Best pacing apps for ME/CFS and Long COVID, compared: what each one measures and what it cannot see

Short answer

A pacing app helps you keep activity inside your energy envelope when you live with post-exertional malaise in ME/CFS or Long COVID. The best pacing app depends on the job: a continuous heart-rate alarm needs a worn sensor, while a one-minute morning reading or a symptom diary does not. Post-exertional malaise typically arrives 12 to 48 hours after the effort, so every tool is working against a delay.

If you have been pacing carefully and still crashed, that is not your fault and not a lack of discipline. The cost of an activity often shows up a day or two later, which is exactly what memory and willpower handle worst. Before you blame yourself, check what your body already recorded — in a heart-rate log, a morning reading or a two-line diary entry.

Note: this article compares consumer wellness tools and is not medical advice. None of these apps diagnoses or treats ME/CFS, Long COVID, POTS or post-exertional malaise. Pacing decisions, heart-rate limits and any change in activity belong in a conversation with a clinician who knows your case.

What does a pacing app actually need to do?

Pacing is limiting exertion — physical, cognitive and emotional — so that you stay within the energy you have, rather than spending it and paying for it later. The UK's NICE guideline for ME/CFS (NG206, 2021) calls this energy management: "a self-management strategy that involves a person with ME/CFS managing their activities to stay within their energy limit, with support from a healthcare professional." The same guideline describes post-exertional malaise as symptoms that "can typically worsen 12 to 48 hours after activity and last for days or even weeks."

That delay is the whole design problem. A tool that only tells you how you feel right now is reading yesterday's bill. A useful pacing setup needs to cover at least one of four jobs:

1. A budget. Some way of deciding, before the day starts, roughly how much you can spend. Spoon theory is the best-known version: Christine Miserandino described it in her 2003 essay The Spoon Theory on butyoudontlooksick.com, explaining lupus to a friend with a handful of diner spoons. Energy envelope theory, developed by Leonard Jason's group at DePaul University, is the research version of the same idea.

2. An alarm. Something that tells you, in the moment, that you have crossed a line you set in advance. In practice this means a heart-rate ceiling on a device you wear all day.

3. A morning check. A short reading — heart rate, heart rate variability (HRV), a symptom score — taken the same way each morning, so today can be compared with your own recent days.

4. A delayed-cost log. A record that links Tuesday's activity with Thursday's symptoms. Without it, the crash gets blamed on whatever was happening when it arrived.

No single app does all four equally well, and that is the most useful thing to know before comparing them. NICE puts it practically: "Make self-monitoring of activity as easy as possible by taking advantage of any tools the person already uses, such as an activity tracker, phone heart-rate monitor or diary." The best pacing app, by that standard, is the one you will still be able to use on a bad day.

If you are new to pacing itself, start with our pacing guide for chronic illness and come back to this comparison once you know which of the four jobs you most need covered.

Best pacing apps compared: approach, hardware, subscription and data

The table below compares five tools people with energy-limiting conditions most often ask about, plus the option many clinicians still prefer: a paper or spreadsheet diary. Every competitor detail is as described on the company's site or help center, October 2026 (checked on 1 October 2026). Features and plans change, so check the company's site before you choose. We list whether a paid plan exists, not what it costs.

Sources for each row are the companies' own pages: Visible and its help center on the free app; Welltory's help center on camera readings, data sources and data export; Bearable; Garmin's Body Battery manual page, abnormal heart rate alert manual page and Connect+ announcement; and Rox with its pacing apps article. All were checked on 1 October 2026.

Read the table by column, not by row. The hardware column decides which of the four jobs a tool can cover: only something you wear continuously can raise an alarm while you are unloading the dishwasher. The data column decides whether your records can travel to a clinician or survive a change of app.

How does each pacing app work, and who does it tend to suit?

Visible

Visible describes itself as providing "the tools you need to understand your energy-limiting condition" and names Long COVID, ME/CFS, fibromyalgia, POTS and EDS on its homepage, as described on the company's site, October 2026. It is the tool in this list built most specifically for pacing.

The free app runs a Morning Check-in with your phone camera: a one-minute heart rate and HRV reading, which Visible's help center says is best taken "right after waking up, ideally before getting out of bed," lying down, at a similar time each day. That reading, combined with your sleep and symptom ratings from the Evening Check-in, produces a Stability Score that "reflects how stable your body is compared to your personal baseline." The free app also lets you generate a Health Report PDF and export all your check-in data.

