Activity, Rest, & Pacing

Goal

To be able to achieve a balance between rest and activity

Move It or Lose It (Turk & Winter, pp. 32-34)

Chronic pain often varies in intensity or comes and goes in an unpredictable manner. This lesson will help you learn to deal with this variability and find out what level and type of activity will be most successful for you. You will also learn about the importance of pacing, and that despite some temporary discomfort, you can become active in ways that increase your energy and improve your conditioning. You will learn how you can regain a level of daily functioning you thought you’d never reach. You may even become more able to do some things than you ever were.

Many people with chronic pain try to prevent or decrease pain by doing less physical activity. While this may be effective in the short-term and seems like a rational strategy, it likely increases disability in the long-term. Lack of movement immobilizes muscles and weakens them. Over a few months of decreased movement, more activities will become difficult and will begin to cause pain. This additional pain is likely not related to the original cause of pain but to weakened muscle. The goal is to find a personal balance-the amount of movement that does not cause increased chronic pain or increased disability. After engaging in movement-oriented activities, evaluate the experience by asking yourself these questions to work toward achieving your personal balance:

Could I have tried too hard?
Could I have not tried hard enough?
Did I not understand or have all the information I needed?
Did a life event or stressor interfere with my plan?

Enjoying Activity (Turk & Winter, pp. 36-37)

Think of activity as a “want” or “choice” rather than a “must” or “should.” You may not think that such wording makes a difference, but listen to how it feels when you say to yourself “I get to do this” rather than “I must do this.” Choosing to do something rather than pressuring yourself to do it will reduce stress. Because stress increases one’s awareness of pain, decreased stress will in turn decrease your awareness of pain. Think of your days as “easy” or “challenging” rather than as “good days” or “bad days” since the latter often results in pushing yourself too hard on the good days-resulting in your pain being worse the following days. On both “easy” and “challenging” days, try to keep to a regular schedule of activity. A “challenging” day may require you to have shorter periods of exertion followed by longer periods of rest and recuperation but by pacing yourself, you will be able to maintain a reasonable, consistent schedule of activity.

Practical suggestions in order to pace yourself include setting a timer or paying attention to your watch on “easy” days to avoid unintentionally overdoing it. If you work at a computer all day, you may benefit from setting a timer to remind yourself to stretch or walk around every 20 minutes or so. A key element to enjoying activity is to incorporate adequate rest between periods of activity. At first, the amount of time you spend resting may exceed the amount of time you spend doing the activity but in time, you will achieve a more optimal balance.

Pacing Yourself Exercise (Turk & Winter, pp. 39-44)

Instructions:

1. Choose an activity that is realistic and motivating. This can be a chore, hobby, or form of exercise. Keep in mind that almost any form of movement that is not contraindicated by your physician will be helpful if you do it gradually. Here are some examples:

   • Housework
   • Golf
   • Volunteer
   • Involvement in children’s or grandchildren’s activities
   • Cooking
   • Walk on treadmill or outside
   • Swim at a leisurely pace
   • Stretch
   • Use hand-held weights
   • Yoga
   • Pilates

2. Develop your baseline by engaging in your activity for 2 days. Reflect on how you feel emotionally and physically before and after you do the activity, and make adjustments accordingly. If you are beginning a new activity, do 10% to 20% less than you estimate you can do without a significant increase in the amount of pain or fatigue you are now experiencing. For example, if you decide to go for a walk, and you think you can walk 5 minutes, walk only 4. This will help you avoid overexerting yourself in the zeal of getting started.

3. Set a goal for the activity or exercise for each day of the first week you plan to begin increasing your activity level. Set your goals at your baseline level for the first 2 or 3 days in order to monitor how you are doing on consecutive days. You may experience some discomfort, but over time you will feel less and less discomfort even as you increase your activities. Goals should be set after the first week so that you are slowly increasing the amount of time you are doing an activity or increasing the number of times that you do it. If you struggle to meet your initial goals (i.e., excessive pain or fatigue), then cut back and work more slowly. But keep moving ahead.

Next Step

If the activity you chose in the Pacing Yourself Exercise was not physical exercise, after 2 or 3 weeks of increasing your other activities, begin to incorporate exercise into your weekly routine. Be sure to follow the steps from the Pacing Yourself Exercise.