Pacing is an evidence-based approach to increasing activity and fitness, which aims to prevent 'boom and bust' patterns of activity.
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Chronic pain and fatigue can be maintained by "boom and bust" patterns, where individuals become active during good days but often overdo it, leading to increased pain or fatigue. Pacing is a technique that involves gradually increasing activity from a low baseline in a controlled manner, promoting consistency regardless of how one feels. Pacing for Pain and Fatigue is an exercise that outlines this technique for both chronic pain and fatigue, although the evidence supporting its effectiveness is mixed.
Pacing aims to encourage sustainable levels of activity without exacerbating symptoms.
Individuals experiencing persistent pain lasting longer than three months, which may limit activity, reduce quality of life, and lead to physical deconditioning and emotional distress.
Individuals with ongoing fatigue that is not alleviated by rest and characterized by reduced physical and mental stamina, cognitive difficulties, and increased sensitivity to activity.
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Pacing is a behavioral strategy designed to help people experiencing chronic pain or fatigue engage in regular activity while avoiding a 'boom and bust' cycle. This cycle describes the pattern in which a person overexerts themselves on 'good' days — when symptoms are less intense — and then experiences symptom flare-ups that lead to rest and inactivity. This irregular pattern often reinforces avoidance behavior, physical deconditioning, and emotional distress, contributing to the maintenance of chronic symptoms (Nielson et al., 2013). Pacing aims to disrupt this cycle by encouraging a more consistent and graded approach to activity, regardless of symptom fluctuations.
The concept of pacing is grounded theoretically in cognitive behavioral models of chronic pain and fatigue, which highlight the role of unhelpful beliefs and maladaptive coping strategies in symptom persistence. For example, people who believe they must 'push through' pain or fatigue to accomplish tasks may exceed their limits and trigger setbacks, while others may catastrophize symptoms and withdraw excessively. Pacing is intended to replace these extremes with a more balanced approach, allowing activity to be gradually increased from a baseline that is achievable and repeatable. When used effectively, pacing can support functional gains and reduce the emotional impact of symptom variability (Andrews et al., 2012; Vlaeyen & Linton, 2000).
Although pacing is widely used in clinical practice, the evidence supporting its effectiveness is mixed. Some studies suggest that pacing can lead to improved functioning and reduced disability, particularly when implemented as part of a broader cognitive behavioral therapy (CBT) approach (Andrews et al., 2012; Nielson et al., 2013). However, other research indicates that when pacing is applied too rigidly it may inadvertently reinforce avoidance behaviors and be associated with poorer outcomes (McCracken & Samuel, 2007; Birkholtz et al., 2004). Current guidance recommends introducing pacing in a flexible, collaborative way that aligns with the client’s personal goals and values (Nielson et al., 2013; British Pain Society, 2013). Therapists are encouraged to emphasize consistency rather than perfection, helping clients notice and challenge patterns of overactivity or underactivity that may undermine a sustainable and balanced approach to activity (Nielson et al., 2013).
