One of the most widely recommended approaches to managing PEM is pacing, sometimes called energy management. For many people, this is a completely new way of thinking about their body and their activity, and it can take time to get used to.

The core idea is balancing activity with rest in order to stay within your energy limits consistently, even when you feel well enough to do more. The aim is to avoid triggering PEM, which occurs when you overexert. Overdoing it, even once, can trigger a significant setback that may take days or weeks to recover from.

Many people find it helpful to think of their available energy as an "envelope." The goal is to stay inside that envelope rather than spending more than you have. In practice this might mean doing less than you feel capable of on a good day, resting before an activity as well as after, or spreading tasks across the day or week rather than doing everything at once. What counts as "too much" may be very different from what it used to be, and accepting that is often one of the harder parts of managing Long Covid.

One of the most common patterns people fall into is doing too much on a good day. Feeling better makes it tempting to catch up on everything you have been unable to do, but this often leads to a significant crash afterwards. Pacing means trying to maintain a more consistent level of activity over time, even when you feel well, to avoid these repeated peaks and crashes.

Rather than completing tasks in one go, many people find it helpful to break tasks into smaller steps with rest built in between, alternate between more and less demanding activities, and build in rest before they feel tired rather than waiting until they are already exhausted.

One of the challenges of managing PEM is that it can be hard to tell when you are overexerting, especially at first. Because the response is often delayed, the connection between an activity and a crash is not always obvious. Over time, and with practice, many people do find that they get better at reading their body's signals and recognising their own early warning signs.

Keeping a simple symptom diary can help with this, making it easier to spot patterns and identify triggers before a crash happens. You might notice that certain types of activity, cognitive or emotional as well as physical, consistently lead to worse symptoms a day or two later.

Some people also find wearable devices and apps helpful to help them pace:

1. Visible

2. Garmin