Action Over Inertia: Worksheets and Resources

Action Over Inertia
Addressing the activity-health needs of individuals with serious mental illness
Terry Krupa, Megan Edgelow, Shu-ping Chen, Carol Mieras, Andrea Almas,
Andrea Perry, Debbie Radloff-Gabriel, Jennifer Jackson, Marla Bransfield
Worksheets and Resources

Table of Contents
Chapter One: Preparing to use this workbook
Worksheets
1.1: Evaluating current activity patterns (service provider version).
1.2: Evaluating benefits of current activity patterns (service provider version).
1.3: My current activity patterns.
1.4: Benefits of my current activities.
1.5: What do others say about my activity patterns?
Chapter Two: Understanding personal activity patterns
Worksheets
2.1: Daily time-use log.
2.2: My daily time use.
2.3: Considering the balance of my activities.
2.4: Am I getting enough physical activity?
2.5: My daily routine and structure.
2.6: Finding meaning in my activities.
2.7: Satisfaction with activities.
2.8: Social interaction through activities.
2.9: Accessing my community.
2.10: Activity Engagement Measure.
Resources
2.1: Levels of activity engagement.
2.2: Daily activity codes.
2.3: Time use of adult and retired Canadians.
Chapter Three: A first step — making quick changes in activity
Worksheet
3.1: Record of activity experiments.
Resource
3.1: Some ideas for ‘quick activity changes’.
Chapter Four: Providing education about activity, health and mental illness
Worksheets
4.1: The health and well-being benefits of my current activities.
4.2: Reducing stress in activity participation.
4.3: Coping with stress in activity participation.
4.4: Understanding how substance use impacts my activities.
Resources
4.1: The multiple “well-being” benefits of activity.
4.2: One activity, many benefits.
4.3: Making clear the benefits of activities.
4.4: The recovery benefits of activity participation.
4.5: How are mental illness and activity participation connected?
4.6: Overcoming potential barriers to activity participation.
4.7: Moving beyond stress in activity participation.
4.8: Substance use, activity and well-being.
Chapter Five: Making longer-term changes
Worksheets
5.1: Preparing for changes in activity participation.
5.2: Prioritizing plans for activity change.
5.3: Planning for activity change.
5.4: Giving shape to plans for activity change.
Resources
5.1: Managing challenges to activity change.
5.2: Road bumps on the path from inertia to action.
5.3: Road bumps on the path from inertia to action [example].
Chapter Six: Supporting and evaluating activity change
Worksheets
6.1: Reflecting on practices of supporting activity change (service provider).
6.2: Enabling sustained commitment by supporting activity performance.
6.3: Enabling sustained commitment by supporting positive activity experiences.
6.4: Identifying changes in my activity patterns.
6.5: Thinking about changes in my activity patterns.
6.6: Measuring changes in my activity patterns over time.
Chapter Seven: Focusing on activity-health to inform service development
Worksheet
7.1: A framework for presenting program-level information
Resources
7.1: Preparing for continuous improvement applied to activity-health: Mission and goals.
7.2: Preparing for continuous improvement applied to activity-health: Engaging the support of
leaders.
7.3: Preparing for continuous improvement applied to activity-health: Taking stock of resources
and structures.
7.4: A framework for presenting program-level information (example).
Worksheet 1.1
Evaluating current activity patterns
(service provider)
Date: ______/________/_____
Name: ______________________________________________________________________
Service provider’s name: _____________________________________________________
Criteria a Examples
The person’s daily activities demon-

strate an imbalance between self-care,
productivity and leisure.
The person spends a large amount

of time without defined activity on a
day-to-day basis.
Much of the individual’s day is spent

in passive activities or rest.
There is a lack of organized routine/

structure to the person’s daily activity.
The person’s daily activities limit their

contact with others.
The person’s daily activities limit

their access to a range of community
environments.
The person cannot define activities

that are meaningful or of personal
interest.
The person experiences distress, or is

easily overwhelmed by activity.
The person’s involvement in activity

is impacted by a limited experience of
enjoyment.
If you have checked off three (3) or more of these criteria, this individual may benefit from intervention approaches directed
to enabling activity-health.
Action Over Inertia © CAOT PUBLICATIONS ACE 2010

Worksheet 1.2
Evaluating benefits of current activity patterns
(service provider)
Date: ______/________/_____
Name: ______________________________________________________________________
This person engages in activities

that provide the opportunity for… a Examples/comments
Skill and/or knowledge development
Making a contribution to society
Gaining physical health benefits
The enjoyment of beautiful things
Self-expression and creativity
A range of social interactions
Meeting personal goals, experiencing

accomplishment
Expressing personal values
Earning a personal income
Giving to others, such as family or

friends
Check 7-10: Experiences a full range of well-being and health benefits through activity.
Check 4-6: Experiences of well-being and health through activity are compromised.
Check 3 or less: Experiences of well-being and health through activity are seriously limited.

Worksheet 1.3
My current activity patterns
Date: ______/________/_____
Name: ______________________________________________________________________
Consider each statement and check all that apply
Criteria a Examples
My days are not balanced with time for fun,

work, taking care of myself, and rest.
I have lots of time, but nothing to do.
I spend most of my day resting, listening to

others or watching television.
I do not have a regular routine.
I don’t see many other people during my day or

week or do many things with other people.
I do not go to many different places to do

things during my day or week.
I can’t think of many things I do that are really

enjoyable to me.
I get easily upset or overwhelmed when I do

activities.
I wish that I could find some things to do that

are really enjoyable to me.
There are things I would like to do, but there

are barriers to why I don’t do them, such as lack
of money, transportation, or a friend to go with.
Are you generally satisfied with your daily time use and activities?
Add any other thoughts or ideas here:

Worksheet 1.4
Benefits of my current activities
Date: ______/________/_____
Name: ______________________________________________________________________
Check all of the items that apply to you.
My daily activities give me the

opportunity to … a Examples/comments
Develop new skills and knowledge
Feel as though I am making a valuable

contribution to society
Remain physically active and healthy
Enjoy beautiful parts of life, such as nature,

music, and art
Express my thoughts and feelings
Interact with other people socially
Achieve goals and feel as though I have

accomplished something
Express values that are personally important

to me
Earn a personal income
Interact with important people in my life

(family, friends, etc.) and make them feel good

Worksheet 1.5
What do others say about
my activity patterns?
Date: ______/________/_____
Name: ______________________________________________________________________
Circle the most appropriate response to each statement below:
1. People tell me that I should be more active throughout the day.
NEVER SOMETIMES OFTEN
2. People tell me I need to find things to do.
3. People sometimes question if I am happy with my activities.
4. People have told me I should socialize and interact more with others.
5. People worry that I have nothing to look forward to during my typical days.
6. People tell me I should get more involved in my community.
7. People tell me I should get out to visit different places in my community more often.

Worksheet 2.1
Daily time-use log
Date: ______/________/_____
Name: ______________________________________________________________________
In the chart below, fill in how you have recently spent a typical day.
The activity was done:

Time Activity Where? alone/with someone else
12
midnight
12:30 am
1:00 am
1:30 am
2:00 am
2:30 am
3:00 am
3:30 am
4:00 am
4:30 am
5:00 am

Worksheet 2.1
Daily time-use log
Name: _________________________________________________ Date: ______/________/_____

5:30 am
6:00 am
6:30 am
7:00 am
7:30 am
8:00 am
8:30 am
9:00 am
9:30 am
10:00 am
10:30 am
11:00 am
11:30 am

Worksheet 1.2
Daily time-use log
Name: _________________________________________________ Date: ______/________/_____

12 noon
12:30 pm
1:00 pm
1:30 pm
2:00 pm
2:30 pm
3:00 pm
3:30 pm
4:00 pm
4:30 pm
5:00 pm
5:30 pm
6:00 pm

Worksheet 2.1
Daily time-use log
Name: _________________________________________________ Date: ______/________/_____

6:30 pm
7:00 pm
7:30 pm
8:00 pm
8:30 pm
9:00 pm
9:30 pm
10:00 pm
10:30 pm
11:00 pm