The paid membership pairs the app with the Visible Band 2.0, which Visible says is "manufactured by Polar" and can be worn "on the wrist, upper arm, or forearm just below the elbow." With the band you get continuous heart rate, heart-rate zones, a personalised daily PacePoints budget and a phone notification "when you are exerting or getting close to your daily budget."

Who it tends to suit: people who want a heart-rate alarm designed around post-exertional malaise rather than fitness, and who are comfortable wearing a band all day.

Welltory

Welltory takes a short HRV and heart-rate spot reading with the phone camera: you rest a fingertip over the camera and flash while the app reads the pulse wave (photoplethysmography, or PPG). It can also take readings from a compatible chest strap that records raw beat-to-beat intervals over Bluetooth, or from an Apple Watch or Samsung Watch. A spot reading is one snapshot. It needs you to be still, and it cannot replace continuous heart-rate monitoring or an ECG. If you want to know how phone readings compare with other methods, see how accurate HRV from a phone camera is.

On an iPhone paired with an Apple Watch or Oura ring, Welltory also shows all-day stress minutes (heart rate raised while you are not moving), recovery, sleep and a Battery score; per its help center, these Today screen features are not available with the phone camera alone. You can tag what was happening during a stress stretch and see the tags collected in My Patterns. It can read data from other devices too: its help center lists Garmin sleep, heart rate, stress level and energy level among the data a direct Garmin connection sends. Garmin watches with an HRV function are not supported for Welltory's own HRV measurements, per the help center's gadget compatibility page (Garmin chest straps such as the HRM-Dual and HRM-Pro are).

Welltory's help center is open about the gap: the app "was first built with a healthy, active user in mind," and building it out for chronic and energy-limiting conditions is a direction the company has committed to. It does not offer heart-rate ceiling alarms during activity.

Who it tends to suit: people who want a morning HRV and resting-heart-rate check without buying a device, or who already use an iPhone with an Apple Watch or Oura ring and want to note what came before a bad stretch.

Bearable

As described on the company's site, October 2026, Bearable is a symptom and mood tracker that lets you record "Mood, Emotions, Sleep, Symptoms, & Energy Levels with just a few taps each day" and create custom metrics, then look for what tends to improve or worsen them. No hardware is required. It can sync heart rate, HRV, steps and other metrics from Apple Health, Google Fit and Fitbit. It runs on iOS and Android.

On data, Bearable says you can "export all of your data in .csv format," that your data "is encrypted at rest," and that it will "never sell your data." The free version includes unlimited custom tracking, weekly reports and a customisable graph; correlation reports, custom experiments and access to history beyond the last 30 days are part of its optional subscription.

Who it tends to suit: people whose main need is the delayed-cost log — linking many possible factors to how they feel — without wearing anything.

Garmin Body Battery

Body Battery is a feature on compatible Garmin watches, not a stand-alone pacing app. As described on the company's site, October 2026, Garmin's manual puts it this way: "Like a gas gauge on a car, it indicates your amount of available reserve energy." The watch combines heart rate variability, stress level, sleep quality and activity into a number from 5 to 100, and Garmin advises wearing the watch while sleeping. Garmin announced in March 2025 that "All existing features and data in Garmin Connect will remain free," with Connect+ as an optional paid tier.

Compatible Garmin watches also offer an abnormal heart rate alert. Garmin's manual is specific about when it fires: it "only alerts you when your heart rate exceeds or drops below a certain number of beats per minute, as selected by the user, after at least ten minutes of inactivity." That makes it a resting alert, not an in-activity pacing ceiling. Our Body Battery explainer covers what the score measures in more detail.

Who it tends to suit: people who already own a Garmin watch and want an all-day picture of drain and recharge, used alongside a diary rather than as a verdict on how much they can do.

