Graded activity is a way of learning to manage chronic pain or illness by finding your baseline (the amount of activity you can do without exacerbating symptoms) and then gradually extending the difficulty, very slowly over time. The aim is to be able to do the things that matter to you without causing flare ups. Pacing is a strategy for avoiding a boom and bust cycle which you do a lot on good days and then very little on bad days. The idea is to even out your energy use and reserves so you can have a little more predictability. I’ve been practising both strategies for a little while and here is the latest update on how that’s going.
- No problems last week so increasing to 14 minutes from today.
- Using wrist braces and fingerless gloves. Still learning touch typing to reduce neck pain from looking down at the keyboard.
I haven’t been pacing with walking up to now. Just walking until I get tired. I would like to increase my fitness so I’m going to start timing how long I walk and taking rest breaks. I’m starting at 7 minutes which is how long it takes to get to my allotment plot and I can usually do that comfortably.
- I’m still in the phase where my muscles are getting used to the activity and if I don’t pay attention to what I’m doing my posture slumps forward.
- I’m hoeing the ground outside now in a bed that has already been dug over and isn’t needed for planting any time soon. This reduces the temptation to rush or overwork.
- I’m going to continue making tiny 5 second increases every few days so that I build up stamina slowly without provoking a flare up in pain.
- I’m increasing by a minute to 5 minutes and I’m following the movements provided by my audiologist (Qi Gong style movements).
My energy level has been much more consistent since changing to 15 minute breaks between each activity. This has slowed my day down but hopefully I’ll be able to build up over time. And if not then I am still happier if I don’t wind up resting in bed as often – and fingers crossed it seems to be okay as far as that’s concerned.
The aim of pacing is to find the approximate length of time that I can work at something without causing a flare up in my symptoms. The principles of pacing are to avoid a cycle of boom and bust and to stop before you need a break. A few months ago I worked out my starting baselines for various activities. I’m working on gradually increasing my baselines by one minute a week for just a couple of activities at a time.
I haven’t tried to extend my baselines (the amount of activity I can be fairly confident won’t increase my pain or fatigue) for weeks. I’ve had setbacks with both migraine and fibromyalgia symptoms and it’s been a slow up and down process to get back to where I was. This week I feel ready to try reviewing and adjusting my baselines in the three areas I’m working on.
Last week I adjusted the pattern of my breaks so I now take a 115 minute break after each activity. This has meant reducing the amount of activity I aim for in a day but I seem to be suffering less with fatigue. I am still always battling the temptation to try and do a little more. I wish I had more patience!
I increased the timer to 4 minutes for mindful movement (movements based on Qi Gong). I’m finding the movement much more comfortable and can increase the variety of movement as well as the length of time. Each time I start with the simplest movement and progress gently.
Using the computer
I’ve increased my time at the computer to 13 minutes. I seemed to be doing okay with 12 minutes in terms of pain in my hands and forearms. I’m doing okay in terms of fatigue as long as I take a 15 minute break each time. I hope in time I’ll able to reduce the length of the break.
Cultivating my allotment with a hoe
I’ve been doing bicep exercises for the last couple of weeks, gradually building up my strength. I’ve also been practising my posture using a mop or a hoe on light loose soil. This week I’m beginning to practise using the hoe on slightly heavier bare soil. I needed some help from my partner who prepared the ground for me so I can very gradually increase the intensity of the activity and control the amount of effort required. I managed 30 seconds today with no increase in pain so I’ll take that as my starting baseline.