11:30 pm

Worksheet 2.2
My daily time use
Date: ______/________/_____
Name: __________________________________________________________________________
Looking at your time use logs, label each activity you recorded as self-care, produc-
tivity, or leisure. Total the hours spent in each category for one day. This will give
you a visual image of the balance of your activities.
Category Hours Spent
Self-care
Productivity
Leisure
Rest
My Time
12
11
10
7
Hours Spent
0
Self-Care Productivity Leisure

Worksheet 2.3
Considering the balance of my activities
Date: ______/________/_____
Name: ______________________________________________________________________
Self-care Examples of my Time

activities Examples activities spent
Personal care • bathing

• dressing
Health-related care • attending appointments

• filling prescriptions
Productive Examples of my Time

Paid work • work for an employer

for pay
• self-employment for
pay
Unpaid work • work for an employer

without pay
Volunteer and other • unpaid work for a

civic work community organi-
zation or association
Education and • attending school

related • attending workshops
or training
• web-based learning
Day programs • attending treatment

programs or services
Parenting • taking care of children
Home management • cleaning

activities • renovating
• shopping for goods
and services

Worksheet 2.3
Considering the balance of my activities
(continued)
Name: _________________________________________________ Date: ______/________/_____
Leisure Examples of my Time

Active leisure • sports

• clubs
• attending
entertainment events
Passive leisure • reading

• watching TV
• listening to music
Socialization • sharing a coffee with

a friend
• attending a dinner
party
• talking with a friend
on the telephone
• joining a friend’s
Facebook site
• writing a letter to a
friend
Rest Examples of my Time

Night Sleep • the time of day when

you get the bulk of
your sleep
Naps • incidental sleep

during the day

Worksheet 2.4
Am I getting enough physical activity?
Date: ______/________/_____
Name: ______________________________________________________________________
Health Canada recommends that you get 60 minutes of light effort activities per day,
or 30 – 60 minutes of moderate or vigorous activities.
Time needed depends on effort…
Very light effort Light effort Moderate effort Vigorous effort Maximum effort
60 minutes 30-60 min. 30-60 min.
Strolling
Light walking Brisk walking Aerobics Sprinting
Dusting
Volleyball Biking Jogging Racing
Easy gardening Raking leaves Hockey
Stretching Swimming Basketball
Dancing Fast swimming
Water aerobics Fast dancing
Look at your time use logs.

Did you get enough physical activity? Yes No
Are you getting back to activity after a break from routine physical activity? Yes No
How could you incorporate more activity into your day?
Suggestions for beginners

(or those returning to activity after a break):
• Work up to 60 minutes of light effort activity every day.
• Activities can be in blocks of 10 minutes and can be added
up to reach the 60 minutes recommended.
• For those just starting out, add ten minutes of activity
every couple of days to avoid getting injured.
• Add moderate effort activities as you progress and are
more comfortable.
Source: Endurance: Kingston, Frontenac and Lennox & Addington Public Health (October 2008). What is Your Intensity? Motiv8. Retrieved from
http://www.kflapublichealth.ca/motiv8/files/EnduranceBooklet.pdf.

Worksheet 2.5
My daily routine and structure
Date: ______/________/_____
Name: ______________________________________________________________________
Daily structure
Answer yes or no where required and provide examples if possible.
What things do you do everyday?
Are there particular activities that structure your day and you plan your days around? Yes No
Is there a difference between your routine on weekdays and weekends? Yes No
Do you tend to plan your days in advance? When you wake up in the morning, do you typically have
a plan for the rest of the day? Yes No
Do you have particular activities or events that you look forward to? Yes No

Worksheet 2.5
My daily routine and structure
(continued)
Name: _________________________________________________ Date: ______/________/_____
Sleep Schedule
Answer yes or no where required and provide examples if possible.
Do you have routine sleep time? Yes No
Do you have naps throughout the day? Yes No
Do you use caffeine regularly? Yes No
Do you have difficulty sleeping? Do you wake up throughout the night? Yes No
Do you wake up feeling rested? Yes No
Do you take medications that affect your activity patterns? How do they influence your activities?

Worksheet 2.6
Finding meaning in my activities
Date: ______/________/_____
Name: ______________________________________________________________________
Rate the following statements in terms of how important each is to you in terms of your partici-
pation in activities.
I would like to participate in activities Very Kind of Not

that… important important important
contribute to my income
make the world better for others
are exciting and active
contribute to the wellbeing of people I love
increase my mental health
increase my physical health
allow me to feel peaceful
help me to find love and intimacy
contribute to my sense of security
are enjoyable and meet my interests
fulfill me spiritually
show my special skills and knowledge
make a contribution to my community
earn me respect and admiration
contribute to my knowledge
help me find friendship and social connections
let me appreciate the natural world
allow me to appreciate art or other creative

expressions
Other meaning:

Worksheet 2.7
Satisfaction with activities
Date: ______/________/_____
Name: ______________________________________________________________________
Consider the activities you identified on your daily time-use logs:
Which activities brought you feelings of satisfaction or well-being?
Which of these activities was the least enjoyable or satisfying?
Do any of the activities bring you feelings of distress or discomfort?
Are there particular times of the day when you are most satisfied and least satisfied with your
activities?
Think of your overall activity patterns — do they bring you satisfaction?
What activities have you done in the past that have brought you enjoyment and satisfaction? Have
you been able to enjoy these activities lately?
What changes in your activity patterns might bring you more satisfaction?

Worksheet 2.8
Social interaction through activities
Date: ______/________/_____
Name: ______________________________________________________________________
In the chart that follows, list all the people that you saw over the course of your “typical” days.
Add those people who you see often, but who may not be included on the time-use logs. Also,
record the activities that you usually do with these people.
People I see Activities that we do
a Do these people include… Who are these people?
Friends?
Family?
Neighbours?
Colleagues or co-workers?
Service workers?
Other:

Worksheet 2.8
Social interaction through activities
(continued)
Date: ______/________/_____
Name: ______________________________________________________________________
Are you satisfied with the social interactions you now have? Yes No
Is there a certain type of social interaction that you would like to experience more?
Are there certain people that you would like to see more? Who are these people?
Do you enjoy interacting with animals or pets? Yes No
Do you have the opportunity to interact with animals or companion animals (pets) as much as you
would like? Yes No

Worksheet 2.9
Accessing my community
(Note: some sections have been derived from Aubry & Miner, 1996)
Date: ______/________/_____
Name: ______________________________________________________________________
Look back over your time-use diaries.

List all of the different environments that you visited.
How much time did you spend at home vs. in the community?
What time of day are you usually at home?
What time of day are you usually out?
Where do you spend the majority of your time, aside from home?
What activities do you do there?
Does anyone know where you are during the day? Yes No
Do you feel safe in your neighbourhood? Yes No
Do you speak with your neighbours when you see them on the street? Yes No
Do you have neighbours that you could ask to watch over your home or check your mail while you
are away? Yes No

Worksheet 2.9
Accessing my community
(continued)
Date: ______/________/_____
Name: ______________________________________________________________________
Think of all of the activities you may have done in the past week.
Check off all that apply.
___ Visited a shopping centre
___ Gone to a movie, concert, or sports event
___ Played a sport outside or went for a walk
___ Went to a restaurant, bar, or coffee shop
___ Visited a community centre, library, church, or place of worship
___ Went to a barber or beauty salon.
Are there places that you used to visit that you don’t anymore?
Are there certain places in the community that you would like to visit but don’t?

Worksheet 2.10
Activity Engagement Measure
Date: ______/________/_____
Name: ______________________________________________________________________
1. Balance in my life: I could benefit from more balance between my self-care, leisure, productivity,
and rest activities.
Rate how true this statement is for you.
1 2 3 4 5 6 7 8 9 10
very true somewhat true not true
2. Physical activity: I could benefit from more “physical” activity in my life.

1 2 3 4 5 6 7 8 9 10
3. Structure/routine: I could benefit from more structure and routine in my day.

