Introduction
When humans travel over a long distance using their own resources, they choose a pace that enables them to reach the goal of locomotion with a self-chosen degree of physiological strain and without threatening their health. This regulation of performance is generally termed pacing.
Pacing requires the integration of anticipation (feed-forward) with physiological signals (feedback) and is particularly apparent in endurance sports: Athletes tailor their metabolic strain, based on their experience and depending on the situation, to temporal or spatial goals (Ulmer,
1996). Pacing also plays a vital role in everyday physical activity, and in the prevention and rehabilitation of lifestyle diseases (Edwards & Polman,
2013; Smits, Pepping, & Hettinga,
2014).
The term pacing has been interpreted in a number of ways, as demonstrated in the following paraphrased reviews. Pacing is, therefore,
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… as originally used in endurance-oriented competitive sports, the efficient utilization of energetic resources during competition, so that all available energy stores are depleted shortly before the finish line, while no considerable reduction of speed occurs (Roelands, de Koning, Foster, Hettinga, & Meeusen,
2013).
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… in expanded contexts, the goal-directed management of performance and effort in the course of a long-lasting physical activity. Pacing is the strategy of individuals, both highly active and physically inactive, to manage physical and mental performance and effort in relation to a specific goal, understanding the presumable demands of the task (Edwards & Polman,
2013).
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… independent of context, the behavioral expression of a continuously running decision process during the regulation of physical performance (Smits et al.,
2014).
The term pacing relates to the process of goal-directed management of human resources during physical activity (including both the mechanisms and the organization of the regulation of performance; Edwards & Polman,
2013; Smits et al.,
2014; St Clair Gibson et al.,
2013) as well as to the result of this management, namely, a profile of the intensity of human work (i. e., physical activity) over time (Abbiss & Laursen,
2008). This intensity profile usually relates to the speed of movement (Abbiss & Laursen,
2008; March, Vanderburgh, Titlebaum, & Hoops,
2011; Tucker, Lambert, & Noakes,
2006), but at times it may relate to the delivered mechanical, physiological, or volitional performance (Bernard et al.,
2009; Edwards & Polman,
2013; Le Meur et al.,
2009; St Clair Gibson et al.,
2013). Pacing in endurance sports may be influenced by a variety of factors, such as duration (Abbiss & Laursen,
2008), mode of competition (Thiel, Foster, Banzer, & de Koning,
2012), emotions and affective response (Baron, Moullan, Deruelle, & Noakes,
2011), deception and false feedback (Jones et al.,
2013), as well as performance level, age and/or sex of the athlete, and environmental conditions (Thiel, de Koning, & Foster,
2015).
In performance-oriented sports, the term pacing strategy has been used to denote a recurring, characteristic sports- and discipline-specific pattern of distributing energetic resources over the course of a competition, demonstrated in the temporal course of speed or power output (Abbiss & Laursen,
2008). There are different types of pacing strategies. Positive strategies, for example, relate to the controlled reduction of performance over the course of a bout of physical activity. Negative strategies refer to the controlled increase of performance over the course of a bout of physical activity, while variable strategies include fluctuations in performance without an immediately recognizable pattern. These fluctuations may arise from preplanned or spontaneous responses to changes of the pace of an opponent, the level of perceived exertion, or the ambient conditions.
The growing topicality and relevance of pacing is demonstrated in the increasing number of international publications on pacing in competitive sports. However, pacing in physical activity in everyday life, as well as in the prevention and rehabilitation of lifestyle diseases, is less frequently considered in the national and international literature.
Pacing is observed in all endurance performance contexts (Edwards & Polman,
2013; Smits et al.,
2014), such as locomotion and transportation, workplace (Ulmer,
1996), and leisure and health (Ekkekakis,
2009). Performance is regulated in regard to the relationship between investment and reward, where investment refers to energetic expenditure, physical fatigue, and perceived risks, and reward refers to the likelihood to reach the intended goals and effects.
In contexts other than competitive sports, the goal is usually not to maximize the speed of locomotion or to deplete physical resources, but to find an individually appropriate pace and level of effort. The anticipatory regulation of physical performance is as relevant for a 65-year-old woman with chronic obstructive pulmonary disease (COPD) who carries her purchases to her flat on the fourth floor (Castro et al.,
2013) as for an overweight skilled worker using heavy tools all day at high ambient temperatures or for a patient with multiple sclerosis doing the six-minute walking test (Burschka et al.,
2012).
