Every person experiences a unique relationship between their activity and their symptoms; so every person needs their own plan for how to manage their physical activity.

Therefore, it is important to consider whether being too inactive (‘sedentary’), too active, or having extreme ‘peaks and valleys’ in your activity levels are causing problems for your health. Then, when you have a better understanding of how different types and patterns of physical activity affect how you feel, you can do something about it. Use the Activity Monitoring Worksheet in this module to track how your activities relate to how you feel. This will help you figure out how best to use the strategies that are presented in this module as well as the Being Active and Relaxation modules to manage your energy.

It is often helpful for people to think about managing their energy on a daily basis. This is because we often start our day thinking about what we plan to do that day. We think about things we must do, such as going to appointments, taking care of basic needs for us and our family, or going to work. We might also think about things we would like to do if we have the time and energy, such as reading a book, talking on the phone with a friend, or exercising. In order to do the activities that you must do or would like to do, you may need to think about how to manage your activity and your energy across the day.

You may already know if you have times of the day when you tend to feel more tired or when your pain is worse. It is normal to experience some ups-and-downs in your energy, pain, and emotions 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 – whether it is something you have to do or something you want to do – uses energy. 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.

Things that give energy:

• Resting: Sitting quietly, laying down for a bit, taking a “power nap”.
• Meditating or practicing a relaxation technique (see the Relaxation Module for ideas).
• Exercising (yoga, a brief walk, gentle stretching).

Time–limited resting is an important way to renew your energy. Resting can help your muscles feel stronger and prepare you to take on bigger activities when needed.

Tips for incorporating rest throughout your day:

• Rest before becoming fatigued. You will need less recovery time.
• You will prevent the onset of severe fatigue or pain.
• Take short, but frequent rests.
• Remember that rest can include using a relaxation technique or a brief walk.
• Experiment with duration, timing, and frequency of your rests.

Many people, even those without MS, would say that they are too busy and too tired. Simplifying your life becomes even more important when you have MS because you tire more easily and need to manage your energy.

It can be harder to push through the fatigue to get things done than it was before you had MS. Here are some tips for ‘simplifying’ so that you make the most out of the energy that you do have:

• Set your priorities – figure out what is really important to you and which things are low priority. Things that are not important to you can either be put off to a later time or dropped altogether.
• Delegate tasks – figure out which things you could ask someone else to help with or take over for you.
• Eliminate tasks – see if you can find ways of doing things that eliminate tasks that drain your energy. 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 convenience meal from time to time or get take-out. Consider doing most of your shopping on-line and have it delivered to your home.

You may have experienced a time when you did too much because you felt well and then paid for it later.

It can be easy to get into a cycle where you overdo it and then feel worse or are not able to do what you had planned. Overexerting yourself can cause a flare-up, which is the term that is used to describe a brief increase in symptoms such as feeling pain, feeling tired or weak, becoming emotionally or mentally exhausted, thinking less clearly, or having trouble getting good sleep.

Many people living with MS 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 can make it hard to accomplish everything that you need to do each day. As a result, you may feel the need to make up for bad days by playing catch-up on good days.

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 reduce it.
• Avoid extremes in pain, tension, stress, emotional changes or fatigue.
• Maintain a more stable level of activity.
• Experience fewer and shorter symptom flare-ups.

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. It might feel natural to clean the entire kitchen and then take a break. But 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.

There are a number of ways you can pace yourself. Here are two strategies:

Time-based pacing. A schedule – or time-based rhythm of activity and rest, where task completion occurs according to the following 3 steps:

1. Do the task for a ‘safe’ set amount of time, even though you may have symptoms.
2. Rest for a set amount of time, even if you are not tired or finished with the task.
3. Repeat steps 1 and 2 until the task is done.

For example: you would start by washing dishes for a set amount of time (for instance, 10 minutes) and rest when that time has passed, even if you were not tired or you did not finish the dishes. After your rest period, start again. As you continue to use time-based pacing, you can change the amounts of time you allocate to activity and rest according to what you are able to do. Note that you will be resting from a planned ‘safe’ amount of work not a flare-up.

Goal-based pacing. Identify an activity that you want to do or a goal that you want to achieve. Then, figure out how to 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: To figure out what may be realistic for you to start out with, you might keep a diary to track what your current activity pattern is like and will give you a sense of a good place to start. You may also get feedback from a trusted friend, family member, or health care professional about what may be realistic for you to do. Then, work at improving your endurance bit by bit until you can 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:

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 are not experiencing your MS symptoms. Be careful that you don’t turn a good day into a bad day by becoming careless and overdoing it in your physical activities.
2. When doing some physical activity that you enjoy. Enjoyable physical activities are wonderful ways to focus your attention on something other than your MS. Unfortunately, they can also divert your attention from using good pacing techniques. Be careful that you don’t become so engrossed in an enjoyable activity that you forget to pace yourself.
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 lead to neglecting your need to 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.