1 2 3 4 5 6 7 8 9 10
4. Meaning: I could benefit from more activities that I find meaningful in my day.
1 2 3 4 5 6 7 8 9 10
5. Satisfaction: I could benefit from more satisfaction from activities in my day.

1 2 3 4 5 6 7 8 9 10

Worksheet 2.10
Activity Engagement Measure
(continued)
Date: ______/________/_____
Name: ______________________________________________________________________
6. Social interactions: I could benefit from having more social interactions through my daily
activities.
1 2 3 4 5 6 7 8 9 10
7. Accessing community environments: I could benefit from activities that take me to a broader
range of community environments.
1 2 3 4 5 6 7 8 9 10
Ratings:
Fill in the scores that you assigned to each area above. A lower score in any area suggests that
the area could benefit from direct attention and perhaps be given a higher priority for change.
Area of activity engagement Rating
1. Balance
2. Physical activity level
3. Structure and routine
4. Meaningfulness of activity
5. Satisfaction derived though activity
6. Social interaction
7. Accessing community environments
Activity dimensions are adapted from the work of Bejerholm (2007) and Bejerholm, Hansson, & Eklund (2006).

Resource 2.1
Levels of activity engagement
Disengagement Some engagement Engagement
Occupational • most of time spent • day has mix • continuous flow

balance and in passive leisure of periods of of small activities
physical activity • few peaks of engagement and during the day
activity periods of passive
leisure
Structure and • organized around • organized around • organized around

routine meeting basic one or two main many different
needs, like eating activities activities
• quiet activity used • long periods of quiet • quiet activity used
to distance self activity to fill empty as break between
from reality time frames periods
• may not leave • first hour or two • leave home soon
house until after waking spent in after early morning
afternoon passive activity waking
• to bed early, with • to bed early, with • reasonable amount
naps throughout naps throughout day of night sleep
day
Meaning of activity • little meaning • peaks of activity • ongoing meaning

overall due to long experienced as derived from
periods of time in meaningful activity throughout
passive leisure • long periods of the day
• some meaning inactivity not
during activity meaningful
peaks
Satisfaction with • little satisfaction • satisfaction high • high satisfaction,

activity overall during activity even in passive
• activity peaks may leisure
be satisfying
Social interactions • limited social • may have some • social interaction

interaction social interaction with multiple
people
Access to • little time spent in • some time spent in • visits to a variety

community few public places community of community
environments environments

Resource 2.2
Daily activity codes
Self-care activities
PERSONAL CARE HEALTH-RELATED CARE

• religious services/prayer/bible readings • medical/health care at home
• travel to religious services • medical/health appointments
• meals, snacks, and coffee • filling prescriptions
• relaxing, thinking, resting • travel to medical/health appointments
• washing, dressing
• getting a haircut
• other personal care activities
Productive activities
PAID WORK VOLUNTEER AND OTHER CIVIC WORK

• work for pay at main job, including • participating in a union or political/civic
overtime work activity
• waiting/delays or coffee/other breaks at • participating in child, youth, or family
work organizations
• hobbies or crafts done for sale or • participating in religious, fraternal and social
exchange organizations
• looking for work • participating in support groups (i.e., al-anon,
• idle time before/after work AA)
• travel to/from work • participating in volunteer work
• helping someone with housework and
UNPAID WORK cooking
• work for an employer without pay • unpaid babysitting
• travel to unpaid work site • care for disabled or ill
• unpaid help for a business or farm
EDUCATION AND RELATED • coaching
• attending full-time or part-time classes • travel for volunteer and civic activities
• watching credit courses on television
• attending special lectures DAY PROGRAM ACTIVITIES
• doing homework • work at program site for pay
• taking a course for career or • attend outing for meal/coffee
self-development • prepare meal at site
• breaks/waiting for class • attend field trip
• travel related to educational activities • attend presentation/meeting/class
• eat meal at site
PARENTING • attend recreational event
• baby or child care • attend support group
• helping/teaching/reprimanding • attend social club
• play with children • socialize at the site
• medical care for children • travel to day program activities
• other child care
• travel related to child care

Resource 2.2
Daily activity codes
(continued)
Productive activities
HOME MANAGEMENT
• meal/coffee preparation and cleanup • care of house plants
• indoor cleaning & tidying • household administration (i.e., pay bills)
• outdoor cleaning • stacking and cutting firewood
• laundry/ironing, folding • putting groceries away
• mending/shoe care • shopping for groceries, clothing, gas, etc.
• dressmaking and sewing • buying take-out food
• interior and exterior maintenance and • shopping for durable household goods
repair • financial services (i.e., banking)
• vehicle maintenance • other repair services (i.e., TV)
• other home improvements • waiting for purchases/services
• gardening/grounds maintenance • other shopping and services
• pet care • travel to shopping for goods/services
Leisure activities
ACTIVE LEISURE PASSIVE LEISURE SOCIALIZING

• playing sports and games • listening to radio, CDs, • restaurant meals with
like miniature golf, tapes, records others
Frisbee, catch, bowling, • sitting • socializing at a home
and billiards • smoking • talking, conversation,
• outdoor activities like • watching TV phone
hunting, fishing, camping, • lying down • socializing at bars, clubs
skiing and ice skating • passing time without • socializing at malls,
• walking, hiking, biking activity hospitals
• board games, cards and • going to social gatherings
video/computer games like weddings
• music, drama, dance • going for a pleasure drive
• exercise like yoga and with another or on a tour
weight lifting bus
• attending sports and • travel to social activities
music events
• going to fairs or zoos
• going to movies or films
• going to opera, ballet,
theatre
• going to museums, art
galleries, heritage sites
• travel related to active
leisure
Rest activities
NIGHT SLEEP NAPS

• night sleep/essential sleep • incidental sleep, naps
Source: Adapted from Statistics Canada’s 1998 Time-Use Survey

Resource 2.3
Time use of adult and
retired Canadians
Time Use of Adult Canadians
Self-care
Hours
Productivity
Leisure
Rest
Activity
Time Use of Retired Canadians

Hours
Self-care
Productivity
Leisure
Rest
Activity
Source: Adapted from Statistics Canada’s 1998 Time-Use Survey

Worksheet 3.1
Record of activity experiments
Date: ______/________/_____
Name: ______________________________________________________________________
List your selected activity experiments, the date and brief comments about the experiment:
Activity experiment Date Comments about the experience and

progress made

Resource 3.1
Some ideas for ‘quick activity changes’
Here is a list of activities that are quick, simple and require little preparation. Consider any that
sound interesting to you. Then, try one, two, or a few — you may be surprised how good you feel
when you’re finished!
A. Examples of small “activity experiments” in the area of self-care:
Personal Care
Dressing Hygiene
• Wear a different shirt. • Shave.
• Try to mix/match a top and bottom • Get a haircut or try a different hairstyle.
differently. • Try a different toothbrushing routine.
• Have or give a manicure/pedicure.
Bathing • Try a new colour of nail polish.
• Have a bath or shower. • Try flossing your teeth.
• Try a new body wash or shampoo.
Health
Eating • Get a flu shot.
• Have breakfast. • Book an appointment for a medical
• Try a new fruit or vegetable. checkup.
• Try a new restaurant. • Throw out your expired medicines.
• Try a new ethnic food – maybe one that a
friend enjoys.
Community Management
Transportation
• Try taking a bus.
• Go for a bike ride.
• Walk a short distance.
• Go for a ride with a friend.
Shopping
• Try a different store for grocery shopping.
• Go shopping with a friend.
• Combine a drugstore visit with a rest at the local coffee shop.
• Go window shopping in a different area of town
Finances
• Record what you are spending each day for a week.
• Check out the thrift shop.
• Look at the flyers for sales.

Resource 3.1
(continued)
B. Examples of small “activity experiments” in the area of productivity:
Paid/Unpaid Work
• Look online at the volunteer positions posted.