Rox

As described on the company's site, October 2026, Rox calls itself an AI companion for chronic illness — "your always available bestie for chronic illness." In its own pacing article (8 July 2026), the company describes "spoon-based energy pacing, the manual kind where you budget your day against how much energy you actually have," alongside logging of symptoms, medications, hydration and vitals, pattern insights and a report for your doctor. A wearable is optional: "Rox works from conversation alone. A wearable just gives it more to work with." Its homepage lists Apple Watch, Fitbit, Garmin and Oura. The company states that logging, insights, pacing and the report are free and "only the AI features are paid." At the time of checking, its site offered an iOS app only.

Who it tends to suit: people who find talking or writing easier than tapping through forms, and who already think in spoons.

A paper or spreadsheet diary

The oldest pacing tool still has one advantage nothing else matches: it costs no screen time. A good pacing diary records each block of activity with the position you were in and how long it lasted, then adds a note 24 and 48 hours later — the column most people skip and most patterns depend on.

Who it tends to suit: people with severe ME/CFS, anyone for whom screens are part of the load, and anyone who wants one document a clinician can read in a minute.

Heart-rate alarms, morning checks and diaries: which approach answers which question?

The tools above are really three approaches in different packaging. Each answers a different question, and the research behind each is at a different stage.

Heart-rate alarms. Clague-Baker and colleagues randomised 47 people — 32 with ME/CFS and 15 with Long COVID — to pace with or without a heart-rate monitor for 8 weeks. The study found monitoring "feasible and acceptable"; follow-up interviews found 89% still using a monitor at 8 weeks and 66% after 6 months, and no serious adverse events were reported. It was a feasibility study, too small to show effectiveness. Thresholds in the trial included the Workwell Foundation's resting heart rate plus 15 beats per minute — a heuristic, not a measured boundary. Our heart rate pacing guide covers thresholds in detail.

Which sensor matters. For an alarm, accuracy during movement counts. In a 2017 study of 50 healthy adults, an electrocardiographic chest strap agreed with ECG at a concordance of 0.996, while wrist-worn optical monitors ranged from 0.67 to 0.92 depending on the device, and accuracy varied with the type of exercise. The authors concluded that "electrode-containing chest monitors should be used when accurate HR measurement is imperative." Devices have changed since 2017, so treat the exact figures as dated.

Morning readings. Ruijgt and colleagues recorded heart rate and HRV continuously in 121 people with Long COVID and 21 healthy controls. HRV was lower in Long COVID during daily activities and sleep, stayed lower for 24 hours after exercise around the first ventilatory threshold, and nighttime HRV fell after intense or longer exercise. That supports HRV as a personal signal worth watching — not as a stand-alone instruction. Our morning HRV pacing guide explains how to read one next to how you feel.

Diaries. In a classic BMJ study, 80 adults with chronic pain kept either a paper or an electronic diary. Paper-diary users reported 90% compliance, but their actual compliance was 11%; electronic-diary users achieved 94%. Back-filled entries are a real risk, and they matter more when the whole point is timing.

Where digital pacing stands. A 2026 article in PLOS Digital Health by the team behind a 6-month randomised trial of the PaceMe platform in Long COVID reported "safety and feasibility," perceived value, "but no added benefit over usual care for PEM over 6 months." The same authors warn about "data overload, where many prompts or alerts can worsen symptoms through overstimulation or fixation," and note that most smart devices "exist to encourage a gradual increase in activity." A 2023 scoping review of pacing in ME/CFS found 17 studies: 11 reported benefit, 4 no effect and 2 a detrimental effect, with methodological quality the authors rated poor to fair. Pacing is the recommended approach; the apps that support it are still early.

Is there a Visible alternative that doesn't need an armband?

Yes — including Visible's own free app, which uses your phone camera for its morning check-in. That is worth saying plainly, because a camera-based morning reading is not unique to any one company.

What you give up without a worn sensor is the alarm. A camera reading, whether in Visible's free app or in Welltory, is taken once, lying or sitting still. It can tell you how this morning compares with your recent mornings. It cannot tell you that your heart rate climbed past your ceiling while you stood at the stove, because nothing was measuring it then.

So the real choice looks like this:

If your crashes come from physical exertion you do not notice in the moment, a continuous heart-rate sensor with an alarm is the tool that addresses it. That can be the Visible Band, or a chest strap or watch whose own app supports a high heart-rate alert during activity.

If your main question is "what kind of day is this likely to be, compared with my usual?", a morning reading plus a symptom score covers it. Visible's free app, Welltory with the phone camera, and Bearable's energy and symptom logging all do versions of this without extra hardware.

