Shifting Gears: A Guide to Pacing

I recently experienced an unforeseen medical emergency that required me to stay in the hospital for four days. Although it was a non-RA related issue, my underlying RA contributed to my extended healing time and increased fatigue. My healing process has taken a couple of months that has afforded me the opportunity to think about (and practice) a great skill - pacing life to compliment my current physical abilities. I have been able to process what I experienced as well as write this blog for the community!


Living with RA often presents moments when you have to accept your current circumstances that are less favorable than the ones you would rather exist in. You know, those moments that produce thoughts such as “I wish I wasn’t so tired because I’d like to be running along with my kids,” “If I did not have this wrist pain then I could make a home cooked meal,” and “This inflammation is making me so miserable it is preventing me from joining in the holiday fun.” We all have moments of being overwhelmed, saddened or frustrated by our disease. However, the most difficult part is accepting these negative feelings.

In contrast, we also have moments where we feel like we’ve defied all odds and are our own kind of hero. The elating feelings when you're finishing every errand you set out to do during a day, despite the nagging pain in your back or when you are able to complete a long leisurely bicycle ride without needing too much pain relief medicine. You feel on top of the world! You feel like superwoman/man! You feel invincible! These are usually the moments we like to think of when we are in a negative circumstance – after all, a bit of optimism goes a long way.

Regardless if you are feeling worse or better than your “normal/baseline,” the truth is our “normal” changes daily. It is difficult, yet very important, to accept your current state of health especially when it is not favorable. I challenge you to think about how accepting your current state of health will change your outlook on it. Will accepting your health status make it easier to deal with mentally?   Consider this acceptance a lesson in self talk. Saying “I wish I wasn’t so tired” vs. “I am tired but I will have more energy later or tomorrow” can change how we view our situation. The latter sounds more accepting. Acceptance of reality can also create the first building block of pacing your life to compliment your physical abilities.


The easiest way for me to describe the principal of pacing is to use an engine analogy. Think of a manual shift car – you have to shift through each gear to get to top speed. You cannot skip any and you certainly cannot fool a car into going faster than it is ready to. This is also true for our bodies. In order to shift to a higher gear, you must gain momentum in the lower gears – building on completing daily life responsibilities that will lead to being able to do more as time passes and you are more physically able.

A way to prioritize your daily life is thinking of all of the possible things you need to do. Think of what requires low, medium and high energy to complete. The low gear category is saved for the things that absolutely need to get done daily – such as self care and childcare – regardless of your physical abilities (thus, keep this list as trim as possible). The medium gear consists of things that you need to do and other things that can be completed semi regularly when you are more physically able. The high gear category would be things that you’d like to do and can be saved for when you have maximum energy. Only you know what should be in each category.

This is a good system to help yourself practice pacing in your daily life. Please keep in mind this is not a linear path – gears shift up or down at any given time. I use this system to remind myself that regardless of what gear I am in, it will not last forever. I find that it helps ease my anxiety when I am stuck in low gear for extended periods of time. Case in point, my healing from my recent hospitalization has been much slower than I originally anticipated. It was incredibly frustrating to go from “running in high gear” to being stuck in low gear for weeks on end. As my recovery continues, I have to accept the reality of my physical abilities while practicing prioritizing and pacing life accordingly.

Focus on the Positive

A positive outlook cannot change negative circumstances, but it will continuously remind you to search for hope amidst the less favorable moments of sadness and frustration regarding your physical health. Pacing your life to compliment your ever changing physical state will give you power. Power to focus on what is in your control. Power to change for the better by taking control of your daily life circumstances and living, rather than suffering, from rheumatoid arthritis.

This blog is based on the principle of pacing (prioritizing and completing tasks according to their importance). As an occupational therapist, I hope to guide you with helpful hints that may make living with RA more manageable.  

By providing your email address, you are agreeing to our privacy policy. We never sell or share your email address.

More on this topic

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Join the conversation

or create an account to comment.