• Dig out your old resume.
• Visit the local employment agency.
• Do an interest inventory to determine what you are interested in.
• Visit a volunteer coordinator.
Household Management
Cleaning Laundry
• Clean off a counter or table surface. • Do one load of washing and drying.
• Spend 30 minutes per day on one room. • Fold and put away clothes that have been
• Organize one drawer or one shelf in your in the laundry basket.
storage closet.
• Recycle your newspapers and cans. Cooking
• Give your old clothes to a local charity. • Plan and prepare your favourite food.
• Try a new recipe.
• Watch a cooking show.
• Eat by candlelight.
C. Examples of small “activity experiments” in the area of Leisure:
Quiet Recreation
Pleasurable activities/hobbies/crafts: • Write a poem.

• Find an unfinished project. • Sing in the shower.
• Look through hobby magazines to see if • Try a new flavour of ice cream.
there is anything of interest. • Reduce your time in front of the TV by a
• Look through the local college or city parks half hour.
and recreation catalogue to see if there is a • Take a nap.
class of interest. • Visit a new website on the computer.
• Play a musical instrument.
• Listen to your favourite music. Reading:
• Listen to a symphony. • Find a short story book and read one
• Watch a sunset. story.
• Repot a plant. • Read a magazine article.
• Listen to a comedian or take in a funny movie. • Borrow a talking book from the library
• Cook a vegetarian dinner. and try listening to it.
• Try a new type of tea. • Try a different newspaper.

Resource 3.1
(continued)
3. Examples of small “activity experiments” in the area of Leisure continued:
Active Recreation
Sports:
• Stretch after a warm shower.
• Rent a yoga, pilates, or Tai Chi DVD from the library or store.
• Dance around the living room.
• Walk along the waterfront.
• Make a list of all the sports you have tried and ones you are interested in.
• Watch a new sports show on TV.
• Read a story about an inspiring athlete.
• Take a free yoga class.
• Take the stairs instead of the elevator.
Outings:
• Visit an art gallery, museum or facility that you have not tried before.
• Try a new food from a different culture (i.e., Indian, Vietnamese, Greek, Japanese, Chinese).
• Go to a local event.
• Go the local library and borrow a CD, DVD, or book.
• Use the Internet at your local library.
• Visit your seniors’ centre.
• Paddle or row a boat.
• Fly a kite.
• Find an activity partner; it is more fun with a friend.
Gardening
• Plant, dig, prune, rake or weed.
Travel:
• Take a different bus.
• Rent a movie about a travel destination.
• Go to a new community in your area with a friend.
Socialization
Visiting/phone calls/parties/ • Send a card to someone.

correspondence: • Send an e-mail.
• Invite a friend for a cup of tea at your • Set up a Facebook account.
home or a local shop. • Send someone your favourite YouTube
• Call an old friend. video.
• Call your favourite relative.

Worksheet 4.1
The health and well-being benefits
of my current activities
Date: ______/________/_____
Name: ______________________________________________________________________
Health and well-being benefits I receive from these

activities
Self-care activities:
Leisure activities:
Productivity activities:

Worksheet 4.2
Reducing stress in activity participation
Date: ______/________/_____
Name: ______________________________________________________________________
I would like to use this

Strategy to reduce I use this strategy strategy or improve the way
sources of stress effectively I use this strategy
Be aware of situations that

were stressful in the past
Set reasonable expecta-

tions for myself
Consider how stressful

aspects of an activity can
be modified or changed
Maintain good health

habits that reduce my
experience of stress
Seek out supportive

relationships that can help
me manage stress
Avoid situations with

arguments and criticism
Give myself credit for

talents and strengths
Balance out the amount

of stress I have across
activities
Other:
Adapted from: National Mental Health Information Center (2003). Illness Management and Recovery Implementation Resource Kit. Washington,
D.C.: United States Department of Social Services. Retrieved from http://mentalhealth.samhsa.gov/cmhs/CommunitySupport/toolkits/illness/.

Worksheet 4.3
Coping with stress in activity participation
Date: ______/________/_____
Name: ______________________________________________________________________
Strategy for coping I use this I would like to try this strategy or
with stress in activity strategy improve the way I use it
Talk to someone about my

feelings and experiences
Use relaxation techniques
Use positive self-talk
Keep a sense of humor
Use religion or other form

of spirituality
Take a walk or exercise
Write in a journal
Work on solving problems
Develop my social skills
Learn new skills for the

activity
Identify and manage my

relapse triggers
Other:
Adapted from: National Mental Health Information Center (2003). Illness Management and Recovery Implementation Resource Kit. Washington,
D.C.: United States Department of Social Services. Retrieved from http://mentalhealth.samhsa.gov/cmhs/CommunitySupport/toolkits/illness/.

Worksheet 4.4
Understanding how substance use
impacts my activities
Date: ______/________/_____
Name: ______________________________________________________________________
Use these questions to consider how substance use might be impacting your activity participation
and well-being.
Yes/No Comments/examples
Substance use is a part of

my daily routine
I regularly use substances

over the course of a typical
week
My use of substances
tends to be linked to
certain activities
Using substances helps

me to deal with bad
feelings or moods
I regularly participate in a
range of activities that do
not involve substance use
My use of substances
could put activities I value
at risk
My use of substances has

been a source of conflict
with important people in
my life
The money I spend on

using substances limits
my ability to participate in
other valued activities
Using substances
helps me to cope with
the anxiety or stress
I sometimes feel in
activities

Resource 4.1
The multiple “well-being” benefits of activity
Every person needs to have the opportunity to experience a variety of activities in order to
experience wellness and satisfaction with their life.
Through activities, you have the potential to experience all of these benefits!
Contributing to Society
Meet your Goals
Developing
new Knowledge
& Skills
Making Others
Feel Good
Enjoy
Beautiful
things
Making Money Expressing

Yourself
Doing Things that are

Important to You
Interacting with other People
Being Physically Active
Taking off with healthy activity!

Resource 4.2
One activity, many benefits!
Any one activity may provide several benefits. For example, a person who works part-time at
the public library could experience all of the following personal benefits:
Developing knowledge and skills:

Part-time work can help to develop important work skills, particu-
larly when an individual has experienced a lengthy period out
of the workforce. It also requires the development of skills
to complete the job (for example, learning how books are
catalogued or how to use technology for library searches). This
work would also give access to reading and other resources for
personal interest.
Interacting with others:

Working at the library could allow for social contacts with both
the staff and the patrons. It also provides an experience that can
be shared with family and friends.
Personal income:
Part-time work will provide an income that might be small but
could provide extra funds to meet expenses or to save for an
important purchase. It could also supplement pocket money and
be used for social opportunities such as going to the movies with
a friend, or buying a gift for a family member.
Contributing to society:
The library is a public resource that depends on community
members to keep it going.
Try to choose activities that provide more than one benefit. For
example, if you are going for a walk, invite a friend or neighbour
along. This will help to get the most from activities.

Resource 4.3
Making clear the benefits of activities
Here are some benefits of a few common activities.
Think about your own activity patterns – what benefits do you get?
Activity Benefits
Exercise • Improved mood and feeling “fit”

• Maintain a healthy body weight
• Decrease the risk of diseases such as cancer, diabetes and heart
disease
• Better endurance, stamina and flexibility for other desired activities
Preparing and • Good nutrition and maintaining a healthy weight lowers risk for many
enjoying meals diseases such as Type II diabetes
• Proper nutrition can give energy to participate in activities
• An activity that can be enjoyed with others
• Learn about the habits and routines of other cultures and develop
skills in the kitchen that will be appreciated by others
• Social supports can help in time of crisis and sadness

Socializing
• A social network can offer practical help
• Social contacts can encourage and support participation in a range of
activities
• Social contacts appear to protect people against some forms of illness
• It feels good to give support to others
Work and • Having a job or volunteer position can give a sense of purpose and
Volunteering importance
• Personal aptitudes and interests can be used in work and volunteer
activities
• New skills can be learned
• Social skills can be practiced in the work place and new friends can be
made
• Working can provide financial benefits
Grooming • Can improve self-esteem and increase comfort in public situations

