Individuals with long COVID experience a range of cognitive and physical symptoms, with chronic fatigue or myalgic encephalomyelitis (ME/CFS) being the most prominent. However, there are lifestyle changes that can help support the impact of long COVID fatigue and aid in improving cognitive health.  

Cognitive pacing is a psychological technique focused on creating an understanding of energy capacity as impacted by long COVID and working with it. Endorsed by the WHO as post-COVID fatigue treatment and for those that experience symptoms worsening after activity, cognitive pacing is a simple strategy that is easy to incorporate into daily life. 

We’ll cover what you need to know about cognitive pacing and long COVID, along with how to create a cognitive pacing plan, and tips for success. Let’s get started.

What is Long COVID?  

Long COVID is a condition where patients (often referred to as long-haulers) experience symptoms that endure more than 12 weeks after the initial COVID-19 diagnosis. Those with long COVID can experience physical and neurological symptoms that worsen after stressful and/or overstimulating activity or environments.  

While not an exhaustive list, some of the common and predominant symptoms of long COVID among patients can include:

• Fatigue 
• Respiratory problems 
• Digestive issues 
• Fever 
• Physical pain 
• Brain fog (difficulties concentrating, thinking or recalling words, confusion, forgetfulness, etc.) 
• Changes in mood 
• Memory issues 
• Anxiety and depression 
• Substance abuse 
• PTSD 
• Suicidal thoughts/thoughts of self-harm
• Trouble sleeping
• Loss of taste and smell 

What is Cognitive Pacing?  

Cognitive pacing is a methodology that fits under the umbrella term pacing.  

Pacing is a psychological technique focused on optimizing the balance between completing activities and reducing strain on your energy levels and has both a cognitive and physical component.  

Its goal is to help individuals better manage their energy and grow a personal understanding of their “energy envelope”. Your energy envelope, as defined by the Provincial Health Services Authority of British Columbia, is how much activity you’re capable of doing without exacerbating your symptoms. Both physical and cognitive pacing involves padding activity with breaks or lower impact activity.  

Types of Pacing:  

Cognitive Pacing - Improves cognitive function and brain health by modifying mental activities to make them easier. This helps individuals manage and maintain energy and slowly improve mental capacity over time. 

Physical or Activity Pacing - Manages physical activity to avoid body strain. This involves taking frequent breaks and/or portioning activities into smaller components.  

How Does Cognitive Pacing Help Treat Symptoms of Long COVID?   

HOW TO GET STARTED 

Cognitive pacing is a technique that’s easy to incorporate into your daily life and starts with the 3 Ps of pacing: 

• Perform an audit of your daily routine. Record your activities and how you feel emotionally and energetically for two weeks. If you’re not able to track everything for two weeks, make a list of common activities and try to reflect as best you can on how you typically feel after each one.  
• Observe any trends, record, and identify any triggers. For example, you may notice that you feel most exhausted after walking your dog during rush hour because the environment at that time is stressful and overstimulating.  
• Speak to your health professional. You may want to work with your general practitioner or therapist to understand activity trends, triggers, and what you should scale back on.  
• Understand where your energy is optimal. This includes which low-intensity activities energize you (where applicable). For example, you may feel more energized after spending time coloring vs after watching a TV show. 

• Create a schedule for every day. You can use a planner or an app to help you stay organized. 
• Categorize your daily activities. Identify which ones are a Need, a Should, or a Want. Prioritize your energy towards your Needs.  
• Pad your necessary activities with breaks. These breaks can consist of rest time or energizing activities. When you start, focus on resting for half of your day.  
• Avoid over-stimulating activities. This can often make symptoms worse. Try not to engage in activities that elevate your heart rate or are in overwhelming, high-intensity environments.   

• Switch activities often. Try not to spend too much time on one activity. Instead, pad your time with breaks (30-40 minutes of rest) or lower-impact tasks.  
• Modify your tasks. Break up necessary activities into smaller parts to make them more manageable. This can also involve making environmental changes, such as sitting in a chair rather than standing or dimming the lights to avoid overstimulation.  
• Use the 3 D’s for non-essential tasks. Categorize non-essentials by using these three options:  
  • Delete - You may have some tasks that are nice to have but won’t make an impact on your daily life. Remove them from your to-do list. 
  • Delegate. Ask if someone else can help. Or, if they are able, see if they can take the task on for you.  
  • Defer. Not comfortable with deleting or delegating? Move these activities to a later time. 
• Keep track of how you feel after each activity. Similar to the planning stage, charting the energetic and emotional impact of your day-to-day tasks can help you understand where to scale up and back.  
• Start small and slow. For any improvements, make sure you give yourself buffer time before adding more tasks or activities. Remember, it’s okay to cut back accordingly if you feel overwhelmed or tired.

TIPS FOR COGNITIVE PACING 

To help set you up for success, here are some tips to keep in mind as you adopt cognitive pacing into your daily routine. 

1. Be patient with yourself. Improvement may not be linear, and that’s okay. It’s normal to have days that aren’t as good as others.  
   
   
2. Incorporate mindfulness or meditation as part of your rest or low-impact activity. As you’re doing activities remember to take deep breaths or pause every so often to a body scan and breathe deeply. This can help manage stress levels and aid in improving your cognitive health.  
   
   
3. Get plenty of sleep. A healthy sleep schedule is an important component of brain recovery. Add in a wind-down routine and take time to create a supportive sleep environment for yourself. 
   
   
4. Maintain a healthy lifestyle. Support your cognitive pacing strategies by eating brain foods, exercising where possible, and reducing alcohol and caffeine intake. 
   
   
5. Plan rests before you begin to experience symptoms. As mentioned, incorporating rests throughout the day not only helps you work within your energy envelope but also avoids overexertion which can make long COVID symptoms worse.
   
   

SUPPORTING YOUR LONG COVID RECOVERY

Your recovery from long COVID will come with its own ebbs and flows. Remember to listen to yourself. Cognitive pacing is a practice of working with your abilities and capacities as they are now, which includes listening to your body and what it’s telling you. Focus on creating balance. If you feel tired, give yourself some rest. And if you’re aware an activity that wasn’t straining you before is starting to strain you, cut back. Above all, if any of your symptoms worsen, remember to contact your health professional.  

Experiencing employee burnout or know somebody who needs help? There are many ways to manage mental health and create balance. Read our top tips here.

To learn more about cognitive health and maintaining mind and body balance, check out the blogs on The Virtual Vine.  

ADDITIONAL RESOURCES:

• Understanding Stress and How to Manage It with Cognitive Pacing 
• Cognitive Pacing: A Step-by-Step Path to Improving Your Brain Health 
• Managing Fatigue in Post COVID-19 Recovery with Pacing 
• Post-Exertional Malaise in Post COVID-19 Recovery and Finding your “Energy Envelope” 
• Working Within Long COVID Limits