Energy Management

Physical activity is a key part of managing symptoms

Managing your physical activity is a very important part of managing your MS symptoms. Unfortunately, messages about activity in MS can be confusing. 

For instance, being physically active and exercising are highly recommended for people with MS. Exercise is important for maintaining overall health and for limiting the intensity and impact of symptoms such as pain, fatigue, and depressed mood. Although people with MS are encouraged to exercise, they also get the message to not “overdo it”. They are told to pace themselves and conserve energy. The message seems to be that you should be active, but not “too active”.  It is no wonder that many people with MS have a hard time knowing how to manage their energy and activity!

• Finding Your Personal Plan for Energy Management
  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”) in general 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.

• Managing your Energy: Planning your day
  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, 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 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 – 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

• Simplify to Save Energy
  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 frozen meal from time to time or get take-out.  Consider doing most of your shopping on-line and have it delivered to your home.

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• Pacing activity
  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 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, fatigue, tension, stress, or anxious or depressed mood
  • Maintain a more stable level of activity
  • Experience fewer and shorter symptom “flare-ups”

• It’s time to pace yourself
  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 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 provider 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.

• Put it into practice
  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	Plan
  1.  Choose a task	You can use time-based pacing for any task you choose, such as household chores, yard work, personal care, shopping, and pleasant activities. To start, pick something you want or need to do. Start with a simple task, such as vacuuming one room, before trying something harder, such as cleaning the whole house.
  2.  Find your pacing rhythm	You can find your pacing rhythm for a task in just 2 steps. First, estimate how Long you can do the task safely before risking a flare-up. Then figure out how long your body needs to rest after this period of activity. Remember, during your rest period, you are not recovering from a flare-up. You are recovering from a safe amount of activity. Everyone is different, but you may need only a brief rest period to allow your body enough time to restore itself before you continue the activity. Your rhythm for each task will depend on how hard the task is and how much you are able to do right now. It may take you a Little while to figure out the right rhythm, so don’t be discouraged if you don’t get it right the first time. Keep these ideas in mind:  •     Pick simple goals that you can meet on good and bad days. For example, if you can get out of bed for only 10 minutes at a time, you might want to try a 5-minute activity and then rest for 15 minutes  •     Divide your activity and rest segments into small, manageable portions spread across the day. For example, do three 5-minute walks a day 3 times a week rather than one 45-minute walk once a week  •     Ask your healthcare provider or use the Pacing Yourself Work Sheet to help you figure out realistic pacing rhythm goals
  3.  Share your pacing plan	Discuss your pacing plan with your healthcare provider so he or she can better understandyour symptoms, your symptom management, and how he or she can help you. Your healthcare provider may be able to offer additional support and ways to adjust your plan so you find the rhythm for each activity that’s right for you. For tips on speaking with your healthcare provider, see Communicating.
  4.  Try your pacing plan	Try your pacing plan for 3 to 4 days. This should give you enough time to find out how well it works for you. For example, for a period of 3 to 4 days, you could: Shop for 15 minutes and stop. Rest for a set amount of time. Repeat the cycle until you’re done •   Stop and rest even if you are not tired or not done shopping •   Rest in a pharmacy area chair, the furniture department, in a dressing room, or at the front of a grocery store Work on your computer for 20 minutes and stop. Rest for a set amount of time. Repeat the cycle until you’re done •   Stop and rest even if you are not tired or not done with your work •   Get up and walk, stretch, or use one of the relaxation techniques discussed in the Relaxation module during your rest time Again, be sure to talk with your healthcare provider about a pacing plan that is right for you. Remember, everyone’s needs are different. These examples are just illustrations for how to use the pacing methods. With practice, time, and the help of your healthcare provider, you will find a pacing plan that is right for you.
  5.  Review and revise your plan	After you have tried your pacing plan for 3 to 4 days, review how you are doing. If you are able to do your task and still feel okay that day and the next day, consider revising your plan and adding time to your activity. To revise your plan: •     Slightly increase the time you are active, and gradually reduce your rest time. Be sure to talk with your healthcare provider any time you are planning to increase your activity •     Try this new plan for another 3 to 4 days to give your body time to adjust •     Use the Pacing Yourself Work Sheet to track your progress While practicing and reviewing your plan, you may start to feel worse or you may experience a flare-up. Remember, flare-ups may still happen from time to time, no matter what you do. But don’t let this discourage you, and don’t stop your activity. Instead, reduce your activity intensity, but continue for the same amount of time so you can keep the fitness gains you have already made. 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.
  6.  Continue to revise and practice your plan	Keep practicing and revising your pacing plan until it works for you. To start, you may want to just try doing pacing plans for 2 tasks a day. With patience, time , and practice, you may be able to find pacing plans that help you avoid the cycle of overdoing it so you are able to do more of what you want and need to do.

• What are Danger Times?

  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.

A note for family and friends

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 MS. 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 with MS 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.

Resources

National MS Society – Resource Support