Traffic Light System For Pacing
How it works
You sort activities into 3 categories. Red activities are those that will cause post-exertional malaise if done no matter what. Yellow activities can be done safely but need to be done in small quantities. Green activities are self-care that help you feel better and can be done all day.
You can then plan a balance of these activities throughout the day. Depending on how aggressive your ME is you will have to adjust the balance of these activities.
For example, many people with ME can plan red activities as long as they have time to recover and return to their baseline. Other people cannot do a red activity without permanently lowering their baseline.
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Implementation Guide
Some possible strategies for implementation are as follows:
1.) Planner style: using a calander or planner of your waking hours and plan activities and rest breaks for each day in advance. Repeat events can be used to establish a baseline schedule that is then modified.
2.) Set mandatory minimums for green activities. Using timers ensure you spend a certain number of hours on green activities each day. These can be increased the days of, before, and after red activities.
3.) Set mandatory maximums for yellow and red activities. These can be timer based for yellow activities or look like rules such as "no more than 1 red activity every 2 weeks."
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Pros and Cons
The advantage of this system is it can be a helpful way to color code and talk concretely about what your limits are. Tracking your time with colors can let you see how you are doing and the way you categorize activities can help people around you understand your limits. If you use a planner or calendar this can be extremely helpful for visualization.
My main criticism of this system is that it is often implemented where red activities are expected to be completed. Because post-exertional malaise can have permanent consequences this can mislead people about what is safe for me to do.
It is, for this reason, I find it helpful to talk about what a healthy person's red activities are, for example getting blackout drunk. Yes, it is doable, but it is never appropriate to force someone to do these activities as they produce significant physical harm and while lots of people can recover from them, they can cause permenant injury.
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Healthy Person
RED
-Getting blackout drunk
-Running a marathon
-Climbing half-dome
-A 17 hour red-eye flight in coach
YELLOW
-Lifting weights
-Skiing
-Taking the SATS
-Going for a run
-Construction work or other physically intense labor
GREEN
-Watching TV
-Desk or customer service jobs
-Going for a walk
-Scrolling social media
-Journaling
-Therapy
-Chatting to a friend
Note: Obviously not every healthy persons lists will look just like this. The same is true for people with ME. The lists here are simply one idea of what the categories might look like for different levels of severity.
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A Mild/Moderate Example
BLACK
-Rock climbing
-Skiing
-Doing high level mathematics
RED
-Going for a walk
-Attending a doctors appointment
-Most working from home
-Filling out paperwork
-Showering
-Washing dishes
-Most cooking
-Most social events
YELLOW
-Watching an exciting movie
-Texting friends
-Crafting from bed
-Reading a book
-Low stress work from home or easy academic work
-Therapy
-Talking with friends
GREEN
-Napping
-Watching boring TV shows
-Meditation
-Scrolling social media
-Listening to music
Note that both mental and physical activities need restriction. Different people may have different balances of mental vs physical ability. The categories here are large examples and most people will narrow in further on this specific abilities.
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A Housebound Patient Example
BLACK
-Running
-Prolonged standing
-Reading novels
-Standing while showering
RED
-Leaving the house for any reason
-Showering with a shower chair
-Any housework
-Almost all work from home
-Almost all academic work
-Reading a book
-Standing
YELLOW
-Sitting up for long periods
-Getting out of bed for any reason
-Going to the bathroom
-Eating a big meal
-Watching TV or movies on a big screen
-Texting friends
-Scrolling social media
-Conversations
GREEN
-Napping
-Meditation
-Watching mindless tv shows on a small screen
-Resting in a pitch black quiet room
Note: for patients with severe and very severe ME even avoiding all red and yellow activities may not be sufficient to alleviate symptoms. Instead patients generally change over to primarily avoiding activities that will cause baseline deterioration.
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A Bedbound Patient Example
BLACK
-Walking
-Prolonged sitting
-Showering
-Following a lecture
RED
-Getting out of bed for any reason
-Using a commode
-Sitting up
-Following plots of TV & Movies
-Bedbaths
-Eating a big meal
-Prolonged conversations
-Journaling
-Using a laptop or TV
YELLOW
-Using a phone for low stress activities
-Eating small portions
-Using a bedpan
-Watching mindless TV
-Texting friends for short periods
-Listening to music
-Short verbal requests
GREEN
-Lying still in a very dark quiet room
-Tube feeding
-IV hydration
-Meditation
-Sedation
-Sleep
Note: The bottom end of the ME severity scale encompasses a massive range of severity. For some patients with very severe ME there are no yellow activities and even tube feeding can contribute to crashes.
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Blue and black.
I also find it helpful to think of two more colors of activities.
Blue activities are those that restore your energy. For normal people sleep, meditation, and resting in a dark room are all blue activities.
The difference between being tired and fatigued is that when you are fatigued there are no blue activities. Only green activities (self-care) which may help you to mentally recharge but will not alleviate your tiredness. Even mild ME patients don't have access to blue activities.
Black activities are those that are impossible. For example, if someone is not in good shape than running a marathon might be a black activity. Even if you were held at gunpoint you could not do a black activity.
For people with severe ME lots of activities go from red to black. This is what people mean when they say "if you don't limit yourself (by pacing) ME will take the choice away."
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What Is Pacing?
For people with MECFS your energy envelope is the amount of energy you can spend in a day without affecting the next days energy. Pacing is the act of planning your days to stay within your energy envelope.
Pacing is essential for people with ME to prevent post exertional neuroimmune exhaustion colloquially known as a crash. Repeated crashes can lead to permenant deterioration in the size of your energy envelope.
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The Traffic Light System is a great introduction to pacing for Myalgic Encephalomyelitis aka MECFS and a versatile system for learning your limits.
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Pacing is an essential energy management strategy for people with ME and can lessen symptoms and help prevent deterioration into severe ME and very Severe ME often described as living death.
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There are many ways to pace, including my previous guide on heart rate pacing. But the traffic light aka Stop Light System of pacing shines for its simplicity and flexibility.
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The traffic light system color codes your time into 3 groups, green, yellow, and red activities. Green activities are restful things you can do all day without draining your energy. Yellow activities drain your energy some but can be done safely in moderation. Red activities are dangerous and likely to cause a crash. If you do too many red activities or do not take breaks from yellow activities you can permanently lower your baseline and change what activities fall into each color.
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This guide adds two additional colors to the stoplight I haven't seen before. These colors do not show up on your schedule but are helpful for explaining ME / CFS.
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Blue-colored activities are activities that restore your energy. What defines chronic fatigue or fatigue and makes it not just tired is that when someone has fatigue there are no activities that restore your energy. Only ones that are more restful (green).
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Likewise, black-colored activities represent things your body is physically incapable of doing. If you repeatedly go over your limits with red and yellow activities you will increase the number of things that go into the black. The difference between moderate ME and severe ME is largely that patients with severe and very severe ME have far far more black activities.
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So take this pacing guide forward if you so choose, and work to craft a colorful schedule that works for you.
Also see: Guide to HR Pacing for MECFS
