Activity Pacing is Associated with Better and Worse Symptoms for Patients with Long-term Conditions

BACKGROUND:Activity pacing has been associated with both improved and worsened symptoms, and its role in reducing disability among patients with long-term conditions has been questioned. However, existing studies have measured pacing according to uni-dimensional subscales, and therefore the empirical evidence for pacing as a multifaceted construct remains unclear. We have developed a 26-item Activity Pacing Questionnaire (APQ-26) for chronic pain/fatigue containing five themes of pacingactivity adjustment, activity consistency, activity progression, activity planning and activity acceptance. OBJECTIVE:To assess the associations between the five APQ-26 pacing themes and symptoms of pain, physical fatigue, depression, avoidance and physical function. METHODS:Cross-sectional questionnaire design study. Data analysed using multiple regression. PARTICIPANTS:257 adult patients with diagnoses of chronic low back pain, chronic widespread pain, fibromyalgia and chronic fatigue syndrome/myalgic encephalomyelitis. RESULTS:Hierarchical multiple regression showed that activity adjustment was significantly associated with increased physical fatigue, depression and avoidance, but decreased physical function (all P≤0.030). Activity consistency was associated with decreased pain, physical fatigue, depression and avoidance but increased physical function (all P≤0.003). Activity planning was associated with reduced physical fatigue (P=0.025) and activity acceptance was associated with increased avoidance (P=0.036). CONCLUSION:Some APQ-26 pacing themes were associated with worse symptoms and others with symptom improvement. Specifically, pacing themes involving adjusting/reducing activities were associated with worse symptoms, whereas pacing themes involving undertaking consistent activities were associated with improved symptoms. Future study will explore the causality of these associations to add clarification regarding the effects of pacing on patients’ symptoms.