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Activity Pacing & Exercise Guide

Safe activity management strategies to prevent post-exertional malaise and symptom flares. Tailored guidance for each condition.

Condition-Specific Exercise Guidance

ME/CFS

Heart rate monitoring & strict pacing

Guidelines

•Stay below anaerobic threshold (~60% max HR) at all times
•Use a heart rate monitor during ALL activities, not just exercise
•Pacing is essential -- alternate activity with rest periods
•Start with 2-5 minutes of gentle movement, increase by 1 minute per week only if no PEM
•Recumbent or supine exercises preferred (lying down stretches, seated yoga)
•Track post-exertional malaise (PEM) -- symptoms may appear 24-72 hours after overexertion

Recommended Activities

•Gentle stretching while lying down
•Seated tai chi or qigong
•Short, slow walks (2-5 minutes) with rest stops
•Recumbent cycling at very low resistance
•Gentle yoga (restorative/yin, not vinyasa)

Avoid

•Graded Exercise Therapy (GET) -- contraindicated by NICE 2021 guidelines
•Pushing through fatigue or 'working through' crashes
•Standing exercises when upright intolerance is present
•Any activity that raises HR above anaerobic threshold
•Competitive or time-pressured activities

Heart Rate Zone Calculator

Age

Resting Heart Rate (bpm)

Condition

Energy Envelope Tracker

Daily Budget:12spoons

Used: 0 / 1212 remaining

Quick Add Activities

Weekly Activity Planner

Plan your rest/activity balance for each day. Aim for more rest than activity minutes, especially on higher-exertion days.

Mon

min rest

min activity

4.0:1

Tue

min rest

min activity

4.0:1

Wed

min rest

min activity

4.0:1

Thu

min rest

min activity

4.0:1

Fri

min rest

min activity

4.0:1

Sat

min rest

min activity

4.0:1

Sun

min rest

min activity

4.0:1

Tip: A rest-to-activity ratio of 3:1 or higher is recommended for ME/CFS, Long COVID, and POTS. For fibromyalgia and Lyme, 2:1 is a reasonable starting target. Adjust based on your personal PEM patterns.

When to Stop Immediately

•Heart rate significantly exceeds target zone and does not recover within 2 minutes of stopping
•Lightheadedness, dizziness, or feeling faint during or after activity
•Chest pain, palpitations, or shortness of breath disproportionate to effort
•Sudden significant increase in pain (above 7/10)
•Cognitive symptoms worsening (severe brain fog, confusion, word-finding difficulty)
•Nausea or visual disturbances during activity
•Feeling 'wired but tired' -- adrenaline surge masking fatigue
•Needing to lie down immediately after stopping activity

Common PEM Triggers

•Physical overexertion (exceeding energy envelope)
•Cognitive overexertion (prolonged concentration, multitasking)
•Emotional stress (arguments, bad news, anxiety)
•Orthostatic stress (prolonged standing, hot environments)
•Sensory overload (noise, lights, crowds)
•Sleep disruption (poor quality or insufficient sleep before activity)
•Infection or immune activation
•Temperature extremes (heat especially)

Recovery Strategies

•Complete rest in a dark, quiet room
•Hydrate with electrolytes (oral rehydration salts)
•Apply cool or warm compress based on what helps (individual preference)
•Gentle diaphragmatic breathing (4-7-8 pattern)
•Avoid screens and cognitive demands
•Compression garments (especially for POTS)
•Salt supplementation if approved by provider
•Do NOT push through -- rest is productive and necessary
•Track the crash: note trigger, onset delay, duration, and severity for pattern recognition
•Gradually resume baseline activities once symptoms stabilize (not when you 'feel better')

Explore Related Modules

Flare Predictor

Predict symptom flare-ups

Symptom Journal

Track symptoms over time

Treatment Guide

Evidence-based treatment info

Nutrition Guide

Diet recommendations by condition

Data Sources (5)

Workwell Foundation. Workwell Foundation -- Cardiopulmonary Exercise Testing and ME/CFS. 2023.
CDC. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Guidelines. 2024.
American College of Sports Medicine. ACSM Guidelines for Exercise Testing and Prescription (11th Edition). 2022.
National Institute for Health and Care Excellence. NICE Guideline NG206: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. 2021.
UT Southwestern / Children's Health. Levine Protocol for POTS Rehabilitation. 2020.

