Note: Elena Rosen is a CFS patient from Vermont and a course leader in the CFIDS and Fibromyalgia Self-Help Program.

For my first few years with CFS, I tried to improve by making sweeping changes, an approach that always failed. Then I learned how to set small, realistic goals and that has made all the difference. By setting short-term targets, I have improved since my diagnosis from 15% on the CFS/FM Rating Scale to 98%, with much greater stability and a lower level of symptoms.

Experiments with Exercise

A good example of the power of small changes adding up over time is my experience with walking. I thought mild exercise would be good for me. With the idea in mind of setting a small, realistic goal, I made it a target to walk 1/16th of a mile every day at a very slow pace.

Once a week, if I was having a good day I started walking ten or twenty feet further. I kept slowly increasing the distance a little at a time, as long as I experienced no increase in my symptoms. As time went on I found that taking a short rest in the middle of my walk allowed me to walk even further. Now, I walk two and a half miles virtually every day.

Logging and Target Setting

Setting targets worked hand in hand with keeping records. Without logging, it was impossible to see the bigger picture of how my targets were affecting me. Keeping a daily record showed how my energy, cognition, digestion, pain and sleep responded to different activities.

By logging both my activities and my symptoms I began to see patterns and the connections between them. Soon I started to experiment with targets in order to establish my baseline tolerance for different activities.

For example in order to find out how long I could drive without aggravating my symptoms and still feel safe, I set a target to drive for five minutes three times a week and log after each drive. After keeping this target for two weeks my logs showed this amount of driving wasn't having any ill effects on my health.

I kept this as my baseline, but as time went on and my energy increased I would set a target to add one more day a week of driving or to make slightly longer drives. Sometimes these targets succeeded and I was able to increase my baseline and drive more. Sometimes it was too much too soon and I needed to stay with the amount of driving I had been doing. Either way I always gained information about my limits.

I've found that knowing for sure how much and how often I can do an activity is freeing. Even if I can't do it as often as I'd like, it makes me feel more secure having these guidelines in place so I can go through my day without worrying "am I doing too much?" or "Will I crash tomorrow?"

Remembering Targets

A problem I had initially with target setting was remembering my target. It's difficult enough to change deeply ingrained habits, but when you have brain fog as well, it makes it even more difficult.

One simple strategy I came up with was putting post-its or signs to remind me of my target. For example, when I had a target of limiting the amount of time I spent on the computer, I put a post-it on the edge of my monitor reminding me to take a break every forty-five minutes.

When I was struggling with staying up too late reading before bed, I made myself a bookmark that said, "No matter how good this book is put it down and go to sleep by 11: 30. You'll thank me in the morning!" I also make a note of my target in my log book every week, so every time I look at it I'm reminded to include my target in my plans for the day.

Another technique I've found helps with keeping me on track with targets is setting a timer. If I want to remember to take a break after thirty minutes of cooking I set the oven timer. If I want to do a rest before going out for the afternoon I set my alarm clock to go off in twenty minutes (that way I'm not peeking out from under my eye mask every five minutes to see if I've rested long enough yet).

The Wider Applications For Target Setting

Target setting has taught me that regular actions, no matter how small, can result in real change. Even though I first used targets to improve my health, I've found that target setting can help me to achieve other goals and to confront tasks that seem insurmountable.

An example is cleaning out a closet in my bedroom. It was in complete disarray and I had been avoiding it since becoming ill because it felt too overwhelming. Looking at it from the perspective of setting a target made me realize that trying to clean it all in one go, like I would have in the past, would cause a flare. I realized I'd have to break it up into smaller tasks and set a time limit on how long I worked.

I decided on two fifteen-minute sessions on two days a week. After the first week, my log showed no signs increased symptoms so I extended the sessions to 20 minutes. After three weeks, I'd accomplished a task that had been hanging over my head for months without any negative impact on my health.

This success, my experience with walking and my overall progress in recent years have all shown me that activities and tasks I had written off as being too taxing may still be available to me when I approach them a little at a time using target setting.