Activity pacing in daily life: A within-day analysis

Activity pacing is a widely used self-management strategy, but we lack a clear understanding of its nature and usefulness. One source of confusion is a lack of clarity about the use of pacing in everyday life (ie, naturalistic pacing) in people not trained on how to pace activities. It is unknown whether people engage in more pacing when pain is high (pain-contingent) or when fatigue is high (fatigue-contingent). Conversely, it is not known whether naturalistic pacing results in reduced symptoms. We conducted a multilevel daily process study in which participants with osteoarthritis (N = 162) reported pain and fatigue severity and frequency of pacing behaviors 5 times per day over 5 days. We hypothesized that increased pain and fatigue would predict increased pacing and that pacing would have a short-term benefit in terms of decreased pain and fatigue. Multilevel modeling results showed that, as expected, both momentary pain and fatigue were positively associated with subsequent pacing behaviors. Contrary to our hypothesis, increased pacing was associated with higher subsequent levels of pain and fatigue. Naturalistic pacing seems symptom-contingent and not reinforced by symptom reduction. Naturalistic pacing may be distinct from trained or programmatic pacing in terms of outcomes, and further research into naturalistic pacing may provide an important foundation for how best to deliver activity pacing interventions.