appointments, work, or basic needs, and things you want to do, like reading, calling a friend, or exercising.
• Think about your energy levels. When do you usually feel more tired? When is your pain worse? These ups and downs are normal, and planning around them can help.
• Avoid "ups and downs." Too much activity at once can cause pain flare-ups. Not enough activity can lead to stiffness, low energy, or low mood.
• Balance your energy. For each activity, ask yourself, does this take energy or give energy? And try to mix energy-using activities (like chores or errands) with energy-restoring activities (like reading a book, talking on the phone with a friend, stretching, or relaxing).
• Use pacing. Spread out tiring activities across your day and avoid pushing through until you crash. Try to plan breaks and rest ahead of time.

You may already be aware of times during the day when you feel more energized, and other times when you feel more tired or when your pain is worse.

• It is normal to experience some ups-and-downs in energy, pain, and mood throughout the day.
• Managing your activity and energy by planning your day can help you avoid extreme peaks in your symptoms and help you to keep engaged in your activities throughout the whole day.
• One strategy for avoiding peaks in your symptoms is to pace activities that tire you out or increase your pain.
• This strategy, which is covered in the next section, can be used as part of your daily plan for managing energy.

As you plan your day, think about how each activity uses your energy – whether it is something you have to do or something you want to do.

• You might expect some things to be especially tiring and other things to be less tiring.
• You can also think about how some activities give you more energy.
• It is important to include things that renew your energy throughout the day.
• This will help you to accomplish the things you would like to do during the day.
• Balancing activities that take energy with activities that give energy will also help you to avoid peaks in your symptoms.

Renew your energy

Here are some activities to renew your energy throughout the day.

• Resting: It means sitting quietly, lying down for a short time, or even taking a quick "power nap." Short, planned rests help restore your energy and prepare your body for bigger tasks.

  • Rest before becoming fatigued.

  • Take short but frequent rests.

  • Resting can include relaxation techniques or taking a short walk.

  • Experiment with the duration, timing, and frequency of your rests.

• Meditating or practicing other mindfulness techniques, visit the Relaxation module to learn more.

• Physical activity that falls within your energy envelope (a brief walk, gentle stretching, Yoga). Visit the Walking program and Exercise module to learn more.

• Proper nutrition and hydration. Visit the Nutrition module to learn more.

• Sleep well. Visit the Sleep module to learn more.

To do what you need and want to each day:

• Decide what is really important to you and which things do not matter to you.
• Things that are not important, you can either put off to a later time or drop by altogether.
• Use a to-do list to prioritize activities. Write down tasks and mark the top 1–2 that must get done.

Delegating tasks is an effective way to prioritize.

• Figure out which things you could ask someone else to help with or take over for you.
• Sometimes people with chronic pancreatitis feel like they need to do activities to please others. Prioritizing activities may involve communicating with friends, family members, or others and being able to say no to them.

Many people would say that they are too busy and too tired, but you are different.

• Simplifying your life becomes even more important when you live with chronic pancreatitis because you may tire more easily and need to manage your energy.
• It can be harder to "push through" the fatigue to get things done as you used to do before.

Here are some tips to simplify your life, so that you make the most out of the energy that you do have:

• Use adaptative equipment to make activities easier
• Use a slow cooker or air fryer for easier, low-effort meals.
• Use a shower chair and place toiletries within easy reach.

See if you can find ways of doing things that eliminate tasks that drain your energy. For example:

• Remove the clothes from the dryer right away so that you don't have to iron (or buy wrinkle-resistant clothes!).
• Let your dishes drip-dry.
• Eat a frozen meal from time to time or get take-out.
• Consider doing most of your shopping online and having it delivered to your home.

• Have you ever felt good one day, did too much, and then "paid for it" later?

• This is common for people living with pain. It's easy to fall into a cycle where you push yourself too hard, feel worse afterward, and then struggle to keep up with your daily tasks.

• Doing too much can lead to a flare-up. A flare-up is a short-term increase in symptoms like pain, fatigue, weakness, brain fog, trouble sleeping, or feeling emotionally drained.

• Many people with pain find it easy to fall into this cycle because tasks that used to be quick and easy, such as household chores, may now take longer to complete. This makes it hard to accomplish everything you need to do each day.

• As a result, you may feel like you need to catch up when you're feeling better.

• When you get caught up in this cycle, you may:

  • Feel well and do too much.

  • Have a flare-up.

  • Fall behind in tasks or miss out on things you enjoy while you rest and recover.

  • Repeat the cycle when you feel well again.

• Learning how to pace yourself can help you break this cycle by teaching you how to alternate between periods of activity and rest so you can do more with less risk of flare-ups.

• Pacing may help you:

  • Continue to take part in many of the activities you enjoy doing.

  • Increase your productivity in the long run, rather than reducing it.

  • Avoid extremes in pain, fatigue, tension, stress, or anxious or depressed mood.

  • Maintain a more stable level of activity.

  • Experience fewer and shorter symptom "flare-ups".

The following videos will teach you more about pacing and how to use it to deal with pain:

Finishing a big task first and then resting is often thought of as a natural way to get things done. For example, you might need to wash dishes.

• You might try to clean the whole kitchen first and then take a break.
• You may risk having a flare-up when you do more than your body can handle at one time without resting.
• Instead, pacing yourself may help you get more done and reduce your risk for having flare-ups. Here are two strategies to help pace yourself:

Time-based pacing.