Activity Pacing & Exercise Guide

Safe activity management strategies to prevent post-exertional malaise and symptom flares. Tailored guidance for each condition.

Condition-Specific Exercise Guidance

ME/CFS

Heart rate monitoring & strict pacing

Guidelines

•Stay below anaerobic threshold (~60% max HR) at all times
•Use a heart rate monitor during ALL activities, not just exercise
•Pacing is essential -- alternate activity with rest periods
•Start with 2-5 minutes of gentle movement, increase by 1 minute per week only if no PEM
•Recumbent or supine exercises preferred (lying down stretches, seated yoga)
•Track post-exertional malaise (PEM) -- symptoms may appear 24-72 hours after overexertion

Recommended Activities

•Gentle stretching while lying down
•Seated tai chi or qigong
•Short, slow walks (2-5 minutes) with rest stops
•Recumbent cycling at very low resistance
•Gentle yoga (restorative/yin, not vinyasa)

Avoid

•Graded Exercise Therapy (GET) -- contraindicated by NICE 2021 guidelines
•Pushing through fatigue or 'working through' crashes
•Standing exercises when upright intolerance is present
•Any activity that raises HR above anaerobic threshold
•Competitive or time-pressured activities

Heart Rate Zone Calculator

Age

Resting Heart Rate (bpm)

Condition

Energy Envelope Tracker

Daily Budget:12spoons

Used: 0 / 1212 remaining

Quick Add Activities

Weekly Activity Planner

Plan your rest/activity balance for each day. Aim for more rest than activity minutes, especially on higher-exertion days.

Mon

min rest

min activity

4.0:1

Tue

min rest

min activity

4.0:1

Wed

min rest

min activity

4.0:1

Thu

min rest

min activity

4.0:1

Fri

min rest

min activity

4.0:1

Sat

min rest

min activity

4.0:1

Sun

min rest

min activity

4.0:1

When to Stop Immediately

•Heart rate significantly exceeds target zone and does not recover within 2 minutes of stopping
•Lightheadedness, dizziness, or feeling faint during or after activity
•Chest pain, palpitations, or shortness of breath disproportionate to effort
•Sudden significant increase in pain (above 7/10)
•Cognitive symptoms worsening (severe brain fog, confusion, word-finding difficulty)
•Nausea or visual disturbances during activity
•Feeling 'wired but tired' -- adrenaline surge masking fatigue
•Needing to lie down immediately after stopping activity

Common PEM Triggers

•Physical overexertion (exceeding energy envelope)
•Cognitive overexertion (prolonged concentration, multitasking)
•Emotional stress (arguments, bad news, anxiety)
•Orthostatic stress (prolonged standing, hot environments)
•Sensory overload (noise, lights, crowds)
•Sleep disruption (poor quality or insufficient sleep before activity)
•Infection or immune activation
•Temperature extremes (heat especially)

Recovery Strategies

•Complete rest in a dark, quiet room
•Hydrate with electrolytes (oral rehydration salts)
•Apply cool or warm compress based on what helps (individual preference)
•Gentle diaphragmatic breathing (4-7-8 pattern)
•Avoid screens and cognitive demands
•Compression garments (especially for POTS)
•Salt supplementation if approved by provider
•Do NOT push through -- rest is productive and necessary
•Track the crash: note trigger, onset delay, duration, and severity for pattern recognition
•Gradually resume baseline activities once symptoms stabilize (not when you 'feel better')

Explore Related Modules

Flare Predictor

Predict symptom flare-ups

Symptom Journal

Track symptoms over time

Treatment Guide

Evidence-based treatment info

Nutrition Guide

Diet recommendations by condition

Data Sources (5)

Workwell Foundation. Workwell Foundation -- Cardiopulmonary Exercise Testing and ME/CFS. 2023.
CDC. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Guidelines. 2024.
American College of Sports Medicine. ACSM Guidelines for Exercise Testing and Prescription (11th Edition). 2022.
National Institute for Health and Care Excellence. NICE Guideline NG206: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. 2021.
UT Southwestern / Children's Health. Levine Protocol for POTS Rehabilitation. 2020.