Introducing the Pacing Budget: Know How Much Today Can Take

If you live with long COVID, ME/CFS or POTS, you already know the cruelest thing about your energy: you only find the edge after you have crossed it. A good morning feels like permission. You do the shopping, answer the emails, stand in the kitchen a little longer than usual. Nothing hurts. Then a day or two later the bill arrives, and it is out of all proportion to what you did.

That delay is the whole problem. By the time your body tells you, it is too late to listen. Today we are launching the feature we built to close that gap: the pacing budget, a daily estimate of how much today can take, measured in minutes, spent as you move, and checked against what happens next.

Pacing works. Doing it by feel does not.

Pacing, staying inside your energy envelope instead of spending everything a good day seems to offer, is the most consistently recommended self-management strategy for conditions that involve post-exertional malaise (we cover the basics in Pacing 101). The UK’s national guideline for ME/CFS builds its advice around energy management, and World Physiotherapy’s guidance for long COVID recommends pacing and heart rate monitoring when post-exertional symptoms are present (World Physiotherapy).

The trouble is that pacing asks you to judge a limit you cannot feel until it is behind you. How you feel at 11am is exactly the wrong instrument, because post-exertional malaise is typically delayed. People keep spoon counts, activity diaries and heart rate alarms because they are trying to see the edge ahead of time. The pacing budget is that idea, done properly.

Meet your pacing budget

Open your Journal and look under your Autonomic Outlook. There is a new line: Pacing, a figure, and a bar.

The figure is what is left of today’s budget, in effort minutes. A minute of moderate effort costs one minute. Harder effort costs more, and gentle effort costs less. We picked minutes on purpose. A percentage would be a second score competing with your Outlook, and points mean nothing until you learn them. Everyone knows what forty minutes feels like.

The bar is what the day has spent. The small white mark is the one new idea in the design: it shows where an even day would be by now. Fill short of the mark means energy in reserve. Fill past it means you are spending faster than the day can sustain. That is what lets a single bar answer “how fast”, because “2h left” means something completely different at 9am than it does at 6pm.

How the budget is built

Your readings set the size

Each morning, Autonomic looks at what your nervous system is telling it: your HRV, your resting heart rate, last night’s sleep and the Autonomic score they add up to. A strong morning against your own baseline earns a bigger budget. A rough one earns a smaller one. It is the same logic endurance coaches use when they let a morning HRV reading decide whether today is a hard day or an easy one, an approach first tested in healthy athletes (Kiviniemi et al.). Here it is turned toward protecting you rather than training you.

What spends it

This is where the pacing budget parts company with a step counter. It counts what actually costs you, including the things a fitness tracker ignores:

• Logged activities. Every workout, walk and session you log, priced by how hard it was.
• Steps. Read from Apple Health or Health Connect, so a day with nothing logged still shows a real number.
• Upright time. Walking, plus standing still. For POTS, time on your feet is often the most expensive thing you do all day, and it barely registers as activity anywhere else. Autonomic estimates standing from quiet stretches where your heart rate sits in your own stand-test range, and it labels that row as estimated.
• Minutes with heart rate above your line. Your exertion line is yours, not a textbook formula. A minute well above it costs more than a minute just over it, so hovering at your line is never one beat of watch error away from a different day.

And two things work in your favor. Legs up and breathwork buy minutes back, up to a quarter of what the day has cost. Rest is not just the absence of spending. It is something you can do.

Four states, and nothing more

The bar only has two ways of telling you something: its length and its color. A color always means a state, never decoration.

Green is a day inside its pace. Gold means you are ahead of an even day, and the line under the bar tells you roughly when the budget runs out if you keep going. Red means over, and it is the only time anything on the card moves: a slow ember drifts through the bar, which reads as heat rather than loading. And on a day Autonomic sees you heading into a downturn, there is no number at all. A small budget on a bad day is still an invitation to spend it, so the budget simply pauses and says so.

One more rule we held ourselves to: filling the bar is never an achievement. Nothing congratulates you for using your budget, and nothing suggests that minutes you did not spend were wasted. A bar that fills like a progress bar would reward exactly the wrong thing.

Tap the strip: where today went

The whole strip is one tap target. Open it and you get the full picture of the day: the budget, the pace, and a ranked list of where it went, largest cost first.

Every row opens into its own detail. Upright time and recovery time are drawn by the hour, so you can see that the expensive part of your day was not the walk you logged at ten but the ninety minutes you spent standing at the stove at six. That is the kind of pattern that is invisible from inside a day and obvious once it is drawn.

It checks its own work, two days later

Here is the part we are proudest of, and the part we think matters most.

