Pacing up is an approach that is central to rehabilitation. I suspect it is so basic a building block of most therapists and clinicians’ understanding that it rarely occurs to any that it needs any justification. Central to this is establishing what the patient is able to do then encouraging practice at just below the current limit in the hope that they will be able to do more. Then as long as they seem able to improve you continue doing this.
This sort of works with something like a stroke where you are primarily dealing with a stable neurology following a one off acute event. You get improvement, though not asking why, until you don’t. In such as a stroke rehab unit, as long as you get improvement rehab continues, until the multidisciplinary team agrees improvement is levelling off, when you discharge. However, unfortunately ME/CFS seems to involve some form of ongoing process, so though initially you may have the illusion that pacing up works, ultimately it for most can trigger deterioration longer term or even a major relapse.
I haven’t read any of the more recent BACME material, but don’t they in part subscribe to the idea of central sensitisation which is different to both deconditioning and fear avoidance. However seeking to desensitise in practice produces an intervention very similar to the previous models. I guess they are seeing ME/CFS as exercise intolerance rather than exercise phobia, which can be overcome by gradual desensitisation.
