Interventions for Activity Tolerance

Mon/Wed

Two Fold Approach

build endurance by completing tasks and energy conservation techniques.

Bottom-Up Tasks

use remedial (exercise or preparatory activities) to work up to the activity.

Top-Down Approach

functional (occupation based) to improve the components of endurance.

“Bottom” Meaning

the components that make up a task, or the client factors such as endurance.

“Top” Meaning

the actual occupation or activity itself.

Energy Conservation Techniques

compensatory strategies to limit exertion and allow increased function.

Ways to Conserve Energy

change the task or change the tools to increase independence.

Changing the Task Example

bathing: have all supplies in one place, shower when refreshed, and shower on days when little else is planned.

Changing the Tools Example

bathing: use a bench in shower to decrease energy demand.

Energy Conservation

the way activities are done to minimize muscle fatigue, joint stress, and pain; by using your body efficiently and doing things in a sequential way, you can save your energy, remain independent, and be less frustrated by your illness when the energy you have lasts throughout the day.

Key Terms for Energy Conservation

pacing, planning and prioritizing, modify/simplify difficult tasks, delegate tasks, use AE, perform activities while seated, and demonstrate PLB.

Pacing

educate your patient to take rest breaks throughout the day when they feel fatigued.

Planning and Prioritizing

complete the most important tasks first and do not over-plan the day.

Delegating Tasks

have family members, friends, or hired caregivers take care of some of the tasks if needed.

Seated Position

it is useful to have chairs in every living area to take breaks during ADLs and IADLs.

Commonly Used Energy Conservation Techniques

successful work/rest ratio, use of electronic aids as needed, flexible home and work schedules, recognition of fatigue warning signals, successful use of compensatory strategies, acceptance of a request for assistance, home/work modifications, appropriate ambulatory aids, power mobility aids (power wheelchair or scooter), control of spasticity, improved trunk control, ADL assistive devices, durable medical equipment, heat control, and pacing.

Tips for Energy Conservation

avoid stress, sit when doing a task (standing takes more energy), do work with arms instead of legs (legs takes more energy), alternate easy tasks with hard or spread the task throughout the day, focus your energy on things you can do, and ask for help if the demands on your energy are too much (hire if needed).

30 Minute Rule

wait 30 minutes after eating to perform tasks (if not, more demand for oxygen to the heart); it also allows the body to have enough energy to digest prior to the activity and use the digested food to re-energize.

Weather Affecting Energy

avoid doing activities in temperatures above 80 degrees F with humidity and below 20 degrees F (extremes have a dangerous affect on the heart).

Rest with Energy Conservation

get at least 6-8 hours of sleep each night and rest for 20-30 minutes at least twice a day; if you get tired, rest for 15 min whether you’re done with the task or not.

The 3 P’s of Energy Conservation & Work Simplification

plan out your daily schedule, prioritize your tasks so you get the most important things done first, and pace yourself so you can get more done.