Post-exertional malaise does not show up on schedule. The UK’s ME/CFS guideline describes it as often delayed in onset by hours or days (NICE), and in a survey of 150 people with ME/CFS, 84% said an episode lasted a day or longer (Chu et al.). And when people with ME/CFS repeat a cardiopulmonary exercise test 24 hours after the first one, their performance on the second day falls in a way that sedentary healthy people’s does not (Snell et al.; Keller et al.). Yesterday’s effort is still being paid for today.

So a pacing tool that judges a day by how you feel the next morning is grading itself on the wrong exam. Autonomic checks every under-budget day against the day after and the day after that. If both hold, the estimate was good. If you dipped anyway, it was not, and the app says so.

That grading is also how the budget learns you. Three rules keep it honest:

1. There is a budget from day one. It starts from your daily score and wears a “Learning · day 3” label and a softened “About 4h” figure until it has seen enough of your days to fit.
2. Held days can only raise the ceiling. What you spent on a day that held proves you can absorb at least that much. It never proves you cannot absorb more, so a quiet week where your phone only saw two short walks can never shrink your budget.
3. Only a dip can lower it. The ceiling comes in when your own data gives it a reason, and not before.

Pacing that reaches you when the app is closed

A budget you have to remember to check is a budget you will forget to check on exactly the day it matters. So the pacing budget does not stay inside the app.

Pacing alerts

Turn on pacing alerts and Autonomic keeps an eye on your day in the background, using the steps and heart rate already flowing into Apple Health or Health Connect. It will tell you when you are running ahead of pace, when the budget is nearly spent, when you have gone over, when your heart rate has stayed above your line for a stretch, and the morning after a day that ran over.

We paced the alerts harder than the budget they describe. There are at most three a day, at least 45 minutes apart, never before your logged wake time and never late at night. They only ever escalate, they stay quiet on a day the crash warning has already spoken, and no alert ever invites you to spend what is left. A heart rate alert names the actual number (“above 95 bpm for 28m”), because “above your line” is meaningless on a lock screen with no app around it.

Home screen widgets

Two new widgets put the budget where your thumb already goes. Pacing shows what is left and the bar. Pacing Detail adds the state and what you have spent against the budget. The pace marker walks across the day on its own schedule, so the widget stays honest even when you have not opened the app since breakfast.

On your Apple Watch

Pacing is now on the Autonomic watch app, too. Raise your wrist in the middle of a long errand and you get the figure, the bar with its pace marker, and what you have spent against your budget. The watch mirrors exactly what your phone and widgets show, because all three are drawn from one budget. They cannot disagree.

What it gives you back

Pacing is sometimes described as a list of things you cannot do. We see it the other way around. The point of knowing your limit is getting to use everything underneath it without fear.

• Plan the day you want. If the beach this afternoon matters more than the laundry this morning, you can see what that trade costs before you make it.
• Stop guessing on good days. A strong morning gets a bigger budget, with a real number on it, so a good day becomes a good day rather than tomorrow’s crash.
• See your hidden costs. Standing, heat and a heart rate that ran high while you sat in traffic all show up in the ranked list, instead of staying a mystery.
• Watch capacity grow. As held days accumulate, your ceiling rises on evidence. For many people that slow widening is the first objective proof that recovery is happening.
• Bring it to your doctor. Your pacing history is included in the doctor summary and health reports you can export, in effort minutes, with a clear note that the budget is fitted from your own history and is not a prescribed activity limit.

The science behind it

Every piece of the pacing budget answers a question the research has already asked. Here is how the design maps to the evidence.

Post-exertional malaise is real, and it is delayed

PEM, the worsening of symptoms after physical, cognitive or emotional effort that would once have been easy, is a hallmark of ME/CFS (CDC). It is also common in long COVID: in an international cohort of 3,762 people, post-exertional malaise was among the most frequent symptoms still present after six months, and 85.9% reported relapses, most often triggered by exercise, physical or mental activity, or stress (Davis et al.). Its onset is often delayed by hours or days (NICE), and in two-day exercise testing, people with ME/CFS cannot reproduce their first day’s performance 24 hours later (Snell et al.; Keller et al.).

In the app: every day is judged by the two days that follow it, never by tomorrow alone. The two-day window is our design choice, built on this evidence rather than proven by it.

Pacing is the recommended strategy

The UK’s NICE guideline for ME/CFS recommends energy management, a plan for staying within your limits across physical, cognitive, emotional and social activity, and suggests using tools people already have, such as an activity tracker or a heart rate monitor (NICE NG206). The CDC likewise says PEM can be mitigated by pacing, balancing rest and activity (CDC). For long COVID, World Physiotherapy advises that exertion should not be pushed to the point of symptom exacerbation, “both during and in the days following exertion,” and that pacing and heart rate monitoring may be effective (World Physiotherapy). In a small study of 31 people with post-COVID syndrome, six weeks of a structured pacing protocol was followed by fewer post-exertional episodes, from 3.4 to 1.1 a week, and better quality of life, though the study had no control group (Parker et al.).

