Managing Energy Levels In CFS - systems analysis approach

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I am very aware that one of the hardest aspects of having CFS is knowing how to manage your time so that in each day you have enough complete rest. Without this the healing process does not have the chance to begin its work and the illness goes from bad to worse.

I am grateful to one of my patients, Andy Stephens, for the theory behind this handout. He has a background in systems analysis, which is a tool used to ensure a consistent output from a system. Lost already? Don't panic. Andy tells me this can be applied to any system, including the body. He has used his experience to devise a system to help him pace his activities and predict the level of activity at which he is going to be well. This is very helpful for CFS patients. It is vital that they pace all their activities, but most sufferers are driven by guilt because they feel they are not doing enough. Working out this system for each sufferer means that how much they are or are not allowed to do in a day is dictated by a few simple guidelines.

I am informed by my patients that this page is the "Marmite" page on my website - they either love it or hate it! So, read on and see which camp you fall into!

Many thanks also to Lindsey Adams, who supplied the figures for our example and made this handout CFS patient friendly.

How to work out your optimum hours of daily activity

This is how you do it for yourself:

1. You keep a daily record of all your activities, which you log on an hourly chart (not shown here). You do it for a month paying careful attention to record the periods of rest when you are either sleeping, lying down without the TV or radio on, or are in the bath. Gentle yoga, relaxation or meditation can also be logged into this category.

2. You add up the hours of activity for each day,

i.e. day1 - 8.5 hours(8 hrs 30 mins),

day 2 - 8.25 hours (8 hr 15 mins) etc.

3. Now you work out the difference between each day's hours of activity and the next. In our example the difference between day 1 and day 2 is 1/4 hour (recorded as 0.25), between day 2 and day 3 is 2 1/4 hours (2.25) and so on.


Hours of Daily Activity

1 8.50 -
2 8.25 0.25
3 10.50 2.25
4 9.50 1.00
5 8.00 1.50
6 8.75 0.75
7 10.50 1.75
8 9.50 1.00
9 11.50 2.00
10 8.75 2.75
11 12.50 3.00
12 12.50 3.00
TOTAL 115.75 17.00

4. Add up all the differences: 0.25 + 2.25 + 1 + 1.5 + 0.75 + 1.75 + 1 + 2 + 2.75 + 0.75 + 3 = 17.

5. To find the average of this sum you divide 17 by the number of differences (the number of differences in our example is 11), i.e. 17:11=1.54).

6. Use this average and multiply it by 1.128 = 1.73 (Don't ask where 1.128 comes from – it is just a number that works for this system!) This figure 1.73 (rounded up to 1.75 hours) is called a standard deviation from the average.

7. Total up the daily hours of activity - in our example the sum is 115.75 hours. When divided by the number of days it gives you your average hours of activity per day;

AVERAGE HOURS: 115.75 / 12 days = 9.64; rounded up to nearest 1/4 hour = 9.75 hours STANDARD DEVIATION: 17 : 11 = 1.54; 1.54 X 1.128 = 1.73; rounded up to nearest 0.25 hour = 1.75 hours


7 [out of 8] Day limit: Keeping your daily amount of activity at or below 9.75 hours (9 hours 45 mins) results in wellness (unless something unexpected happens, i.e. extra stress you did not budget for);

  • You can get away with 7 days of 9 hrs and 45 mins of activity in every period of 8 days. Exceeding the average (9 hours 45 minutes a day) for more than 7 days out of 8 results in relapse.

3 Day limit (Average hours + 1 standard deviation = 11.5 hours):

  • Exceeding 11.5 hours (11 hour 30 mins) of activity a day on more than 3 out of 4 days results in relapse.

2 [out of 3] Day limit (Average hours + 2 standard deviations = 13.75 hours):

  • Exceeding 13.75 hours (13 hours 45 mins) of activity a day on more than 2 in 3 days results in relapse.

0 Day limit (Average hours + 3 standard deviations = 15 hours):

  • Exceeding 15 hours of activity ALWAYS results in relapse.

These rules can also be represented by a graph.

Safe maximum hours of activity‎


This does make sense. What it means is that to work most efficiently you should never do more than 11 hours 15 minutes of activity and never less than 7 hours 45 minutes. Working outside these limits means you become inefficient and waste energy needlessly.

This is comparable to a marathon runner. If he is to succeed he must pace himself carefully and always run within certain limits - not too fast, not too slow. The runner who sprints 100 metres, then walks 100 metres is not going to manage a marathon. The runner who jogs along at comfortable running speed will make it!

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