Routines • Can be an important form of self-soothing that helps to reduce anxiety
or distress
• Can reduce the costs associated with costly health/dental care
Relaxation • An antidote to stress

• Can improve mood and reduce frustration
• Can sharpen thinking skills
• Reduces physiological effects that can lead to poor health

Resource 4.4
The recovery benefits of activity participation
Becoming
empowered and
exercising citizenship
Participating in activities
provides the context for
having a “voice” and
Finding
Renew hope influence in the
social support
Activity participation community
Through activities
provides evidence of important social
possibilities beyond connections are
illness made
Assume control
Redefine self Activity
Activities provide
Through activities, Patterns the means to exercise
personal and social Individualized choice and to become
identity (beyond Strengths-based actively involved with
the illness) are Personal meaning the world in a way that
realized Self-determination supports personal
well-being
Live a full life – Manage

not an illness symptoms
A range of daily life Participation in
activities define an important activities
individual’s life. The provides the
illness experience is context for learning
only part of this Overcome stigma to manage
“whole” life Social stigma is reduced symptoms
through positive inter-
actions with people
with mental illness in
important social
activities

Resource 4.5
How are mental illness and activity
participation connected?
Biological, psychological and social explanations
People with mental illness often describe tremendous changes in the way they experience their daily
activities. These descriptions have typically included:
• difficulties with feeling motivated and sustaining interest

in activity;
• weakened sense of enjoyment and pleasure from
activities;
• unpleasant emotions such as anxiety associated with
activity participation;
• few opportunities for activity participation that holds
meaning and value;
• difficulty in activities with particular types of social
interactions;
• more difficulty planning and following through with
activities;
• cognitive changes or changes in thinking such as reduced
attention, working memory (i.e., holding information in
your mind), and flexibility in thinking processes; and
• sensory overload or understimulation in activity.
These changes can be uncomfortable both for the individual experiencing them, and for their family,
friends and others.
The reasons for these changes are complex and not completely understood.
This resource is meant to provide you with information about some of the ways that mental illness is
believed to impact the experience of daily activities. These are grouped into biological, psychological
and social explanations.
Not every explanation will apply to each individual; you are encouraged to talk to your health provider
to discuss how these ideas might apply to you.
It is important to remember that, regardless of the reason, many positive elements of activity
participation remain and changes in the experience of activity participation can be addressed.
Achieving the health and well-being benefits of activity is possible!

Resource 4.5
Biological explanations
Biological explanations focus on the structures, physiology and functions of the human body that
could account for disruptions experienced in activity and activity patterns.
Brain structure
The brain is divided into two halves- the left and right hemispheres. Each
hemisphere contains four lobes: frontal, parietal, occipital and temporal.
One area that has been found to play a role in activity participation
in people with mental illness is the frontal lobe. The frontal lobes are responsible for complex
thought processes, such as:
• planning activities;
• making decisions;
• interacting with others;
• controlling behaviour;
• processing emotions; and
• personality.
An impact on the frontal lobes through illness or injury can lead to changes in personality and
behaviour including, for example, difficulties controlling emotions and behaviour, and higher
levels of disorganization. This can interfere with motivation to do things that were once enjoyable
and the sense that the thinking and planning involved is overwhelming.
The frontal lobes are adjacent to the temporal lobes, and their
functions overlap. The temporal lobes contain the limbic system,
which is known as the “reward centre” of the brain. The limbic
system is important for motivation and pleasure. Changes in the
limbic system associated with mental illness may be another reason
why activities are experienced as less rewarding.
Some forms of mental illness have also been associated with

enlarged lateral ventricles. Ventricles are cavities within the brain
that are adjacent to many important brain structures. Enlarged
lateral ventricles have been associated with lower energy and motivation, less social interaction,
lack of enjoyment, and decreased ability to sustain attention – all likely to impact the experience of
engaging in activities.

Resource 4.5
Neurophysiological changes
Neurotransmitters are the chemical messengers that neurons or nerve cells use to communicate
with each other. Neurons carry information from the body to the brain and vice versa. There are
billions of neurons in the brain.
Impulses from other neurons are received by the dendrites and sent to the cell body of the
neuron. The cell body receives all impulses and keeps track of all of the inputs. If enough inputs
are received, the cell body reaches its threshold and transmits the impulse down the axon. When
information travels along the axon, it is called an action potential. The axon is covered with
myelin, which is a fatty layer that acts as an insulator and speeds up the rate at which information
travels along the neuron.
At this point, the impulse has traveled the full length of the neuron. For the impulse to be trans-
mitted, it has to be passed on to another adjoining neuron. Passing impulses between two
neurons is called synaptic transmission. A synapse is the space between the synaptic terminal of
one neuron and the dendrites of the receiving neuron.
How is the impulse transmitted across the synapse? It is passed along by chemicals called
neurotransmitters stored in packets called synaptic vesicles that are at the end of the axon. When
the action potential reaches the end of the axon, it signals to the release of neurotransmitters
which then spills into the synapse or synaptic cleft, and lands on receptors on the postsynaptic
membrane of the receiving neuron, where the whole process begins again.
What do neurotransmitters have to do with the experience of enjoying occupation?

Changes in neurotransmitters appear to be involved in the way people with mental illness
experience activities. Researchers are not exactly certain what roles neurotransmitters play, but
they do know that they are involved. Dopamine, serotonin, and glutamate (among others) are
neurotransmitters that have been associated with a wide range of mental illnesses. Disruptions
in neurotransmitters in the context of mental illness might affect the experience of activities, by
impacting motivation rewards, enjoyment, attention, energy, and so on.
The impact of medications on activity
Medications taken to treat mental illness and their side effects may also change the experience
of activities. While medications prescribed for mental illness can be very effective in reducing
symptoms and avoiding relapse of acute mental illness, managing medications may require
the development of coping strategies to deal with the impact on activity. Common side effects
of medications that impact activity participation include: feeling tired; lack of motivation and/or
energy; difficulty concentrating or feeling “foggy”; weight gain; changes in body movements.

Resource 4.5
Psychological explanations
The psychological elements of particular relevance are those mental
functions that lie at the heart of human potential for growth and
change. These are the psychological processes that influence how
humans think about themselves in relation to activities and how this
influences their participation and engagement.
Humans are believed to be inherently motivated to participate in activities – this motivation is funda-
mental to survival. Motivation is a complex psychological process that includes initiating human
activity, giving it direction and sustaining involvement. Motivation can be quickly and profoundly
disturbed by experiences with mental illness.
The following are a few ways this disruption in motivation for activity can occur:
Hopefulness vs. hopelessness

Ongoing symptoms of mental illness, personal limitations experienced in the wake of mental
illness, and the disruption of important life plans and activities can interfere with an individual’s
ability to imagine a future with new possibilities and potential.
Active involvement vs. inactivity/passivity

Individuals experiencing mental illness can feel that they have lost control of their health and
well-being — and of their present and future lives.
Activity-promoting self-evaluations vs. activity-inhibiting self-evaluations

Negative experiences with mental illness can impact self-confidence and self-esteem and belief in
one’s own abilities. This self-doubt can lead to caution and even avoidance of activities.
Feelings of pleasure vs. distress

Mental illness can be associated with an increase in feelings of distress in activity. For example,
anxiety, worry, and fear in activity can cause discomfort, even when the desire to participate in a
particular activity is present.
Coping and adaptation

Participation in valued activities requires ongoing coping and adaptation for everyone. Partici-
pation in valued activities while living with a mental illness requires the development of new
coping strategies and the resilience to bounce back and learn from successes and problems.