If your crashes seem to come from cognitive or emotional load — a long call, an appointment, a difficult conversation — heart rate may barely move. A diary with a 24–48 hour column, in any app or on paper, is what makes that pattern visible.

For pacing there are several approaches: heart-rate pacing with a wearable (Visible, Garmin), spoon theory, a symptom diary. Welltory adds a morning HRV check with your phone camera — one more signal about today, next to your own sense of how much you have. It is a complement to an alarm, not a replacement for one.

Which pacing app fits your situation?

Pacing advice has to be separated by condition, because the same word covers different things.

ME/CFS with post-exertional malaise. Pacing here means limiting exertion to stay within the envelope. NICE NG206 tells clinicians not to offer "any programme… that uses fixed incremental increases in physical activity or exercise, for example, graded exercise therapy." If a tool nudges you towards more steps or longer workouts each week, switch those prompts off. A band with a conservative alarm, or a diary, tends to fit best.

Long COVID with post-exertional malaise. The same caution applies. The Clague-Baker study found recruiting people with Long COVID harder than people with ME/CFS, which is a reminder that the evidence here is thinner. Morning readings can help you see how uneven recovery really is: in a 2026 study of 63 people tracking neurologic Long COVID in an app, those who improved showed more fluctuation in their self-rated recovery than those who did not.

POTS without post-exertional malaise. Supervised, gradually progressed exercise is part of many POTS programmes; a 2018 review by Fu and Levine describes starting with horizontal exercise such as rowing, swimming or a recumbent bike. That is a clinical decision, not an app setting — and if post-exertional malaise is part of your picture, it changes the answer.

Fibromyalgia and chronic pain. Graded activity is used in some chronic-pain programmes. Do not borrow that approach for ME/CFS or Long COVID with post-exertional malaise, and do not borrow ME/CFS limits for fibromyalgia without your clinician.

Severe ME/CFS. The lowest-effort tool wins. A band that records without any interaction, a camera reading taken lying down on the days you can manage it, or a two-word diary entry dictated to someone else — all count. Skipping tracking on a bad day is part of pacing, not a failure of it.

Already own a watch? Start with what you have, as NICE suggests. A Garmin, Apple Watch or Samsung Watch already records heart rate; adding a diary is often a bigger step forward than adding a new device.

Use more than one. Many people pair an alarm or an all-day gauge with a diary, and a morning reading with a spoon count. If you are working out your own limits, our guide to finding your energy envelope walks through a two-week baseline, and spoon theory explained covers the budget side.

What no pacing app can do yet

None of the tools in the table is sold as a medical device. Visible's own FAQ says it "is not a medical device." Rox's site says it "is an AI, not a medical device." Garmin's manual says its heart rate alert "is not intended to treat or diagnose any medical condition or disease." Welltory is a general wellness product with no regulatory clearance.

None of them can tell you in advance that a crash is coming. We are not aware of any validated algorithm that can predict an individual crash. Any app that implies otherwise is claiming more than the research supports.

Readiness and recovery scores deserve particular care. Most were built on healthy people and athletes. Welltory's own help center notes that for chronically ill bodies a spike in HRV can accompany a crash rather than recovery, and that stress minutes can stay high on quiet days, because they count raised heart rate without movement. When the screen says "recovered" and your body says otherwise, believe your body. A dashboard that disagrees with you is information about the dashboard.

Continuous monitoring has a cost, too. The PaceMe authors' warning about data overload matches what many people report: checking numbers all day can become its own drain. Tracking in seasons — a couple of weeks when something changes, then a break — is a reasonable way to keep the information without the load. For what the days around a crash can look like in personal data, see what post-exertional malaise is.

None of this is obvious on your own, and most people work it out alone. Welltory runs a paid community, Energy Lab, where women living with energy-limiting conditions learn to read their own tracked data together — education and peer support, not medical care.

Living with pacing: the questions people ask next

Do I need a heart rate monitor to pace with ME/CFS?

