Pace Yourself: The Key to Managing Chronic Illness

Coauthored by Janelle Gast and Kathleen Bogart, PhD

Spoons on a yellow background

Source: Hitomi Bremmer / Unsplash

Two years ago, one of us (Janelle) was diagnosed with postural orthostatic tachycardia syndrome (POTS)—an autonomic disorder that, among other things, makes standing for too long, heat, and even simple daily tasks exhausting. Some days, it’s possible to push through and function relatively normally, but overdoing it can lead to crashes that can last for days—or, in more extreme cases, weeks. Other times, symptoms like syncope (fainting) or severe fatigue make even standing up feel like too much effort.

The hardest part? Finding information about how to manage energy. Some days involved pushing too hard and ending up completely wiped out. Other days meant resting too much and feeling stuck in a cycle of doing nothing.

People living with fatiguing conditions have figured out creative strategies, and a few researchers have taken up the cause as well. Here, we summarize key insights to make life a little easier for the next person navigating this journey.

But this isn’t just information for people with a chronic illness. Understanding pacing helps everyone. Whether you have a friend, family member, or coworker with an invisible condition, knowing how energy management works can help you support them better.

Spoon Theory

Spoon theory, created by Christine Miserandino, is one of the most well-known ways to explain energy limitations in the chronic illness community. It uses spoons as a metaphor for daily energy, where each activity—getting dressed, cooking, socializing—costs a certain number of spoons. Once you run out, you’re done for the day.

A person without a chronic condition might have around 15 spoons to use in a day, while someone with a chronic illness only has five to eight. For people with chronic illnesses, spoons run out much faster than for healthy individuals. Some activities that seem “easy” can be incredibly draining.

Spoon theory helps with energy budgeting by making it easier to plan days realistically. To make tracking spoons easier, some people use an app or a notebook to log how many spoons they think they use during the day. This can help identify patterns and adjust daily activities accordingly.

What Is Pacing?

Activity pacing is an approach to energy management that helps people with chronic illnesses function without constantly crashing. It’s about balancing activity and rest to prevent and lessen symptoms like dizziness, extreme fatigue, brain fog, and fainting. Essentially, it's an evidence-based approach to managing spoons.

For people with conditions like POTS, myalgic encephalomyelitis/chronic fatigue syndrome, fibromyalgia, and long COVID, the body doesn’t recover from exertion the way it typically should. Overdoing it on a “good day” can lead to post-exertional malaise (PEM)—a worsening of symptoms that can last for days or even weeks.

Pacing is essential because it allows people with chronic illnesses to:

• Maintain a more stable energy level: Instead of bouncing between bursts of activity and days of recovery, pacing helps create a steady routine that minimizes crashes.
• Prevent worsening symptoms: Overexertion can cause dizziness, tachycardia, and even full syncope (fainting) for people with POTS.
• Improve overall quality of life: By learning to work with their body instead of against it, people with chronic illnesses can regain a sense of control.

Pacing isn’t about avoiding activity altogether—it’s about finding a sustainable balance that works for each person’s unique energy limits. Below are key pacing methods, along with resources so you can explore them further.

The 4 P’s: Prioritizing, Planning, Pacing, and Positioning

The 4 P’s method is an evidence-based, structured approach to managing energy and preventing overexertion:

1. Prioritizing: Choosing what truly needs to get done and letting go of nonessential tasks.
2. Planning: Breaking tasks into smaller steps and scheduling them across the day/week.
3. Pacing: Taking frequent breaks before reaching exhaustion.
4. Positioning: Adjusting how tasks are performed to use less energy (e.g., sitting while cooking, using mobility aids).

Chronic Illness Essential Reads

ME/CFS, Long Covid, and Disconnection From the Self

The Negative Consequences of Invalidating Patients' Symptoms

Many people with chronic illnesses unintentionally follow parts of this method already, but using the 4 P’s method intentionally can help create a more sustainable balance. For example, someone might prioritize grocery shopping on a low-energy day, plan by making a list and ordering some items online, pace by taking rest breaks while shopping, and position by using the cart for support instead of carrying a basket.

This method works well for people who need a step-by-step system to help avoid overexertion while maintaining independence.

Hydration and Electrolyte Monitoring

For people with POTS or other chronic illnesses, staying hydrated isn’t just important—it’s essential. Many conditions that affect the autonomic nervous system, including POTS, disrupt blood circulation and fluid regulation, leading to symptoms like dizziness, fainting, and extreme fatigue. Increasing fluid and salt intake helps stabilize blood volume and circulation, making hydration a critical part of symptom management.

The Cleveland Clinic recommends that people with POTS consume 3,000 to 10,000 mg of sodium per day to help maintain blood pressure and prevent symptoms like lightheadedness and tachycardia. This is significantly higher than the general population’s daily sodium intake, but for people with autonomic disorders, it’s a necessity, not a luxury.

Many people with chronic illnesses use electrolyte drinks, salt tablets, or high-sodium foods to stay balanced. Tracking hydration levels and preloading with fluids before standing can also reduce dizziness and fatigue.

Activity Tracking With Wearable Tech

Wearable devices like smartwatches or chest strap monitors can be incredibly helpful for pacing. Many people with POTS use heart rate monitors to stay within their safe limits. When the heart rate gets too high, it’s a signal to stop and rest before symptoms worsen.

Beyond just tracking, these tools can help bridge the gap between self-management and advocacy. Since chronic illness is often invisible, having objective data—such as heart rate variability, exertion levels, and symptom patterns—can be helpful when explaining energy limitations to doctors, employers, professors, and even friends and family.

For those who struggle to communicate their needs, tracking tools can be a game-changer. The data helps validate what many of us have been trying to explain for years: that overexertion has real consequences and that pacing isn’t just about “taking it easy.” As tools like this become more widely used, they also help raise awareness about energy-limiting disabilities and the need for better accommodations.

Why Should the Public Care?

Even if you don’t have a chronic illness, you probably know someone who does. Millions of people live with conditions that make everyday activities exhausting, and yet the world isn’t built for people with limited energy.

Here’s how you can help:

• Believe people when they say they need to rest.
• Be flexible with plans. A last-minute cancellation isn’t personal—it’s survival.
• Support accessible policies. Whether it’s workplace flexibility, public seating, or remote work options, small changes make a huge impact.
• Understand that wearable tools often reflect a medical need—even if they’re not immediately visible.

For more guidance on supporting loved ones with chronic and invisible illnesses, organizations like Invisible Disabilities Association and Dysautonomia International offer helpful resources.

Final Thoughts

Pacing is more than just a strategy—it’s a lifeline for people living with chronic illnesses. Learning how to manage energy effectively can bring a sense of control, even when the condition itself remains unchanged. But increased awareness and support from others can help make an even bigger impact.

By understanding pacing strategies and sharing this information, you’re already helping create a more supportive world—one that challenges harmful assumptions about energy, productivity, and disability. The next step? Keep learning, keep advocating, and keep listening.

Janelle Gast is an undergraduate psychology student at Oregon State University and an alum of Dr. Bogart’s Psychology of Disability course. She plans to pursue graduate studies in clinical psychology with a focus on disability and chronic illness.