All these tasks, if performed in the usual manner under the given circumstances, induce considerable cardiorespiratory, metabolic, and neuromuscular stress in the individuals carrying them out. A lack of regulation would potentially threaten health, inducing strong physical discomfort (Ekkekakis, Parfitt, & Petruzzello,
2011) and/or slowing down or otherwise impairing the completion of this task or following tasks due to fatigue.
Thus, endurance-related physical activity in the prevention (that is, sports for health) and rehabilitation (that is, exercise therapy) of lifestyle diseases also requires pacing. Promoting adequate pacing in health sports and exercise therapy would facilitate increased competence orientation in these contexts (Sudeck & Pfeifer,
2016) as recommended by health insurances and social pension funds (Deutsche Rentenversicherung,
2016), and empower and strengthen autonomy in terms of patient and client orientation.
The current paper aims to initiate a discussion on the role of pacing in the context of endurance performance in sports for health and exercise therapy. First, pacing will be explained in relation to fatigue and sense of exertion, and then the role of pacing in optimizing health effects and minimizing risks will be discussed, using examples from cardiac prevention and rehabilitation. Next, the relationship between pacing, sense of exertion, and affective condition will be explored, and determinants and approaches for the acquisition of competence will be presented. Finally, application potential and further research requirements will be outlined.
Fatigue and perceived exertion as a basis for pacing
Perceptions of fatigue and exertion play an important role in endurance-oriented physical activity and exercise training. Muscular fatigue is the exercise-induced reduction in the ability of a muscle to produce strength or power, independent of whether or not the currently executed movement task can be continued (Enoka & Duchateau,
2008). In a fatigued state, a higher subjective effort may be necessary to produce the same performance (Davis & Bailey,
1997).
The supraspinal sensation and appraisal of fatigue enables the foresightful dosing of the current performance and prevent excessive peripheral fatigue when considering the remaining physical work (anticipation of the endpoint of a motor task) and ambient conditions (Knicker, Renshaw, Oldham, & Cairns,
2011; Weir, Beck, Cramer, & Housh,
2006). Perceptions related to fatigue are continuously used to estimate the effect of the intensity of the momentary exercise on the future performance capability and to adapt the intensity if necessary (St Clair Gibson et al.,
2006).
According to Borg, the sum of the situationally relevant peripheral fatigue signals, combined with feelings of physical stress and effort, can be verbalized and measured as the rating of perceived exertion (RPE; Borg,
1970). Findings from high performance sports show that the rating of perceived exertion will usually increase linearly until the finish, provided that an even pacing strategy is being used under standardized conditions (Faulkner, Parfitt, & Eston,
2008).
Pacing is based on [1] the sense of exertion as the perception of current fatigue, but it goes far beyond that (Tucker,
2009). It also includes the following:
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[2] The conscious choice or subconscious preference of a desired or maximally tolerated level of effort to reach the intended goal: “I do not feel very motivated today, so I would rather put in a moderate effort.”
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[3] The anticipation of the remaining physical work (feed-forward mechanism): “I still have two laps in the park to go.”
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[4] The estimation of the current physical capacity: “I have been able to practice a lot in the last months, so my aerobic fitness level should be relatively good.”
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[5] The consideration of experiences with the completion of the same or somewhat similar exercise task: “Right now, with two of four laps finished, I feel similarly stressed as in the last training bout, which I completed without a problem.”
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[6] The choice of keeping or changing the momentary physical performance based on Points [1] to [5] above: “Right now, I have finished half of my training distance. The exercise feels fairly light (Borg 11). Considering my previous experience and estimating my aerobic fitness, this is how I had expected it to be at this point. I will maintain my running speed so that I will feel only moderately exerted at the end of this training bout.”
Thus, the actually generated physical performance is the obvious, objectively measurable result of psychophysiological decision processes. These processes may or may not take place consciously, and can be verbalized as in the examples above if conscious. As shown in the following section, this does not occur only in high performance sports but also in health sports and exercise therapy.
Side effects and potential of self-regulated exercise training in health sports
If exercisers take greater responsibility for regulating their training load, some will exercise less and others more intensively than recommended. In this respect, before starting an exercise program, it is necessary to identify persons with contraindications (physical activity questionnaire, sports medical examination) and persons who need special support (e. g., no previous experience with sports training). The latter usually have to be instructed, guided, and coached more intensely. Apart from studies with very small samples, in which no side effects were observed during self-regulated exercise (Ilarraza et al.,
2004), it is unclear how far self-regulation alters the risk for side effects. Both increased as well as decreased risk seems plausible, depending on the control competency and the respective conditions. The absolute risk of a cardiac complication during physical training is generally very low, with 0.08 to 0.24 incidents per 10,000 training hours, and it is quite similar for patients in cardiac outpatient rehabilitation and healthy persons doing leisure sports (Foster & Porcari,
2001). The relative risk of an immediate cardiac event during physical training (as compared to being sedentary) lies between 2.1 and 56 (Franklin & Billecke,
2012). Physically inactive individuals with cardiovascular disease who perform high intensity work that they are not used to have the highest relative risk (Foster & Porcari,
2001; Franklin & Billecke,
2012). These individuals should increase their training load very carefully over a long period of time and should be educated concerning load regulation with special diligence.