No, but it covers a job nothing else can. Pacing with ME/CFS is limiting exertion to stay inside your energy envelope, and people did it with diaries long before wearables existed. NICE NG206 recommends using "any tools the person already uses, such as an activity tracker, phone heart-rate monitor or diary." What a continuous heart rate monitor adds is an alarm in the moment. In a 2025 feasibility trial in ME/CFS and Long COVID, follow-up interviews found 89% still using a monitor at 8 weeks and 66% after 6 months. If physical exertion you do not notice is your main problem, a monitor helps; if cognitive load is, a diary matters more.

Is resting heart rate plus 15 a safe heart rate limit for pacing?

Resting heart rate plus 15 beats per minute is a working heuristic from the Workwell Foundation, not a measured limit, and it was one of the thresholds used in the 2025 Clague-Baker pacing trial. The measured version comes from a two-day cardiopulmonary exercise test, which Workwell researchers describe as provoking "a robust post-exertional symptom flare" — so it is not a casual check-up. People with severe ME/CFS or POTS may need a lower or differently structured limit. Agree any heart-rate ceiling with a clinician, treat it as a cap rather than a target, and adjust it by what your diary shows 24 to 48 hours later.

Can I pace with severe ME/CFS if using an app is itself exhausting?

Yes. With severe ME/CFS, the pacing tool has to cost less than the information it gives back. A band or watch that records without any interaction is often the easiest option; a camera reading lying down on days you can manage one is another; a one-line diary entry written by a carer counts too. Screens, light and decisions are part of the energy budget. The PaceMe researchers warn that frequent prompts can worsen symptoms "through overstimulation or fixation," so turn notifications down or off. Stopping tracking during a bad stretch is pacing, not giving up.

Do pacing apps work for POTS or fibromyalgia too?

They can, but the pacing advice differs by condition. In ME/CFS and Long COVID with post-exertional malaise, NICE NG206 advises against programmes with fixed incremental increases in activity, such as graded exercise therapy. In POTS without post-exertional malaise, supervised, gradually progressed exercise — often starting lying or seated — is part of many treatment programmes, and graded activity is used in some chronic-pain and fibromyalgia programmes. A pacing app does not know which situation you are in. Tell your clinician whether you get delayed crashes after effort, because that one fact changes which approach is safe for you.

Does tracking every day make fatigue worse?

For some people, yes. The authors of a 2026 article on digital pacing tools name "data overload" as a potential harm, where many prompts or alerts "can worsen symptoms through overstimulation or fixation." Daily tracking also invites over-reading single days. In a 2026 study of 63 people with neurologic Long COVID using a tracking app, those who improved showed more fluctuation in their self-rated recovery than those who did not — a bad day inside an improving trend is common. Tracking in seasons, a couple of weeks at a time, keeps the useful pattern without making the app another thing to manage.

What should I show my doctor from a pacing app?

Bring a short summary, not the whole app. The most useful items are your usual morning heart rate, how your worst days compare with it, what tended to come 24 to 48 hours before a crash, and what you can do now compared with before you were ill. Real-time records are more trustworthy than recall: in a BMJ study, paper diaries reported as 90% complete were actually 11% complete, against 94% for electronic diaries. Visible offers a Health Report PDF, Bearable exports CSV, Welltory exports CSV from its web app, and a paper diary can simply be photographed.

Will pacing make ME/CFS or Long COVID better long term?

Pacing is a management strategy, not a cure. NICE NG206 says energy management "is not curative" and that it "helps people learn to use the amount of energy they have while reducing their risk of post-exertional malaise." The research is mixed: a 2023 scoping review found 11 of 17 pacing studies reported benefit, 4 no effect and 2 a detrimental effect, with poor-to-fair study quality. Long COVID recovery is often uneven. What pacing reliably offers is fewer self-inflicted setbacks from overspending, and records that make a changing baseline visible to you and your clinician.

Is a pacing app a medical device?

None of the tools compared here is marketed as one. Visible's FAQ states it "is not a medical device, and does not provide medical services such as diagnosis, cure, mitigation, prevention or treatment." Garmin says its heart rate alert is not intended to diagnose or treat any condition. Welltory is a general wellness product with no regulatory clearance. That matters in two ways: none of these apps can confirm ME/CFS, Long COVID, POTS or post-exertional malaise, and none can tell you a safe level of activity. They record; you and your clinician interpret.

How to bring this up with your doctor

A pacing app is only as useful as the conversation it feeds. Clinic visits are short, and post-exertional malaise lives in the days between them.

