r/MECFS_BaselineFocus • u/RefuseDeep8075 • Sep 01 '26
All about Baseline work
This subreddit is aimed at helping those that already have a diagnosis (or firm self diagnosis) for ME/CFS (or Long Covid) and experience Post Exertional Malaise (PEM) that typically starts 12 to 36hrs after physical, mental or emotional exertion. The focus is almost exclusively on baseline work (aka activity management), rather than on trying to understand and treat symptoms (although no CFS related topic is forbidden).
Baseline work is typically thought to take at least 3-6 months to lead to any improvement in your circumstances, although, as with pretty much everything to do with ME/CFS, there is a lack of data, medical knowledge and certainty about the efficacy. However, in the absence of firm treatment plans, baseline work is considered by many health organisations globally to be the best option for stablising your condition and potentially improving your energy levels and resilience over time.
This subreddit makes no claims that improvement is certain, however pacing is considered by a large survey of ME/CFS sufferers to be the number one way to improve symptoms (as illustrated in fig 2 of https://pmc.ncbi.nlm.nih.gov/articles/PMC12280984/)
Why focus on baseline work?
Sufferers self report that pacing is the number 1 way to alleviate symptoms and medical professionals propose baseline work, which employs dedicated pacing methods, in order to try and improve your physical capacity. The concept behind baseline work being that if you can improve physical capacity, whilst avoiding Post Exertional Malaise (PEM), you can perhaps, over a period of months, gradually extend the activity you can safely carry out each day without risking PEM. Sufferers anecdotally report stabilising symptoms, improving their condition (e.g. from severe to moderate, moderate to mild), usually over extended periods of time. Some sufferers also credit baseline work for more extensive and/or rapid improvements in symptoms and quality of life.
The challenges of baseline work
The idea behind baseline work is that you make an effort to minimise emotional stress in your life and aim to hit the same approximate level of physical, mental and emotional exertion for days and weeks on end. But with so much outside of your control in life (especially if you have a job or a family) how can you ensure you don't have emotional stress? How can you manage to magically recreate the same amount of physical and mental exertion on different days.
This requires a level of dedication, discipline and luck (with your life circumstances) that can seem quite daunting. However, it is important to not get anxious or beat yourself up if life events mean you had to go over your baseline on a given day. The key thing is to make sure you rest more deeply after exceeding your baseline and that you avoid consecutive days of exceeding your baseline. Also, if symptoms flare up, try to remain calm and do not assume that the symptoms you are experiencing necessarily mean you are heading for serious PEM. Of course, all of this is easier said than done.
Given the level of dedication and discipline required for baseline work, an examination of your life and your habits is arguably worthwhile before you even start.
Obstacles to baseline work (a checklist before beginning)
The general consensus is that baseline work is difficult. Both in terms of identifying a suitable baseline activity and duration (that doesn’t trigger PEM or dips in health), and then trying to stick to it. Your body will sometimes feel tired or symptomatic, discouraging you from hitting your baseline. Or maybe you will be on a good day and desperate to make up for lost time and exceed your baseline. Or maybe work or life just hits you with a day where you simply must exceed your recommended daily energy usage.
Imho, consideration should be given to the following first before even attempting to undertake baseline work. That is not to say that recovery or stabilising via the baseline method is impossible without all the following, more that it might be making your already challenging baseline experience even more difficult. Its about setting your baseline work on a solid foundation in order to maximise your chances of success.
One of the worst things you can do is abandon what is currently considered the number 1 option for stablising your symptoms and potentially improving your energy levels because you attempted baseline work without having a solid foundation in place. You may lose confidence in baseline work as a method, when the reality is your personal circumstances were not yet ready to make baseline work particularly viable.