In the app: the budget is an envelope you stay inside, and nothing in it rewards spending more.

Heart rate is an early warning, if it is personal

Heart rate pacing means keeping activity below an individual threshold. The Workwell Foundation suggests resting heart rate plus 15 bpm as a starting estimate (Workwell Foundation), and in an international survey of 488 people with ME/CFS, those who paced with a heart rate monitor reported less severe and shorter PEM (Clague-Baker et al.). The evidence is still early, mostly surveys and clinical guidance, and the word that keeps coming up is individual. A textbook “220 minus age” line says little about a nervous system that is not behaving by the textbook.

In the app: minutes above your own exertion line are charged by how far above it you went, and the line is yours.

Morning HRV can guide what a day should hold

Heart rate variability reflects autonomic balance, and it responds to accumulated load. In a trial with healthy, moderately fit men, letting each morning’s HRV decide between hard training and rest improved fitness at least as well as a fixed plan (Kiviniemi et al.). That research was done in healthy people, not in ME/CFS, long COVID or POTS, so we borrow the principle rather than the protocol: read today’s readiness instead of following yesterday’s plan.

In the app: your HRV, resting heart rate and sleep set the size of today’s budget against your own baseline.

Standing is work, especially with POTS

Postural orthostatic tachycardia syndrome is defined by what happens on standing: an excessive rise in heart rate, in adults at least 30 bpm within 10 minutes, with symptoms of orthostatic intolerance (StatPearls). A step counter sees nothing while you wash the dishes. Your autonomic nervous system sees everything.

In the app: upright time, including estimated standing, is a spend row of its own.

Spoons, measured

Many people with chronic illness already think of energy as a limited daily allowance, thanks to Christine Miserandino’s spoon theory. The pacing budget keeps that intuition and gives it a unit, a pace and a way to check itself.

How to get started

1. Download or update Autonomic. The pacing budget arrives in version 1.28.
2. Connect Apple Health or Health Connect. Steps and heart rate are what let the budget count your whole day, not just what you remember to log.
3. Take a morning reading. An HRV reading with a chest strap, your Apple Watch or your phone’s camera gives the budget the best starting point.
4. Glance at the strip, then live your day. Check the marker when you are deciding whether to do one more thing. Let the alerts and widgets do the rest.
5. Give it a couple of weeks. The “Learning” label comes off as the budget sees your days hold, and the “How well this holds” card shows you how much to trust it.

References

1. National Institute for Health and Care Excellence. Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management (NG206). 2021.
2. Centers for Disease Control and Prevention. Symptoms of ME/CFS.
3. Centers for Disease Control and Prevention. Strategies to prevent worsening of symptoms.
4. Chu L, Valencia IJ, Garvert DW, Montoya JG. Deconstructing post-exertional malaise in myalgic encephalomyelitis/chronic fatigue syndrome: a patient-centered, cross-sectional survey. PLoS One. 2018.
5. Snell CR, Stevens SR, Davenport TE, Van Ness JM. Discriminative validity of metabolic and workload measurements for identifying people with chronic fatigue syndrome. Physical Therapy. 2013.
6. Keller BA, Pryor JL, Giloteaux L. Inability of myalgic encephalomyelitis/chronic fatigue syndrome patients to reproduce VO2peak indicates functional impairment. Journal of Translational Medicine. 2014.
7. Davis HE, Assaf GS, McCorkell L, et al. Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. eClinicalMedicine. 2021.
8. World Physiotherapy. Safe rehabilitation approaches for people living with Long COVID: physical activity and exercise. Briefing Paper 9. 2021.
9. Parker M, Sawant HB, Flannery T, et al. Effect of using a structured pacing protocol on post-exertional symptom exacerbation and health status in a longitudinal cohort with the post-COVID-19 syndrome. Journal of Medical Virology. 2023.
10. Workwell Foundation. Pacing with a heart rate monitor to minimize post-exertional malaise in ME/CFS and long COVID.
11. Clague-Baker N, Bayliss K, Leslie K, et al. An international survey of experiences and attitudes towards pacing using a heart rate monitor for people with myalgic encephalomyelitis/chronic fatigue syndrome. Work. 2023.
12. Kiviniemi AM, Hautala AJ, Kinnunen H, Tulppo MP. Endurance training guided individually by daily heart rate variability measurements. European Journal of Applied Physiology. 2007.
13. Zhao S, Tran VH. Postural orthostatic tachycardia syndrome. StatPearls. 2023.
14. Miserandino C. The Spoon Theory. But You Don’t Look Sick. 2003.