Background

Activity Tolerance describes a person’s ability to perform an activity or occupation without experiencing a disproportionate amount of physical, emotional, or psychological fatigue. The following videos discuss ways the occupational therapist (OT) can screen, manage, and increase their client’s activity tolerance. The videos detail the screening process, demonstrate effective breathing techniques, show how to use vital signs to improve activity tolerance training, and finally, demonstrate and discuss both remedial and compensatory interventions.

In lab, you will participate in the six-minute walk test while using the pulse oximeter and see how your heart rates changes throughout the walk. As you walk, your heart rate increases. You’ll also see that everyone’s heart rate is different because each person exerts a different amount to reach their different heart-rate zones. During the lab, you’ll learn energy conservation and breathing techniques to use to help your client accomplish his or her occupation without reaching fatigue.

Using Vital Signs for Activity Tolerance Training

This video explains how to calculate maximum heart rate and the different heart rate zones for activity tolerance training.

Video is licensed under CC BY 4.0.

Using Vital Signs for Activity Tolerance Training Video Transcript

Measuring Vital Signs Tips

• Use Pulse Oximeter to calculate normal heart rate (HR).
• Calculate maximum HR by subtracting the person’s age from 220.
• Take the maximum HR and multiply it by each percentage section ranging from 40 percent to 80 percent to find each zone’s HR.
• Start at the lowest HR zone for cardiopulmonary clients and gradually increase the zones as their health improves. 

Activity Tolerance Screening and Assessment

This video explains how to screen activity tolerance using the six-minute walk test. 

Video is licensed under CC BY 4.0.

Activity Tolerance Screening and Assessment Video Transcript

The six-minute walk test tips

• Set out a course that your client can walk repeatedly and as far as they can in six minutes. 
• Let your client know that they are allowed to slow down or take breaks when needed, but they must return to walking as soon as they can. 
• Advise your client to only walk, not jog, the course. 
• Count the number of times your client repeats the course. 
• Note the number of breaks your client takes as well as the physical state the client is in throughout the test, for example, are they breathing heavily, sweating profusely, etc. You’ll use this information to track their progress for later testing.
• Administer the test throughout the next few weeks and months. 
• Compare the data from the previous tests to gauge your client’s progress. 

Breathing Strategies

This video explains pursed–lip breathing and diaphragmatic breathing techniques to help your client recover from shortness of breath and, or, to reduce anxiety. 

Video is licensed under CC BY 4.0.

Breathing Strategies Video Transcript

Pursed Lip Breathing Tips

• Relax your neck and shoulder muscles. 
• Breathe in, inhaling slowly through your nose as if you are smelling a flower. 
• Bring your lips tightly together to form a round shape. 
• While keeping your lips pursed, breath out, exhaling slowly.  
• Try to exhale twice as long as you inhale. 

Diaphragmatic Breathing Tips

• Find a comfortable place to either sit or lie down. 
• Place your hands over your stomach. 
• Inhale slowly through your nose, allowing your chest and stomach to fill with air. 
• Slowly exhale.
• As you inhale, you should feel your stomach expand. As you exhale, you should feel your stomach contract and move in. 

Activity Tolerance Training

The following video explains remedial and compensatory interventions to improve activity tolerance and ways to grade an activity. 

Video is licensed under CC BY 4.0.

Activity Tolerance Training Video Transcript

Remedial Intervention – Activity Tolerance Training Tips

• Find an exercise or activity that is tolerable but that challenges your client’s activity tolerance. 
  • To find the correct challenge level, you can grade the activity by using the following tools: 
    • Physiological values, such as heart rate and blood pressure: measure your client’s heart rate, figure out their max heart rate, and then figure out their zones. During activity, take note of their oxygen saturation. *Note: If the zones don’t line up with what makes sense, use a different tool* 
    • Talk–test: During the activity, if your client can carry on a conversation using complete sentences, they are most likely in the 40-50 percent MHR zone. If the client starts using phrases or is only able to spit out words, the challenge is too hard. If the client can talk in monologues, the activity isn’t challenging to them.
    • Borg RPE: The client will self-grade the activity using a 1-10 scale. Once your client can tolerate either the exercise or activity, increase the challenge. 

Compensatory Intervention – Energy Conservation Strategies Tips

• Discuss with your client ways to adapt the task so they stay in a comfortable zone by using the following energy conservation strategies: 
  • Prioritization
  • Planning
  • Pacing
  • Power Saving
  • Posture

Resources

• Activity tolerance intervention ideas for occupational therapists by Sarah Stromsdorfer
• Fight Fatigue by Conserving Energy, Multiple Sclerosis News Today