The Pacing Problem: Why Most People With ME/CFS and Long Covid Are Doing It Wrong

You’ve been told to pace yourself.

You’re trying. And you’re still crashing.

If that sounds familiar, you’re probably doing a version of pacing that was never going to work, because the way it’s typically explained leaves out the parts that matter most.

What most people actually do

The version of pacing most people receive goes something like this: don’t overdo it, rest when you’re tired, stop before you crash.

The problem is that by the time you feel tired, you’ve already crossed the line. Resting in response to symptoms isn’t pacing. It’s damage limitation. And for people with ME/CFS or Long Covid, repeatedly crossing that line, even slightly, compounds over time.

This is the push/crash cycle. It’s exhausting in a way that goes beyond the physical, because it creates the illusion that you’re managing, right up until you aren’t.

What post-exertional malaise actually is

Post-exertional malaise – PEM – is not tiredness after activity. It is a physiological response, a measurable worsening of symptoms that occurs after exertion. Standard rest does not resolve it in the normal way.

The emerging research points in the same direction as what I see working with clients: restore autonomic regulation first, and the energy follows. In ME/CFS and Long Covid, the autonomic nervous system appears stuck in chronic sympathetic activation – the body’s threat response, unable to switch off. This suppresses mitochondrial function: the body deprioritises efficient cellular energy production when it perceives persistent threat. Energy metabolism under any load – physical, cognitive or emotional – becomes disproportionately costly and slow to recover from.

The exertion threshold is different for everyone. For some people it is a short walk. For others it is a phone call, a difficult conversation, or 40 minutes of concentration. What matters is that the threshold exists, and that crossing it repeatedly causes harm regardless of how small the individual transgression feels in the moment.

This is why the standard advice to ‘listen to your body’ can mislead you. In ME/CFS and Long Covid, the body’s signals are often delayed. You may feel fine during an activity and pay for it 18 to 36 hours later. By then, the connection between cause and effect has blurred.

What also counts as exertion in ME/CFS and Long Covid

Physical output is only one part of the picture. Cognitive effort – reading, writing, processing complex information – draws on the same limited energy pool. So does emotional exertion: a stressful conversation, an upsetting piece of news, the mental load of managing a medical appointment. Sensory input matters too. Loud environments, bright lights and crowded spaces carry a genuine physiological cost for many people with Long Covid and ME/CFS, one that rarely appears in tracking alongside steps walked or tasks completed.

If you are only monitoring physical activity and still crashing, this is likely why.

Proactive versus reactive rest

Reactive rest is what most people practise: rest because you’ve done too much, or because symptoms have worsened. It keeps you in a cycle where you’re always recovering from the last thing rather than protecting capacity for the next.

Proactive rest means building rest into your day before you need it – as a non-negotiable input, the same way you would take medication on a schedule rather than waiting until pain is unbearable.

This shift is harder than it sounds, particularly for people whose identity was built around productivity, capability and getting things done. Resting when you don’t feel bad yet runs counter to everything high-functioning people are wired to do. Giving up is not what this is. Breaking the push/crash cycle is.

Finding your energy envelope when your baseline keeps shifting

One of the most disorienting aspects of ME/CFS and Long Covid is that your capacity is not fixed. A baseline that held for two weeks can crash after one difficult day, one infection, one period of stress. Energy envelope management is genuinely difficult when the envelope itself keeps changing.

Working from your worst days rather than your best is where to start. Your sustainable baseline is not what you can do when you feel relatively well. It is what you can do consistently without triggering a PEM crash – and that number is almost always lower than it feels like it should be.

Tracking more than steps also matters. A simple daily log covering sleep quality, cognitive load, emotional exertion and sensory exposure gives a far more accurate picture of where your energy is going. And when a crash comes, as it will, treating it as data rather than a setback allows you to locate your actual threshold more precisely over time. You can work with that.

Pacing ME/CFS and Long Covid is a long game

Pacing is not a short-term strategy. For most people with ME/CFS and Long Covid, meaningful improvement is measured in months and years, not weeks. Clinical trials running four to 12 weeks tell you almost nothing about what this condition requires.

This is not a counsel of despair. Recovery is possible – I know that from the inside, not just the research, having fully recovered from ME/CFS and Long Covid. But it asks for a different relationship with time and activity than most people, especially previously high-functioning people, are used to.

The goal of pacing is to create the conditions in which the body can begin, slowly, to do what it is trying to do: restore itself.

If you want to understand what’s driving this at a deeper level, this is where to start: ‘5 Secrets Your Doctor Never Told You About Chronic Illness’