Richmond and Kingston
ME Group
Richmond and Kingston
ME Group
Richmond and Kingston
ME Group
Richmond and Kingston
ME Group
Richmond, Kingston &
West London M.E. Group
Aiming to reduce M.E.'s impact on our lives
Self-Management - PEM & Pacing
(aka Crashing & Avoiding Crashing)
PEM - Post Exertional Malaise
Often referred to as 'crashing', PEM (Post Exertional Malaise), also called Post Exertional Symptom Exacerbation (PESE), is a worsening and triggering of symptoms which can follow what would previously have been seen as minimal physical, social, emotional or mental activity.
PEM is considered to be a key symptom of ME/CFS and interferes with the ability to lead a 'normal' life.
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PEM tends to be delayed, on average, 1-2 days after exertion and can last several days, or sometimes months or longer. Repeated triggering of PEM can lead to further deterioration in symptoms so the aim is to avoid or minimise it.
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With some diseases, patients experience symptom relief after exercise. It is important to understand that the opposite is true for ME/CFS patients, for whom even minimal physical, mental or social exertion may cause PEM.​​
Pacing
The NHS ME/CFS e-Learning programme advice, reproduced here is that there are 3 key elements of self-management a person can try whilst awaiting an appointment with the ME/CFS service:
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Energy management (energy conservation or pacing)
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Activity management
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Diet
ME Association booklet on pacing:
PACING: Activity and energy management for people with ME/CFS and Long Covid
Pacing with a Heart Rate Monitor
The Workwell Foundation developed pacing with a heart rate monitor (HRM), an approach which enables many people with ME to feel more confident they are pacing effectively. A HRM can be a Garmin, Fitbit, Apple Watch or any one of many other wearable 'fitness' devices which measure heart rate.
Pacing with Visible
Visible's 'Visible: Pacing for illness' is an app developed to help people with ME or Long Covid to pace effectively. It is free to download and use.
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Combined with Visible's wearable heart-rate monitor and monthly membership, the Visible app can also calculate your heart rate zones and give personalised pacing insights. It can help track and budget the energy you use throughout the day and notify you through your phone when you’re over-exerting, so you know when to rest. Many people with ME find Visible helps them pace effectively and avoid crashes.
