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Plan a gradual, time-based increase in activity from a sustainable baseline — not guided by pain, but by a pre-set schedule.
Graded activity means starting from a baseline you can always manage (even on a bad day) and increasing gradually by time, not by how you feel. Track your planned amount, actual amount, and pain level to show that gradual increases are sustainable.
Introduce after the boom-bust cycle has been understood and the client is ready to begin a graded approach to increasing activity. Use when fear-avoidance or deconditioning is maintaining disability beyond what the pain condition alone would predict.
Explain that graded activity involves starting at a manageable level and increasing gradually, regardless of pain levels. Frame this as retraining the body and the pain system rather than 'pushing through' pain. Emphasise that the starting point should feel easy — the goal is consistency, not achievement.
For clients with significant fear of movement (kinesiophobia), combine with exposure techniques and behavioural experiments around feared movements. For those with physical limitations, consult with physiotherapy regarding appropriate activities. Adjust progression rates for older adults or those with significant deconditioning.
Do not use graded activity if there is an undiagnosed or unstable medical condition that could be worsened by increased activity. Ensure medical clearance is in place. If the client's pain condition has specific activity restrictions (e.g., post-surgical), work within these limits.
Start below the client's current tolerated activity level to ensure early success. Increase by no more than 10-20% per week. Use time-based goals rather than distance or repetition goals. The most common mistake is starting too high and triggering a pain flare-up, which reinforces fear-avoidance beliefs.
Suitable for clients working with chronic pain, graded activity, pacing, cbt, exercise, deconditioning. This tool can be used as a standalone worksheet or as part of a structured homework plan.
Create a free account to access 10 worksheets per month.
Create a plan for managing pain flare-ups — covering prevention, early action, and what to do at each level of severity.
Track pain levels alongside activity, mood, and coping strategies to identify patterns.
Identify and challenge catastrophic thoughts about pain — helplessness, magnification, and rumination.
A biopsychosocial formulation for chronic pain — mapping biological, psychological, and social maintaining factors.