This method uses a schedule where you alternate between activity and rest, no matter how you feel. It follows three simple steps:

1. Do the task for a set amount of time, even if you have symptoms.
2. Stop and rest for a set time, even if you are not tired or haven't finished the task.
3. Repeat steps 1 and 2 until the task is done.

For example, you might wash the dishes for 10 minutes, then take a 5 minutes break, even if you are not tired or done. After resting, go back to the task.

As you continue to use time-based pacing, you can adjust how long you work and rest based on how you feel. The goal is to rest before a flare-up, not because of one.

Goal-based pacing.

• Identify an activity that you want to do or a goal that you want to achieve.
• Break the activity up into reasonable steps.
• Once you complete each step in the task, regardless of how long it takes, take a break to rest.
• After the break, begin the next step toward achieving the goal.

For both types of pacing.

• Keeping a diary can help you track your current activity pattern and will give you a sense of what is realistic for you. This can give you a sense of where to start.
• You may also get feedback from a trusted friend, family member, or health care provider about what may be realistic for you to do.
• Then, little by little, build up your ability to do more between rest breaks.

Time-based pacing allows you to be active for a set amount of time, which could be minutes or hours, depending on your personal needs. Certain tasks may take more effort and take longer to do than others. Only you can determine which is the best pace for each task you do.

To create a personal pacing plan, try following the following 6 steps discussed below:

STEP 1: CHOOSE A TASK

• You can use time-based pacing for almost any activity, household chores, yard work, personal care, shopping, or fun activities.
• Start by picking one simple task, like vacuuming one room. Later, you can try something more challenging, like cleaning the whole house.

STEP 2: FIND YOUR PACING RHYTHM

• First, estimate how long you can do the task safely before risking a flare-up.

• Second, figure out how long your body needs to rest afterward.

• During rest, you're not recovering from a flare-up—you're giving your body a break from healthy activity.

• Your rhythm will depend on the task and how much you are able to do right now.

• It might take a few tries to find your right rhythm, so don't get discouraged.

• Keep these ideas in mind:

  • Pick simple goals you can do on both good and bad days.

  • Break activities into small parts and spread them throughout the day.

  • Talk with your healthcare provider or use the Pacing Yourself Worksheet to set realistic goals.

STEP 3: SHARE YOUR PLAN

Talk about your pacing plan with your healthcare provider. This helps them understand your symptoms and how they can support you. They may offer helpful tips or changes to improve your plan. For ideas on how to talk with your provider, see the Communication Skills module.

STEP 4: TRY YOUR PLAN

Use your pacing plan for 3 to 4 days to see how it works. For example:

• Go shopping for 15 minutes, then rest. Repeat the cycle until you finish. Rest in a chair near the pharmacy, the furniture section, a dressing room, or at the front of the store.
• Work on the computer for 20 minutes, then rest.
• Use rest time to walk, stretch, or try a relaxation exercise from the Relaxation module.

Stop and rest even if you don't feel tired or aren't finished. That's part of the plan! Always check in with your healthcare provider to make sure your pacing plan is safe for you.

STEP 5: REVIEW AND ADJUST YOUR PLAN

• After 3 to 4 days, check how you're feeling.

• If you can do the task and still feel okay that day and the next, you can try to slowly increase your activity. To review your plan:

  • Add a little more time to your task and slightly reduce rest time.

  • Try this new plan for another 3 to 4 days.

• Use the Pacing Yourself Worksheet to track how you're doing.

• If you feel worse or have a flare-up, don't give up!

• Flare-ups can happen.

• Instead of stopping, lower the intensity but keep the same time.

• For example, if you have been walking at a moderately fast pace for 15 minutes, slow down and walk at a slower pace for 15 minutes.

• Then very slowly work back to your first goal so your body has time to adjust.

STEP 6: KEEP PRACTICING AND ADJUSTING

• Keep testing and improving your pacing plan until it works for you.
• At first, try just two tasks a day.
• With patience and practice, pacing can help you avoid overdoing it and help you do more of what matters to you.

Many people tend to overdo it and exceed their limitations during certain danger times. Here are some common examples of danger times:

1. Days when you feel good. Good days occur when you are feeling good and your pain is less severe. Be careful that you don't turn a good day into a bad day by becoming careless and overdoing physical activities.
2. When doing some physical activity that you enjoy. Fun physical activities can help distract you from pain. But they can also make you forget to take breaks. Don't get so caught up in the fun that you forget to pace.
3. When competing with other people. Competition is a great motivator, but it can also get you into trouble. Don't let competition trick you into exceeding your physical limitations.
4. When trying to please other people. It is nice to please others, but don't let this trick you into exceeding your physical limitations. Stay within your limits.
5. When feeling rushed, pressured, or emotionally upset. These are times when you can become careless and forget to use good judgment while doing physical activities.

You can help the person you care for manage their energy

The person you care about may not be able to do as much as he or she used to do because of their pain. That is why it is so important for him or her to break large tasks into small steps and rest in between steps. This may have an impact on you as well. It may mean that the things you do together may also take more time to do.

To help someone who is living with pain get used to this new way of doing things:

• Stay positive and encourage the person to follow his or her pacing plans.
• Try not to finish a task for him or her while he or she is resting, unless asked.
• Ask if he or she needs help figuring out pacing plans.
• Acknowledge what the person is able to do.
• Suggest that the person speak with a healthcare provider if the person has asked you a health question you cannot answer.

It is also important that you allow and encourage the person you care about to continue to do the things that they are able to do. Do not be too quick to step in and do things for them when they can take care of it themselves. Completing certain tasks on their own may help boost self-esteem and improve mood. You may want to practice pacing and/or use the energy management tips yourself.