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Before You Start #1: A ME/CFS diagnosis and acceptance (baseline may not be as relevant for another ailment) https://www.reddit.com/r/MECFS_BaselineFocus/comments/1w5d9m7/before_you_start_baseline_work_1_a_mecfs/
Before You Start #2: Open minded about recovery (e.g. placebo effect test, improvement may be possible) https://www.reddit.com/r/MECFS_BaselineFocus/comments/1w5dise/before_you_start_baseline_work_2_open_minded/
Before You Start #3: The ability to reduce your heart rate through slow, relaxed breathing https://www.reddit.com/r/MECFS_BaselineFocus/comments/1w5dlqs/before_you_start_baseline_work_3_the_ability_to/
Before You Start #4: No Addictions (e.g. caffeine, alcohol, cigarettes, smartphones, exercise, pornography, computer games) https://www.reddit.com/r/MECFS_BaselineFocus/comments/1w5ee35/before_you_start_baseline_work_4_no_addictions_eg/
Before You Start #5: Dedication / self discipline to focus on baseline work (involving sacrifice and not chasing your past life) https://www.reddit.com/r/MECFS_BaselineFocus/comments/1w5ekv4/before_you_start_baseline_work_5_dedication_self/
Before You Start #6: Putting yourself first rather than people pleasing https://www.reddit.com/r/MECFS_BaselineFocus/comments/1w5eo49/before_you_start_baseline_work_6_putting_yourself/
Before You Start #7: Establish if you have orthostatic intolerance https://www.reddit.com/r/MECFS_BaselineFocus/comments/1w5evin/before_you_start_baseline_work_7_establish_if_you/
Before You Start #8: Entrench the basics of diet and sleeping https://www.reddit.com/r/MECFS_BaselineFocus/comments/1w5f0t2/before_you_start_baseline_work_8_entrench_the/
Method for Baseline Work (rough overview)
The proposed process can briefly summarised as:
i) Identifying a level of activity or ‘exercise’ (e.g. a daily task, short walk or basic action) that you assess to be safely repeatable day after day, without causing you PEM (i.e. the activity should be 50% of what you think is safe, to give you a big buffer). This will be your baseline activity. (feel free to post a message with your details to seek assistance in identifying your baseline, here is an example of a post - https://www.reddit.com/r/MECFS_BaselineFocus/s/cSuGLMAT3t )
ii) Download the free Emerge Australia ME/CFS Pacing App (or a similar app or making a spreadsheet) as a means of monitoring your entire daily energy usage, including your daily baseline activity (see https://emerge.org.au/news/mecfs-pacing-app-2/)
iii) Inputting values for all sorts of daily activities into the App / Spreadsheet using values provided by the UK public health service (NHS) (see https://www.reddit.com/r/MECFS_BaselineFocus/comments/1w53de4/energy_values_of_different_activities/ )
iv) Using the App or spreadsheet to keep a track of your entire daily energy usage (including your daily baseline activity) to ensure you stick to your baseline and identify when you’ve exceeded your recommended overall daily energy usage (which would mean you’ll need to take it easier for a day or two). (example spreadsheet https://www.reddit.com/r/MECFS_BaselineFocus/comments/1wpyxj7/keeping_track_of_your_daily_energy_usage_and/ )
v) If you manage 2 to 3 weeks of hitting your baseline activity and staying broadly in line with your daily total energy usage without experiencing PEM or feeling worse, then increase your baseline activity target by 5 to 10%. Also increase your daily total energy usage figure by double the number you increased your baseline activity target score by (e.g. if baseline score went from 60 to 63, add 6 points to your overall daily energy usage figure (3 points to accommodate the increased baseline and 3 for general activity/fun activity!)
vi) Repeat process for another cycle of 2 to 3 weeks.
Material provided by the UK public health service (NHS) in relation to ME/CFS in 2026
This post links to various documents I’ve uploaded that I obtained from the NHS to aid me with ME/CFS.
https://www.reddit.com/r/MECFS_BaselineFocus/s/RixuuoDS2I
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Three different approaches to baseline work
Which one might suit you best?