People with chronic fatigue syndrome (CFS) are prone to postexertional malaise (PEM), an extreme, prolonged exhaustion that is the result of a worsening of symptoms following any kind of physical or mental exertion (not necessarily from intense or strenuous activity). To try to avoid PEM, get an overall picture of how you spend your energy dollars (EDs). Every activity has an energy cost. The goal is to have some EDs left at the end of each day. For example, if you begin with 10 EDs, aim to have 2 EDs left. If you spend more EDs than you have, you have to make them up the next day.

Energy means more than physical activities. In your assessment, include mental activities such as reading, working on the computer, and concentrating on something. Think of social activities like talking on the phone or the time you have been with others. Consider your emotions, which can run the gamut from frustration, anxiety, and stress, to happiness.

Special events are stressors that subtract from your EDs. These include vacations, holiday celebrations, having dinner guests, or going out of the house for various appointments, and call for strategic planning to avoid PEM. These activities, as well as feeling pressured by others or yourself to be more active, can be a cause for PEM or a relapse.

People with CFS can use strategies to meet the challenge of special events. For example, take extra rest before an event and extra rest afterward. If participating in a long activity, for example, sitting in class for 2 hours, take a stretch or bathroom break.

Before the event, make a detailed plan to include alternate activities you can do if your energy level is being depleted. For example, choose the parts of a family outing that you can participate in and enjoy. Discuss your plans with others involved in the event so they understand what to expect from you. Being upfront with others regarding what you will participate in may reduce their trying to encourage your full participation.

People with CFS must define their limits, simplify their tasks at hand, substitute or eliminate demanding tasks with less demanding ones, and delegate chores. If it is a “good” day for company to come, for example, keep it simple. Enlist family to help you prepare food for the guests and clean up afterward. Know your time limit for entertaining and make this clear to your guests beforehand. Do not be tempted to extend the time because you will pay for it later.

It is difficult to accept that you are not the same as you were before CFS. Rather than make this comparison, listen to your body’s signals and remind yourself that you are resting so that you can return to finish the task at hand. Try changing the negative way of thinking, “I’m weak if I need to rest,” to “If I rest, I’ll have quality time with my husband and grandchildren.”

PEM is unpredictable. Researchers have not yet found the cause or treatment; however, people with CFS can use strategies to try to minimize it. Pacing is one way that people with CFS can help themselves. Pacing strategies include setting activity limits, reducing activity levels, taking daily planned rests regardless of how the person is feeling, switching among tasks, and keeping detailed records. It also includes making mental adjustments based on the acceptance that life has changed.

Pacing is not a cure for PEM or for CFS. While some patients may be able to be active, other patients may not; however, pacing, and being able to prevent PEM to some degree, gives CFS patients some power over the illness. If a patient can predict the consequences of an activity, that patient is empowered to make informed choices.