Pacing, Planning, and Prioritizing: Must-Know Energy-Management Secrets for Progressive MS

Fatigue is one of the most common and challenging symptoms for people living with primary-progressive and secondary-progressive multiple sclerosis (MS). It affects physical stamina, mental clarity, mood, and the overall ability to get stuff done, whether that’s for your work, home obligations, or favorite activities.

MS fatigue is not ordinary tiredness. Many people describe waking up already feeling worn down, and even simple activities like showering, dressing, and preparing breakfast can drain energy quickly.

“How you feel day-to-day is also unpredictable when you’re living with MS,” says Kathy Zackowski, PhD, associate vice president of research at the National MS Society.

One day you may feel like you can take on the world and then the next day … not so much.

Fatigue affects much more than physical strength. Concentration slows, decisions take longer, and multitasking becomes harder. When mental effort piles up, you may find yourself forgetting steps, losing track of conversations, or struggling to organize the day. These cognitive demands can exhaust you just as much as physical ones.

On days when you feel like you’re starting with an empty tank, it may seem like you spend all your energy for the day just trying to get out the door — before you do the things you actually want or need to do, says Dr. Zackowski.

The emotional toll of this cycle is real, and it’s why learning new energy-management strategies can make such a meaningful difference for people with MS.

Energy management works best when you structure your day around your abilities, rather than pushing through and hoping for the best. Overexerting yourself can have a cumulative effect that can result in a crash that takes multiple days to recover from, says Alyssa DeCarlo, a clinical specialist occupational therapist at Cleveland Clinic in Ohio.

“When that happens, you can’t continue in your daily routines, which affects your overall mood,” she says. And that can set up a cycle that’s hard to break.

DeCarlo teaches people to think about their energy like currency. “Everyone gets about a hundred pennies a day, and every single task takes a penny or 5 or 10. You want to know where those pennies are going.”

This exercise can help with prioritizing — basically, deciding what truly needs to get done versus what would simply be nice to get done. Once you do that, take stock of your goals to make sure they are realistic, then set a reasonable timeline for what you want to accomplish.

Once you’ve identified your most important tasks, think about when you usually have the most energy, says DeCarlo.

Do difficult tasks when you have the most energy. “Morning is often a more effective and safer time for higher-effort activities such as showering, grocery shopping, and exercising, because fatigue often builds throughout the day,” she says.

That’s important for many reasons, but safety is a big one. Showering is a great example. Even when you’re at your best, showers and bathtubs are slippery, challenging places, and if you wait to bathe until the end of the day when you’re most tired, your risk of falling goes way up, says DeCarlo.

Avoid multitasking. Focusing on one task at a time can protect your energy. Multitasking forces the brain to switch back and forth — a process that becomes more draining when you have MS — and it often leads to mistakes that require even more energy to fix. Concentrating on a single activity helps you work more steadily and reduces the mental load.

Practice pacing yourself. Many people rest only after feeling completely exhausted, but short breaks taken before fatigue peaks can prevent the steep crash that makes it hard to continue, she says.

“When we become fatigued and attempt to push through a task, our body reacts physiologically by increasing our heart rate, which can reduce motor control. This can lead to errors that take longer to fix than walking away for a moment and coming back fresh,” says DeCarlo.

Use placement for energy conservation. Placement is all about setting up our environment for success, says DeCarlo.

“We expend a significant amount of energy in our daily routines by reaching overhead or below the waist to get objects we use every day,” she says. While not everything can be placed at a convenient height, DeCarlo suggests moving frequently used items such as a hairbrush or deodorant to countertops.

“Another way to be set up for success is to gather all the items needed to cook a meal, then sit to do the prep work,” she says. While you cook, having a bowl or plastic bag for scraps nearby can keep you from getting up for individual trips to the trash, says DeCarlo.

Plan ahead. A little forethought can save you unnecessary trips up and down stairs, or from having to run out to the store for missing ingredients.

But sometimes you might miss a step in planning or underestimate how long or hard a task will be — and that’s okay, says Zackowski. “Giving yourself grace is part of the process. The biggest thing that drains the battery is stress, so don’t be too hard on yourself,” she says.

Beyond pacing and planning, several practical strategies can help you maintain stamina and reduce fatigue’s impact.

Do Regular, Low-Impact Exercise

Consistent, gentle movement helps maintain strength and endurance, which supports better energy. You don’t need to completely exhaust yourself to get benefits, says Zackowski.

“For example, house cleaning counts as exercise. You’re moving things around, maybe going up and down stairs — that all counts. If you’re using your muscles regularly, you’re helping your body stay stronger,” she says.

Depending on your disease progression, you may want a more structured exercise program, says DeCarlo. “Working with a therapy team that specializes in people with neurological conditions like MS can help you find ways to safely challenge yourself,” she says.