Resource 4.5
Social explanations
Social explanations focus on factors “external” to the individual that can impact activity patterns.
They can occur in an individual’s immediate environment, reflect social and cultural expectations,
or emerge from the structure or organization of important resources in the community.
Impact on “typical” developmental milestones
For many individuals, mental illness is first experienced in youth or young

adulthood, at a critical time period for the creation of activity opportu-
nities, learning important skills, and establishing the social networks that
will support activity engagement. For example, engaging in education is
a typical activity of youth, but when it is disrupted by mental illness it can
have far reaching implications for the individual as they age — impacting
career opportunities if courses are not completed, influencing the ability to
secure good references, and constraining the ability to develop a good support network that will
enable intimacy and romance, family life, work, career and leisure possibilities.
Spending time in hospital or other settings removed from daily routines and
activities
Receiving treatment is an important resource for individuals who experience mental illness. For
some people that treatment might be delivered in a hospital setting. If the hospital stays are
relatively brief and infrequent they may pose only a minor disruption to activity participation and
patterns. For some people, hospital stays, or other time away from the community where daily
activities occur, can have a significant impact on activity experiences and participation. While
in hospital, daily routines and activities may be curtailed and offer few
choices. Hospital rules or procedures may limit access to certain types
of activity opportunities. Following a hospital stay, some people report
the need for a period of recuperation, overwhelmed by their absence
from daily activities and unsure how to reengage.
Stigma and discrimination
Societal stigma and discrimination have been described as particularly powerful forces
constraining the opportunities for individuals with mental illness to engage fully in personally and
socially valued activities. Societal stigma that constrains activity participation comes from at least
two sources:
1. Powerful assumptions held within the public about the ability of people with mental illness to
participate in important activities in the community. For example, assumptions might include
faulty information about the abilities and strengths of people who experience mental illness.
2. The inclusion of these assumptions into policies, standards and other social structures
surrounding important activities. For example, hiring procedures for paid or volunteer work
might be designed in a way that discriminates against (even inadvertently) people with mental
illness.
Stigma is a particularly powerful force when it is accepted by the person – a process referred to as
“internalized stigma.”

Resource 4.5 Social explanations
(continued)
Limited resources and opportunities
Full participation in meaningful activities depends on access to resources: things, people and
opportunities. People who experience mental illness can find themselves with constrained
financial means that limits their access to the “things” required to participate. For example,
students may have limited access to the money required for tuition, working may be constrained
by limited access to easy transportation or suitable clothing, and leisure may be impacted by
limited funds for equipment or entrance fees. Doing activities is supported by social networks,
and to the extent that people with mental illness find themselves experiencing reduced social
contacts, this situation will decrease their opportunities for participation.
Activity participation has not been a primary area of concern of service provision in the mental
health system. Indeed mental health service providers may not see the active support for activity
participation as a primary area for attention and they may hold faulty assumptions about the
relationship between activity and mental health. The mental health system has been slow to take
up interventions and practices shown to support activity participation.
Understanding the factors that might be involved in supporting or limiting activity participation
can be helpful in taking steps to move ahead.
Remember…
Health remains — even when illness is present
Capacity and ability remain — even when disability is present
Opportunities exist — even when participation has been affected

Resource 4.6
Overcoming potential barriers to activity participation
Factors constraining activity participation may be present, but are not necessarily insurmountable.
Here are just a few examples to get you thinking:
Stigma Overcoming stigma
Some people who have not experienced Being active in the community can help
mental illness hold misguided attitudes about to change people’s attitudes about mental
mental illness. These attitudes may make illness. Through such positive interactions
it difficult for people with mental illness stigma and discrimination is lessened.
to maintain healthy self-esteem or to be
included in important community activities/
opportunities.
Anxiety Overcoming anxiety
Feelings of anxiety and worry, whether due Being bored can also create feelings of
to mental illness or because of stigma and anxiety and depression. When people are
negative experiences, can make it difficult to inactive, they tend to spend a lot of time
engage in new activities or return to activities alone, which also increases anxiety. Being
once enjoyed. active is an effective distraction from
worry, and learning relaxation and anxiety
management techniques can help.
Stress Overcoming stress
The fear that stress could prompt a relapse is Engaging in valued activities is important in
often a barrier to participating in activity. learning to manage illness and experience
recovery. Best practice in mental health
matches activity participation with supports
to enhance coping, manage expectations and
demands and ensure much needed supports
are in place.
Changes to social networks Developing new social networks
Social contacts can change or be lost during Friends provide social support that can help
the course of mental illness. Confidence to to enjoy and manage day-to-day activities. By
socialize can be shaken. Changes in activity participating in new activities, opportunities
patterns can also affect the opportunity to to meet new people and develop new friend-
meet new people. ships can present.
Financial barriers Dealing with financial barriers
People with mental illness on a limited income Activities do not have to be costly. Low cost
may find their activity options limited. Activ- (or no cost) activities exist. Funds may be
ities can be costly, which may be a barrier to available to cover some costs of working.
participation. Disability income may impact Familiarity with the policies related to income
work opportunities. can ensure that all opportunities for activity
participation are pursued.

Resource 4.7
Moving beyond stress in activity participation
Consider these strategies to actively manage stress experienced in activity:
i. Choosing Activities
Choose activities that hold personal meaning and value
This can help you sustain your commitment in activity if the
going gets rough.
Choose activities that are a good match for your strengths, skills,
abilities and past experiences
Capitalize on your many strengths to reduce the experience
of stress in activity.
Learn more about your own experience of stress

Use this information to help you in planning your activity
involvement.
ii. Managing Stress in Activity

Learn new skills necessary to participate in the activity
Consider the task and social skills required and create the opportunities to learn these skills.
Take stock of your coping style and skills and learn new skills to help you adapt
Consider what coping strategies have worked for you and which haven’t.
Try out new coping strategies.
Learn to identify signs/symptoms of your mental illness in activity

By identifying potential “triggers” you are in a good position to learn new ways to actively
manage your illness while continuing with important activities.
Develop supports and resources to assist you with your activity participation
Supportive people can provide emotional support; help you learn new skills; and ways
to cope. Consider what resources might make it easier for you to participate and work with
your supports to get these resources where possible.
iii. Reducing the Experience of Stress in Activity

Consider how the activity might be changed to support your participation and reduce stress
Most activities can be adapted to create a better “match” for individuals. These modifications
are sometimes called “accommodations.”

Resource 4.8
Substance use, activity and well-being
While the use of street drugs and overuse of alcohol has been shown to increase symptoms and
community living problems associated with mental illness, it can also interfere with the ability to
experience the benefits of participation in activities.
Here are a few examples:
• Substances can be expensive, taking away from

money that could be spent doing valued or potentially
rewarding activities.
• Using street drugs and other non-prescription drugs

may be difficult and dangerous to get. Getting these
drugs may deplete energy - energy that could be put
into other rewarding and valued activities.
• Abusing substances can cause isolation from

important family and friends. Activities that do not
depend on substance use are more likely to provide
opportunities for positive social connections.
• The effects of using drugs or alcohol may make it

unsafe, difficult, or even impossible to do other
activities.
• Frequent substance use can reduce the opportunity to

experience the pleasure and good feelings that can be
associated with activity.
• While using substances might reduce anxiety or other

distress associated with participating in valued activ-
ities, in the long run it can seriously limit opportu-
nities for learning healthy ways of participating.
Consider reducing your use of substances. Services and resources are available to help.
Ask your mental health service providers for more information!

Worksheet 5.1
Preparing for changes in activity participation
Date: ______/________/_____
Name: ______________________________________________________________________
The activities that I enjoy doing now are:
Activities that provide structure and order to my days are:
The most meaningful activities I now do are:
Thinking about the way I now spend my time, the things I don’t want to change are:
The activities I do now that I don’t enjoy are:
If I could change one thing about the way I spend my time it would be:
My ideal day would include these activities:

Worksheet 5.2
Prioritizing plans for activity change
Date: ______/________/_____
Name: ______________________________________________________________________
A. Look back at the Worksheet 2.10: Activity engagement measure. Fill in the chart below using
your ratings for each dimension from this measure.
Remember that a LOWER rating indicates that you could benefit from attending to this
dimension of activity more in your life.
Area of Activity Engagement Rating (out of 10)
Balance in my life
Physical activity level
Structure and routine
Meaningfulness of activity
Satisfaction derived though activity
Social interaction
Accessing community environments
Based on these scores, what three areas would you rate as the most important to improve?
1.
2.
3.