Under certain premises, in some patient groups, the use of high intensity training (HIT) is considered effective and safe (Guiraud et al.,
2012; Helgerud et al.,
2011). Preliminary studies showed that during or immediately after a total of 46,000 h of supervised intensive interval exercise, two non-lethal cardiac events (cardiac arrests) occurred, and one event occurred during 129,000 h of moderate intensity training (Rognmo et al.,
2012). The data are still far from sufficient to make a safe statement concerning the long-term effects and risks of high intensity training. Yet, they indicate that higher exercise intensities (which may occur more frequently during self-regulated exercise) are not inevitably associated with high risks. Focusing on the affective response, however, it has to be considered to which extent higher intensities may be associated with negative side effects on adherence, especially in persons with limited exercise experience (Decker & Ekkekakis,
2017).
If pacing and load regulation is viewed as outlined here, this also has implications in the role of monitoring training load and the response to this load. Instead of a permanent verification of whether exercise is being done within the desired (“correct”) intensity range, characteristics of load (e. g., speed) and stress (e. g., heart rate) can be regarded as feedback to educate an individual’s own perception during a learning process. Information and communication technologies that allow the direct display, processing, and communication of field-registered signals, indicators of performance, and subjective parameters (Meißner,
2012) may simplify this learning process. Such technology can include accelerometers, pedometers, GPS systems, dynamometers, and heart rate monitors, as well as successive registrations of perceived exertion and affective response. Telemetry enables therapists and physicians to monitor and support the process of learning pacing from a distance.
Patient orientation and the promotion of self-determined and competent participation are pivotal elements of modern approaches to rehabilitation. They are especially challenging in patients who are unsettled because of physical deconditioning and who have to (re-)learn the handling and estimation of physical load. If, step by step, patients are empowered to (co-)regulate their exercise, they will even more become co-producers of their own health and well-being. Increasingly, they will become organizationally independent and will be able to use more diverse exercise offers, which can promote motivation and compliance.
Conclusion and outlook
Pacing is the fundamental mechanism of regulating physical performance. It is based on the perception of effort and further includes the choice or preference of a level of exertion, anticipation of remaining physical work, estimation of the current physical capacity, consideration of past experience, and, building on this, perpetuation or alteration of the momentary physical work rate.
The scientific discussion and examination of pacing offers valuable links for exercise regulation in health sports and exercise therapy in order to do the following:
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substantiate existing concepts for the promotion of the subordinate aim of “control competency” as a component of physical-activity-related health competence;
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correspondingly broaden practical approaches of its promotion; and
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make control competency measurable in the field.
Several related aspects have already been considered in exercise therapy programs and can be found in the target setting of the German classification of therapeutic services (KTL, DRV, 2015). The potential benefits of a stronger consideration of pacing seem great, and pacing to promote control competency therefore is important in research on sports for health and on exercise therapy. Such research is fundamental for the physiological as well as pedagogic–psychological foundation of sports for health and exercise therapy.
For research on target-group-specific opportunities and limitations of the self-regulation of physical/sports load, all three target levels of control competency—optimizing of health effects, minimizing of health risks, and inducing positive affective responses—should be considered. In addition to models of the fatigue-mediated regulation of physical work rate and analyses of pacing profiles in health sports contexts, research on the freely chosen speed of walking and running (Ekkekakis,
2009) and on the correlation between exercise intensity and affective condition (Ekkekakis et al.,
2011) provides a basis and inspiration for further studies.
Currently, relatively little is known about how everyday work regulation actually takes place. We need a better understanding of the physiological regulation mechanisms and conditions favorable for perception and learning in specific target groups. This would make it easier to identify populations suitable for self-regulation as well as to advance interventions that improve the perception of stress and the effective self-regulation of exercise loads (Ekkekakis,
2009). Based on this, it remains to be seen in controlled studies if and which feedback on the objective stress under varying load conditions best enables exercising persons to optimally educate and calibrate their control competency.