Use Mobility Aids When They Make Getting Around Easier

Mobility aids preserve energy you can spend elsewhere. A cane, walker, scooter, or wheelchair can make activities safer and more sustainable. Using “a walker or wheelchair doesn’t mean you’ve lost ability; either can be a useful tool to help you save your energy for the things you want to do,” says Zackowski.

Using a mobility aid wisely can also expand how much you’re able to do in a day and keep you doing the things you enjoy.  For example, it is reasonable to use a wheelchair to get to your son’s soccer game, especially if “the alternative is missing it altogether because the terrain is uneven or the walk would completely drain you,” she says.

Take Steps to Improve Sleep Quality

Improving your sleep quality can make a noticeable difference in how you feel; it directly affects our energy levels and helps prevent fatigue, says DeCarlo.

“We typically recommend following a good sleep hygiene routine of having a dark environment without distractions from television or music, reducing caffeine intake prior to bed, engaging in techniques such as 4-7-8 breathing to relax the mind and body, having a cool environment, avoiding large meals before bed, and maintaining a consistent sleep-wake time,” she says.

The 4-7-8 breathing technique is a simple method for managing stress and anxiety that can help you relax. By focusing on your breath — inhaling for 4 seconds, holding for 7 seconds, and exhaling for 8 seconds — you engage your body’s natural relaxation response.

Use Labor-Saving Devices

Adaptive tools reduce unnecessary steps and protect your energy. Lightweight vacuums, electric can openers, rolling carts, grabber tools, and shower chairs all make tasks easier and safer.

These tools can not only help reduce overall fatigue but also reduce undue strain on various joints and support autonomy and independence in routines that typically become challenging quickly or have already been lost due to their difficulty, says DeCarlo.

Ask for Help With Chores or Tasks

Asking for help is a form of energy conservation, not a loss of independence, says DeCarlo. For example, asking for a ride to an appointment, rather than driving yourself, is a way of pacing yourself: When someone else drives, you can rest during the ride.

When you ask others for help, be clear about what you want, because people can have a different idea of what it is you need, says Zackowski. “It can be as specific as, ‘Can you get the door for me?’” she says.

Maintain a Healthy Diet

A balanced diet supports energy and overall wellness. There’s no single MS diet, but eating in a way that fuels you consistently throughout the day is important. The Mediterranean diet, which focuses on lean proteins, fruits, vegetables, and healthy fats, is a good example, says Zackowski.

“In general, eating healthy foods in moderation is the best advice,” she says.

Cognitive fatigue, which can include difficulty thinking, remembering, or planning, can be just as draining as physical exhaustion. Simple-to-use tools like these can help you stay organized and make daily tasks feel more manageable:

• Smart pill bottles and pill organizers can help prevent missed or doubled doses. Options include systems with morning, afternoon, evening, and bedtime compartments, or with alarms to keep schedules on track. If you take only a few medications, an old-school pill organizer could be enough, says DeCarlo.
• Calendars and reminders on a phone app, smartwatch, or wall calendar reduce the mental load. “Use the system you’ll actually use,” says Zackowski.
• Checklists placed in visible spots like on the fridge or next to appliances can make it easier to remember steps. Not having to hold everything in your head can be a relief, says DeCarlo.
• Automating tasks such as bill payments safely and reliably cuts down the number of things you need to monitor, which is a good thing, says Zackowski.
• Voice assistants and phone voice memos are included on smartphones and offer quick ways to capture reminders before they slip away, especially on days when thinking feels like more of an effort.

If fatigue continues to interfere with your daily life, working with a specialist can help you put these strategies into action. Occupational therapists are trained to help people adapt their activities and environments so they can participate as independently as possible.

“You want to keep doing the things that matter to you, just in a way that works with your body now,” says Zackowski.

It is never too early or too late to start therapy services, says DeCarlo. “We can meet needs as they arise and ensure that people with MS maintain their identity in the face of MS, not allow MS to rule them,” she says.

Occupational therapists can help with energy conservation and increasing your independence in daily routines big and small — things like bathing, writing, medication management, crocheting, and putting on makeup — as well as find appropriate community resources to help you maintain your quality of life and provide a supportive environment to assist with life transitions, says DeCarlo.

• Fatigue in progressive MS can affect both physical stamina and mental clarity, but pacing, planning, and prioritizing your activities can help you conserve energy and stay engaged in the things that matter most.
• Simple strategies such as focusing on one task at a time, planning higher-effort activities for your strongest time of day, and resting before exhaustion sets in can prevent the crashes that make recovery harder.
• Practical tools like mobility aids, adaptive devices, sleep-supporting routines, and organization systems for cognitive fatigue can make daily tasks safer and less draining.
• If fatigue continues to interfere with your routines, working with an occupational therapist can help you adapt your environment, build sustainable habits, and stay connected to meaningful activities.