Travelling with ME/CFS or Long COVID: Realistic Preparation and Pacing Your Energy on the Road

A weekend with family, a long-awaited trip to the seaside, a wedding in a neighbouring country: for people with ME/CFS, Long COVID or POTS, travelling is rarely a spontaneous decision. It's a project full of unknowns – and sometimes the wisest choice is precisely not to do it. This article looks at three questions that matter before any trip: how to prepare realistically, how to budget energy while travelling, and how to recognise when skipping the trip is the better choice.

Why travelling costs so much more than it looks like

Travelling is often perceived as purely physical exertion – carrying luggage, walking, standing. In reality, travel piles up physical, cognitive and emotional strain all at once: finding your way in unfamiliar places, making decisions under time pressure, sensory overload from crowds, noise and light, plus the excitement itself. It's exactly this combination of several kinds of strain at once that makes travel days so risky for post-exertional malaise (PEM). The Bateman Horne Center therefore advises deliberately resting over several days before a trip and staying well hydrated, since travelling depletes energy reserves faster than one would expect.

To make things harder, a crash following travel exertion often doesn't show up immediately but sets in with a delay – a pattern described in more detail in the article Recognising PEM: Why the Crash Often Comes Only Days Later. Anyone planning a trip should factor in this delayed effect from the start, rather than being misled by a seemingly good first day of travel.

Realistic preparation: starting weeks before the trip

Good travel preparation doesn't begin on packing day – it starts much earlier. Research into routes, accommodation, accessibility and restaurants can be spread out in small portions over several weeks instead of being crammed into the last few days before departure – this leaves more energy for the trip itself. A comprehensive practical guide on Long COVID and ME/CFS recommends planning routes in advance to save time and energy, and researching restaurants and shopping options beforehand to avoid spontaneous decisions while on the road.

Anyone still new to pacing benefits from practising the basics of energy management in their familiar daily routine first, before a trip is on the horizon. The approach – staying within your own energy envelope instead of living in a cycle of overexertion and exhaustion – is explained in the post Pacing Basics: What Pacing Is and Why It Helps with PEM, and it forms the foundation on which any travel planning is built.

In concrete terms, this means for preparation:

• Choosing direct connections over multiple transfers, even if they're more expensive or take longer.
• Deliberately building in buffer time – between arrival and the first activity, but also between individual items on the itinerary.
• Reserving fixed recovery days before and after the trip during which nothing else is planned.
• Thinking through a "minimal version" scenario of the trip: what would the shortest, calmest option be if a particular day goes badly?

Budgeting energy on the road

On the travel day itself, it helps to consciously treat the day as a high-exertion day and scale everything else back around it. In practice, this means building fixed rest breaks into the day's schedule, avoiding rushing, and keeping fixed, predictable times for meals and fluid intake instead of letting the flow of travel dictate them.

For people with POTS or orthostatic intolerance, further factors come into play: standing in long queues, heat at the destination, or changed eating and drinking habits can additionally intensify symptoms. How strongly heat, irregular meals or other everyday triggers can affect symptoms is described in the article POTS: Heat, Meals and Cycle in Everyday Life – aspects that become especially relevant when travelling, because familiar routines shift.

Practical aids can noticeably ease the energy balance while travelling: compression garments and electrolytes can help manage circulatory issues and prevent dizziness, particularly with POTS or orthostatic intolerance. Wheelchairs, mobility scooters or walking aids can also save energy and prevent overexertion, with foldable versions being particularly suited for transport. Noise-cancelling headphones, sunglasses and earplugs can further help cope with symptoms in loud or brightly lit environments such as airports or busy streets.

Anyone using wearables for self-monitoring should keep in mind that travel days can shift the usual reference values for resting heart rate or heart rate variability – excitement, time-zone changes and altered sleep all affect the data. A realistic way of handling these fluctuations is described in the post Heart Rate Variability (HRV) as an Early Warning Sign for Crashes and helps put readings on the road into proper perspective instead of over-interpreting them.

When skipping the trip is the better choice

As personally important as travelling can be, there are situations in which skipping it is more honest than trying to "somehow" get through. Experts point out that some people with ME/CFS cannot travel at all, while others travel only for necessary medical appointments – the range is wide, and there is no "right" or "wrong", only one's own current limit of tolerance.

A helpful checkpoint before any travel decision: can genuine recovery days be scheduled before and after the trip? Is the route complicated with many transfers? Is the current baseline level of strain already unstable? If several of these points apply, the risk of a long-lasting crash rises considerably – and a shorter, calmer trip, or forgoing it entirely, can be the more responsible decision. This is not failure but applied pacing: just as with exercise, limits in travel cannot be shifted by willpower either, a connection explained in more detail in the article Pacing Is Not a Training Programme.

Anyone unsure whether and how a particular trip is feasible should not decide this question alone but discuss it with their treating medical professional – especially if cardiovascular symptoms, severe orthostatic complaints or an unstable underlying condition are present. Travelling with ME/CFS, Long COVID or POTS is possible for many, but it rarely looks like the travelling of before. Anyone who accepts this and plans the trip accordingly – or deliberately forgoes it – ultimately makes the decision that best does justice to their own body.

Sources

• Travel and Crash Considerations
• Traveling with Chronic Illness: Strategies for ME/CFS Patients
• 10 Tips for Traveling with ME/CFS and Long COVID
• Pacing – American ME and CFS Society