Activity Management

Activity Management helps many conditions such as: Fibromyalgia & Chronic fatigue

The definition of activity management is: Breaking down activities you are doing to make them more manageable. Occupational Therapists are trained to help with this. So my training plus  29 years of experience of putting this into practice I makes me a good person to ask for advice, the lovely testimonials I have also confirms this. (See contact details below).

The following is some generalized tips to explain why it is so important to manage our activities. Many of us know we all need to learn how to conserve our energy levels and to use our energy in a way that will stop us crashing, which is often called 'Boom and Bust'. We can find it hard to put this into action and I sometimes boom and bust! This can be because of the pressures put on us by others and our personalities can be our greatest hindrance. Many of us are ‘perfectionist /carers’. For example:

  • We are not content when someone else does some work for us, they perhaps haven’t done it to the standard you would have done.
  • We often put the needs of others before our own health.

It can be hard to find the energy to assertively tell others that you are not able ‘to do the washing today’ or your energy levels are so low ‘you can’t manage to go out that evening’.

Then there are choices we have to make for example, do we make the beds or go to lunch with a friend. When for example planning an event like the family coming to stay. One way is to assertively say you were too unwell for them to be able to stay, especially if they have no appreciation of the amount of fatigue and pain you are in. Another way to cope is to spread the work over many days, don’t try to be the best cook and buy in food that’s easy to prepare, share out jobs without the feeling of guilt. The risk is if you wear yourself out preparing you’ll have no energy left to enjoy the time with the family, a phase you could use is ‘Plan for help’.

The following suggestions are to help you manage activities  and to help you be more assertive when you have to ask for help. I attended a medical professional master class on ‘Fatigue management’ run by Sue Pemberton, OT Director Yorkshire Fatigue Clinic. She has written an excellent book called ‘Fighting Fatigue’ which has a lot of practical tips. I also visited Sandi Derham; OT at the Royal National Hospital for Rheumatology Disease, Bath. Sandi ran a condition specific pain and fatigue management course for those with fibromyalgia and there is another team at the hospital running courses for those with CFS and ME. I have also added information from Dr Sarah Myhill and Dr Jonathan Kuttner.

A typical energy pattern


When I first saw the following graph on energy patterns with chronic fatigue, which is in the book ‘Fighting Fatigue’. I was shocked when I realised this was me..

Our personality can be like this:

We like to continually push ourselves until the job is complete. We don’t like to make mistakes. We want to finish tasks to a high standard. Not want to let people down. Keep going despite all. I was then even more surprised when I saw the following graph showing how ‘normal’ energy levels can fluctuate during the day.

So how can we balance our energy levels? Are you using more energy than you have?

Try to consider the energy in your cells is like a battery. Normally the cells are full of energy.

For those of us with fatigue we only have a small amount of energy. This energy is called ATP (adenosine triphosphate). When we push ourselves too hard we can find ourselves with no energy. This is often called ‘crashing’ or going ‘beyond our ceiling of energy’. It can take up to 4 days of total rest to start to gain more energy. The Alpha-Stim has been proven to increase ATP levels.

  • The Kreb's cycle in summary, if you'd like more information about this please ask to see a summary of a lecture by Dr Myhill that I wrote up for our support group. Energy is produced by 2 forms of respiration.  Aerobic respiration (using air, oxygen) and is very efficient. Aerobic respiration: 1 molecule of sugar + oxygen = 30 - 36 ATP. Or the inefficient anaerobic respiration (without oxygen). This type of respiration takes energy by breaking down muscle and leaves us with a debt of energy. It also produces lactic acid and this causes pain when trapped in muscle tissue. Anaerobic respiration: 1 molecule of sugar = 2 ATP +lactic acid (pain) N.B. it takes 6 ATP to rid the body of lactic acid. You can tell when you move from aerobic respiration to anaerobic respiration as the muscles feel different and can start to burn. For me it feels like my legs are walking through treacle. This is different from the 'good' perhaps painful, feeling after you've done some gentle exercise that has stretched muscles and the muscle is getting stronger. You may notice a change to anaerobic respiration when for example walking or another activity when you've pushed yourself too far you can be gasping so much for air that you can't speak or whistle.

It is better to always keep a little energy in reserve. With practice we can learn when to stop and rest to gain more energy. We need to listen to our bodies. I know when I’m in danger of reaching 'empty' is when my legs start to feel like jelly or I get severe tinnitus.

What is rest?

What it is not, is sitting watching the TV. Rest is relaxing both mind and body to recharge the battery. That is ideally lying down in a quiet room mediating, practicing mindfulness techniques, listening to a relaxation CD or gentle music.

Managing the energy we use in activities is vital to the success of completing the task. If we are like the hare we will complete the task but then suffer the consequences of an increase in pain and fatigue, and possibly a crash. This can be a delayed response up to hours or days later. We will achieve more with less consequences if we add in times of rest or gentle activity during times of high energy activities.


Adding visualisation

I've been following the advice of a pain consultant in New Zealand called Dr Jonathan Kuttner. He's written an excellent book called 'Life After Pain'. (See more about his book on this page). In his latest talk he was discussing how to manage our activities with a different twist.

You will see above a photo of a guard dog. The guard dog - represents our over alert sympathetic nervous system (the fight and flight response).

This sleeping dog - represents the parasympathetic nervous system (that promotes rest and digest).

When we are about to do an activity or we notice we have activated our ‘fight and flight response’ we should do a 'mind-body session' of our choice that will send the dog to sleep.

You might have observed Olympic competitors as they prepare to take their turn, such as snowboarders, visualising the course before they set off. I now add this in before I do my VERY VERY gentle exercise or stretches.

To give you an example: I'm currently doing a series of 6 very gentle exercises to strengthen my body with the aim that if I have stronger back muscles I will feel less pain and have more energy.

  • Before I do the exercises I do a mind-body session to get 'the dog to go to sleep'.
  • Then I visualise myself doing the exercise with a feeling of ease and success.
  • Then I do the exercise with regular slow breaths to 'keep the dog a sleep'.
  • If I ‘wake the dog up’ either immediately or in a delayed response I will reduce the number of exercises the next day or if everything is calm over a few days or a week I'll gradually increase the number of exercises.
  • The plan is to do this for 3 days then a day's break. By doing this regularly it will become a habit that I can incorporate into everyday activities. The more I do it the easier it will be to keep the dog asleep!

Contact Linda now....

If you'd like help working out the best way to use your energy or need help working out how to avoid the 'crashes' and gain a better quality of life then call Linda for advice, the first 15 minutes is FREE.