Functional Stability Limits

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VIDEO TRANSKRIPT:

Hi, Remission Biome. This video is part of a series on pacing, crashes and Post Exertional Malaise or PEM. So, today we’re going to talk about what is pacing and what is the goal of pacing? And how you should think about it to make it make more sense to you than the way it probably has.

So, when I think pacing, I think of a term which I’ve come up with, which is “functional stability limits”. So, most of the time when people hear pacing, it means, you know, don’t do too much or know what you need to get done in a day and then do slightly less. Yes, these are all sort of loose ways that you can think about pacing but a much better way to think about pacing is that it’s a functional stability limit. And the stability is directly related to whether your symptoms are stable or declining and whether you’re losing function.

So, the goal of pacing is actually to make sure that you don’t decline further. The goal of pacing is to make sure that you don’t trigger post exertional malaise. So, the goal of pacing is to make sure you don’t get PEM, you don’t trigger post exertional malaise, you don’t trigger crashes and you don’t cycle, you don’t have good days and bad days. The goal of pacing is to get you stable, to get your system, your symptoms to a place where you can actually predict a little bit how you’re going to be able to do, what you’re going to be able to do in a day. And, for most of you, you’re probably in a stage right now where you’re very unstable. Your symptoms increase and decrease, you feel like you’re cycling all the time, you’re going up and down. And, this is really one of the things that we can use all of our bio-trackers to help with. So, it’s not as important to know sort of what your mean HRV is, or how your HRV was just last night. What’s really important with all of the metrics you get is to look at their stability. You want to see the trend lines overtime. So, for example with HRV, what you really want to see is an HRV of 30 that is not declining every day. Or much better that it’s actually increasing every day. But the goal is actually to not see it fluctuate randomly. And, if one day it’s 15 and another day it’s 25 and then one day it’s 40 and then another day it’s 21. Well, you’re in sort of a boom and bust crash cycle. You’re triggering crashes, you’re triggering PEM.

And the really key thing to remember about this is PEM is not just a concept. PEM is damage, PEM is mitochondrial damage. And when you have PEM, the damage that is actually happening to your mitochondria, actually keeps increasing and increasing. And if you keep pushing, that damage keeps increasing. And it keeps increasing and eventually what happens is, is you start to decline to a new stable state or a new baseline. Now, you’re probably familiar with the Remission Biome graphic. You know, we have this ball in a trough. And then, there’s a lip and it goes down and the trough and it goes down. And this is really the process of decline in ME/CFS. If you keep pushing past the PEM limits, you trigger mitochondrial damage and that stability ball, which is in that trough, gets pushed up and it gets pushed down into the next baseline. And if you continue, you will continue to go down and it will continue to go down and it will continue to go down.

So, when you’re thinking about pacing, don’t think about all the things that you need to do in a day and how you can pack them in. Think about “functional stability limits” and think about “resilience”. You know, what we’re trying to do is, we’re trying to get our systems into a place where we’re not actually cycling, we’re not experiencing highs and lows, we’re not experiencing crashes. And if you are still experiencing crashes, this means that you are not pacing correctly. And part of the reason is because thinking about it, using this word pacing doesn’t really make a lot of sense. So, let’s start thinking about pacing as a functional stability limit and let’s focus on resilience and use our HRV and our other bio-trackers to make sure that our trends are stable or slightly increasing. The second you see a decline or you see random values and this up and down, you’re not doing it correctly.

OK. I hope this was helpful. Many more videos in this series to come. Have a great day. Bye, Remission Biome.

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