Say the pattern in one sentence. "Activity that I tolerated before now makes me worse 12 to 48 hours later, and the worsening lasts days." That is the core description of post-exertional malaise NICE uses, and it tells your clinician which management rules apply. The 2015 US Institute of Medicine report made post-exertional malaise one of the core symptoms required for a diagnosis of ME/CFS.

Bring one page. Your usual morning heart rate and, if you track it, HRV; how often you have crashed in the last month; what came in the 24 to 48 hours before; and one line on what you could do before you became ill compared with now.

Ask about the tools you already have. NICE recommends making self-monitoring "as easy as possible" with tools you already use. Ask whether a heart-rate ceiling makes sense for you, and at what level.

Ask whether any activity plan is fixed or adjusts to how you respond. If a plan increases on a calendar regardless of delayed symptoms, that is the fixed incremental approach NICE advises against for ME/CFS. NICE also describes referral to a physiotherapist or occupational therapist working in an ME/CFS specialist team.

Be cautious about exercise testing. A two-day cardiopulmonary exercise test is used to document post-exertional malaise precisely because it provokes it. Discuss the risks before agreeing to one.

Know when not to wait. Chest pain, fainting, sudden breathlessness at rest, new one-sided weakness or confusion need emergency care — call 911 — not a pacing adjustment.

How Welltory helps — and what it cannot do

The limits first. Welltory is a general wellness product, not a medical device. It does not diagnose, predict, monitor, prevent, treat or mitigate ME/CFS, Long COVID, POTS, post-exertional malaise or any other condition, and it does not set or sound heart-rate ceiling alarms. If you need an in-the-moment alarm, pair Welltory with a wearable whose own app supports one.

What Welltory can add is a record of your physiology next to your own account of the day. A routine that works for pacing:

Take a morning reading the same way each day. With the phone camera (fingertip over the camera and flash, lying or sitting still for the whole reading) or a compatible chest strap, Apple Watch or Samsung Watch. The Heartbeat Report view is designed for readings taken strictly in the mornings under the same conditions. Remember it is a snapshot, not continuous monitoring. After the trial, the free version allows one HRV measurement a day.

Log the crash and what came before it. On an iPhone with an Apple Watch or Oura ring, when Welltory flags a stress stretch and asks "What happened?", tap a suggested tag, type a few words or just talk: "crash," "PEM," "long call," "shower," "short night," "period day 1." You can also add a note any time with the plus icon ("Share your thoughts…"); notes go to your Journal, while tags from stress stretches feed My Patterns.

Look at the days before, next to how you feel. Morning HRV and resting heart rate — plus sleep, stress minutes and Battery if you wear a supported device — are personal trends compared with your own recent baseline, not a verdict. If the screen looks fine and you do not, believe the floor.

Check My Patterns after two to three weeks. Once a tag has appeared at least 7 times in the current month, with some history from the month before, My Patterns shows which tagged situations tend to come before stressful stretches, tags that don't happen often but hit your body hard, day-of-week trends, heart rate during those stretches and a complete list of every time a tag happened. See how My Patterns works.

Keep a personal log for your doctor. Journal shows HRV measurements, tags, mood and how you feel physically, notes, workouts and menstrual cycles synced from Apple Health, Samsung Health or Health Connect. For an appointment, add a CSV export from the web app (Dashboard → choose a chart → Export) and your own diary.

Patterns in Welltory are associations to discuss with your doctor — not proof of a trigger and not a warning system.

Where to learn this with other people. Welltory runs Energy Lab, a paid, moderated community for women aged 18 to 65 living with energy-limiting conditions — ME/CFS, Long COVID, fibromyalgia, POTS, MCAS and similar. It runs alongside the app: you keep collecting your own data, and the Lab is where members learn to read it together. Welltory's health educators and medical board answer questions from the group in plain language; there are no one-to-one consultations. It is education and peer support, not medical care, and it does not replace your own clinician.

How we made it

Made with AI tools, then edited and fact-checked by the Welltory team. See our Editorial & AI policy.

Data analysis by Jane Smorodnikova, co-founder of Welltory and the person who built the methodology behind how we read physiological data.

Written by Tatsiana Yashyna.

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