Worksheet 5.2
Prioritizing plans for activity change
(continued)
Date: ______/________/_____
Name: ______________________________________________________________________
B. Look back on all of the worksheets and reflections. What activities or activity patterns have
you identified as perhaps requiring change? Write them down here.
Add other new activities or activity pattern changes that you have been thinking of:
C. Could any of these activities help you improve those areas of activity participation you
prioritized above in section A? How?
D. What changes to your activities or activity patterns would you most like to make?

Worksheet 5.3
Planning for activity change
Date: ______/________/_____
Name: ______________________________________________________________________
1. List ONE desired activity change: __________________________________________________________
2. What challenges or issues do you expect might arise in making this activity change?
Use Resource 5.1 and Resource 5.2 to help guide you in this exercise.
a Challenges Examples
Personal learning
Material resources
Illness management
Emotional needs
Managing social judgments
Activity modifications or
accommodations
Social supports
Other

Worksheet 5.3
Planning for activity change
(continued)
Date: ______/________/_____
Name: ______________________________________________________________________
3. Consider each of the challenges listed in the previous section. How might these issues or
challenges be managed to help you participate successfully in this activity? What supports might
you need to address these challenges?
Challenges How can this challenge be reduced or managed?

Worksheet 5.4
Giving shape to plans for activity change
Date: ______/________/_____
Name: ______________________________________________________________________
1. I would like to make the following change to my activity participation:
2. In order to make this change I will: (Outline the steps to be taken.)
3. The following people will be involved in helping me achieve this plan for change: (Identify
the people and explain how they will be involved.)
4. The changes I expect as a result of this change are:
5. I will monitor my progress on this activity change by:

Resource 5.1
Managing challenges to activity change
Challenges Examples
Personal learning - Practice asking co-workers for assistance or asking a

New activities might require new supervisor for clarification
information/knowledge or skills or - Learn about a new area of town or transportation
“tuning up” old skills services
- Learn how to use a new or updated computer
program
Material resources - Secure employment supports available through

Every activity will require access to government financial assistance
things such as transportation, new - Gain access to a computer to use social networking
clothing, equipment, etc. programs
- Update clothing for a job interview
Illness management - Speak with the doctor about a medication schedule

Understanding how experiences that reduces morning fatigue
of illness present in new activities - Identify symptom “triggers” in the activity and learn
and learning how to manage is to avoid or manage these triggers
important - Build rest times into the day to give energy to
manage symptoms
Emotional needs - Learn relaxation techniques to help deal with

Keeping up involvement in any new feelings of anxiety
activity depends on experiencing - Identify negative thought patterns that are affecting
positive emotions and a sense of the experience
well-being - Remember the positive experiences of activity to
counterbalance any negative emotional aspects
Managing social judgments - Decide what to “disclose” about mental illness and
Addressing misguided attitudes practice how to disclose
about mental illness that other - Connect with supportive people while participating
people hold can help make activity in activity
participation more pleasurable and - Become familiar with legal rights protecting
rewarding involvement in community activities
Activity modifications or - Work schedules can be flexible to accommodate

accommodations the need for a later start because of early morning
There are aspects of activities that fatigue
can be changed or modified when - Training time can be increased to give more opportu-
activity participation is difficult. nities to meet learning needs
- Private space can reduce distractions
Social supports - Identify a friend who is willing to participate with

Activity participation is enhanced you
when practical, emotional or infor- - Find a confidante who will give another perspective
mation support is available from or help with problem solving
other people - Organize your time to be with other people just for
fun – to offset other activities that are challenging.

Resource 5.2
Road bumps on the path
from inertia to action
Contributes to
Action
Before the Activity Activity Challenge

or Problem • Which of your strengths could be
used to change this cycle?
• Are there some ways that you’ve

coped with previous challenges
that might work now?
What was the Could be related to: • What is one thing you could do
situation? differently to overcome a piece of
• Activity this challenge or problem?
• Beliefs about activity • Situation
• Things you did • Thoughts
• What did you think? • Beliefs

Activity
• What did you feel? • Feelings • Thoughts
• Body response • Feelings
• Describe your body’s • Beliefs
reaction • People • Physical response
• What did you do?
• Was there a benefit?
• What in this situation contributes
to inertia?
Contributes to
Inertia

Resource 5.3
Road bumps on the path
from inertia to action (example)
Contributes to
Action
Ideas generated:
• Start with 10 min. walk around the
Activity Challenge block
Before the Activity • Get exercise equipment for house
or Problem
• Exercise with a TV program
• Buy a beginners exercise DVD
(e.g., Yoga, Tai Chi)
• Exercise early in morning/late at
night/during when fewer people are
likely to see me
I want to exercise • Ask a friend to do it with me
• Put on weight
but I don’t do it!! • Decide to do it at my best time of
• More self-conscious
about looks day – after lunch
• Get stopped before I • Reward myself with a cup of
even put on my favourite tea
runners • The 95% ‘doable’ idea to experiment
• Afraid I’ll run into with this week is: walk around
people I know the block every day after my early
• Don’t want people to supper
see me
• Frustrated with myself
• Keep thinking of how • Make excuses
many times I’ve tried • Feel worse
and failed at this • Distract myself with other things in
the house to keep from going out
• Eat more
• Smoke more cigarettes
• Drink more coffee
• Sleep more
• More bored
• Feel worse about myself
• Become more isolated from friends
and family
Contributes to
Inertia

Worksheet 6.1
Reflecting on practices of supporting
activity change
(service provider)
Date: ______/________/_____
Name: ______________________________________________________________________
What knowledge/evidence do I have that assures me that the planned activity changes hold
personal meaning for the individual?
From my knowledge of this individual I think my support actions will need to be sensitive to
the following issues:
How will I deliver my practice efforts so that they are attentive to these sensitivities?
How will I ensure that my efforts to support change with this individual are collaborative and
person-centred?

Worksheet 6.2
Enabling sustained commitment by supporting
activity performance
Date: ______/________/_____
Name: ______________________________________________________________________
The following checklist provides an opportunity to consider how specific enabling processes to
support the positive performance of activity are implemented with an individual. The information
gained from this worksheet can be used to make explicit these enabling processes for discussion
with the individual, other health service providers and for documenting and recording.
Supporting activity performance Specific efforts
Balance difficulties that emerge with attention

to the person’s strengths and capacities that
emerge in activity participation.
Build on strengths and capacities rather then

focusing on personal weaknesses or inabilities.
Refine or modify the context or conditions

of the activities to promote success and
well-being.
Develop additional human supports to support

performance, with particular attention to
engaging the support of people that also
participate in the activity or “natural supports.”
Access new material resources that will

enhance performance.
Identify and support the learning of new

knowledge and skills needed to perform the
activity well.

Worksheet 6.3
positive activity experiences
Date: ______/________/_____
Name: ______________________________________________________________________
The following checklist provides an opportunity to consider how specific enabling processes to
support the positive experience of activity are implemented with an individual. The information
gained from this worksheet can be used to make explicit these enabling processes for discussion
with the individual, other health service providers and for documenting and recording.
Support action Specific efforts
Convey an attitude of experimentation – an

attitude where there is no failure only new
learning and growth.
Decrease the assistance of formal supports in

activities as the natural benefits of activities
emerge and the individual gains confidence.
Make explicit the benefits the individual experi-

ences with changes in activity patterns. Use
the dimensions of health through activity to
identify and expand upon benefits.
Highlight any positive impacts on important

friends, family, and other social connections,
which emerge in the context of new activity
patterns.

Worksheet 6.3
positive activity experiences
(continued)
Date: ______/________/_____
Name: ______________________________________________________________________
Support action Specific efforts
Validate and address difficult emotional experi-

ences and help to equip the individual with
the knowledge and skills to manage these
emotions.
Identify and address situations that leave the

individuals vulnerable to experiences of trauma
or victimization.
Assist with refining activities and activity

patterns to match individual needs through
periods of instability of mental health.
Provide ongoing support to refine activities so

that they most closely reflect the meaning and
purpose that the individual associates with the
activity.
Validate concerns related to stigma and

discrimination and assist the individual with
developing personal disclosure plans and ways
to manage social evaluations or judgments in
activity.
Build in ways to celebrate achievements in the

process of changing activity patterns.

Worksheet 6.4
Identifying changes in my activity patterns
Date: ______/________/_____
Name: ______________________________________________________________________
Look back at the areas of change you prioritized (e.g., Worksheet 5.2: Prioritizing activity change).
Are these areas being improved by your participation in these new activities?
Fill in the chart below.
What changes have I

Area of activity actually experienced
engagement that I My activity changes in this area? How has
wanted to work on… that target this area… this area changed?
1.
2.
3.

Worksheet 6.5
Thinking about changes in my activity patterns
Date: ______/________/_____
Name: ______________________________________________________________________
Think about the activity changes you have been working on over the past _______ (time
period). How would you answer these questions?
The most difficult change to make in my daily activities was:
It was difficult because:
I managed these challenges by:
The easiest change to make in my daily activities was:
It was easy because:
The most enjoyable change I made to my activities was:
It was enjoyable because:
What benefits did you experience as a result of these activity changes?
Is there anything about your activity changes that you have been unhappy or concerned
about? If so, what are these concerns?

Worksheet 6.6
Measuring changes in my activity patterns over time
Date: ______/________/_____
Name: ______________________________________________________________________
This form is meant to be used along with Worksheet 2.10: Activity engagement measure.
Directions:
Use this form to keep track of the change in your ratings on the different aspects of your activity
patterns over time. List the ratings given for each of the dimensions of activity for both time 1
and time 2. Examine these ratings to identify changes. In the final column, note if positive change
(a higher ranking) has occurred.
Time 1 Ratings Time 2 Ratings Change: Positive

Date completed Date completed change yes/no
Balance in my life
Physical activity
Structure/routine
Meaning
Satisfaction
Social interactions
Access to community
environments

Worksheet 7.1
A framework for presenting
program-level information
Date: ______/________/_____
Name: ______________________________________________________________________
I. Activity-health – Baseline status

Total number of people completing the Activity Engagement Measure: N= __________
Activity Engagement
Measure
I could benefit Ratings: number of people
from more of the
following in my
day… 1 2 3 4 5 6 7 8 9 10
Balance
Physical activity
Structure/routine
Meaning
Satisfaction
Social interactions
Accessing community
environments

Worksheet 7.1
A framework for presenting program-level
information about activity-health
(continued)
II. Activity-health – Tracking change over time

Total number of people completing the Activity Engagement Measure (baseline): N= __________
(follow up 1): N= __________
(follow up 2): N= __________
Difference between
baseline and last
follow-up: (check all
Activity Engagement Baseline Follow-up Follow- up that apply)
Measure evaluation evaluation evaluation -ve = 2 or more point
(Mean) at ____ at ____ decrease
I could benefit from months months Neutral = no change
more of the following (Mean) (Mean) +ve = 2 or more point
in my day…. increase
( ) – ve
Balance ( ) Neutral
( ) + ve
( ) – ve
Physical activity
( ) Neutral
( ) + ve
( ) – ve
Structure/routine
( ) Neutral
( ) + ve
( ) – ve
Meaning
( ) Neutral
( ) + ve
( ) – ve
Satisfaction
( ) Neutral
( ) + ve
( ) – ve
Social interactions
( ) Neutral
( ) + ve
( ) – ve
Accessing community
( ) Neutral
environments
( ) + ve

Resource 7.1
Preparing for continuous improvement applied
to activity-health: Mission and goals
Are the mission and goals of my service/program consistent with attending to the
activity patterns of people served?
Does the philosophy underlying the service mission and goals support attention
directed to activity patterns and the dimensions of health supported by activity
patterns?
What specific concepts or ideas in the mission and goals are consistent with attention
to activity-health?
What values espoused by the service or program are consistent with a focus on
activity-health?
What service priority goals may compete with efforts directed to activity-health?
What knowledge/research will help to explicitly link activity-health to the mission,

goals and values of the service?

Resource 7.2
to activity-health: Engaging the
support of leaders
1. Identifying key leaders

Who are the “leaders” in this service who are in a good position to influence the extent to which
intervention approaches focused on improving health and well-being through activity are integrated
into daily service delivery?
Who are the formal leaders?
Who are the informal leaders?
2. Informing key leaders

What information do these leaders need in order to increase their appreciation of health through
activity for this service and its intended outcomes?
What evidence can I share with these leaders that will raise the profile of the importance of services
directed to health through activity for people receiving this service?
How might the evaluation of services related to health through activity be integrated into program
evaluation activities?
3. Securing the support of key leaders

What ideas can I share about how attention to health through activity might be developed as a funda-
mental part of service delivery?
What are the challenges I can expect to the integration of health through activity in daily service
delivery? How can ideas about service delivery related to activity-health be presented to key leaders
in a manner that remains sensitive to these challenges?
How can I explicate the link between activity-health and the mission and goals of the service in order
to secure support?

Resource 7.3
to activity-health: Taking stock of
resources and structures
1. Who are the people connected to this service who will have a particular interest, and commitment
to activity-health?
2. What experiences, knowledge and training of service providers and other stakeholders can be used
to move forward an activity-health approach? How might these be mobilized to encourage dialogue
and increase awareness of activity health?
3. What service structures can be used to increase awareness of and commitment to activity-health
approaches and outcomes? For example, could service meetings, service-level communications,
educational sessions, and so on, be used to support dialogue and interest?
4. What written organizational structures do or could provide support for an activity-health approach?
For example, do service descriptions, job descriptions, annual reports, intake assessments, and so
on, currently include information related to activity-health? Could they be developed or modified to
include an explicit activity-health focus?
5. What program-level evaluation resources and activities currently exist? Do they include evaluation
of service processes and outcomes that are consistent with activity-health? Could they be modified
or developed to include an activity-health perspective?

Resource 7.4
A framework for presenting program-level information
about activity-health (example)
Background:
Jamie and Afsanah collected the completed responses from the initial Activity
Engagement Measures for all individuals who received services focusing on their
activity patterns over a two year period. They first compiled the resources into
a format that provided an easy to understand description of these responses at
baseline (the initial completion of the activity measure). In total they had responses
for 40 people. This represented 25% of the total population of people who were
served by their program in this time period.
The responses at baseline were consistent with a picture of individuals who

experience their activity patterns as lacking in important dimensions of health and
well-being. While ratings suggested a need for attention across all dimensions,
responses were particularly low for physical activity, satisfaction experienced in
activity and access to community environments.
The Activity Engagement Measure was readministered at six months and one year
for these individuals. Only 34 people actually completed both follow-up periods.
Jamie and Afsanah calculated the means for each dimension across the three time
periods. They noted that for each dimension ratings either improved or stayed the
same. Positive change was particularly noticeable in the areas of balance, physical
activity, meaning, and access to community environments. Changes in social interac-
tions and satisfaction did not improve appreciably.
Jamie and Afsanah presented these results at a service meeting. Excited by the
changes, there was interest in adapting the scale to allow for examining the statis-
tical significance of change. The service member responsible for program evaluation
agreed to work with Jamie and Afsanah to develop this. Discussions also focused on
the area of social interactions and how specifically this was being addressed by the
service. Jamie and Afsanah were charged with taking these evaluation findings out to
people using the service to get their impressions of the findings and the implications
for the services they receive.
Activity dimensions are adapted from the work of Bejerholm (2007) and Bejerholm, Hansson & Eklund (2006).

Resource 7.4
information about activity-health (example)
I. Activity-health – Baseline status

Total number of people completing the Activity Engagement Measure: N= 40
Activity Engagement
Measure
Very true
Not true
I could benefit Ratings: number of people
from more of the
following in my
day… 1 2 3 4 5 6 7 8 9 10
Balance 4 5 10 4 10 4 3 0 0 0
Physical activity 7 10 9 10 4 0 0 0 0 0
Structure/routine 3 2 4 10 10 6 4 1 0 0
Meaning 6 7 10 10 6 1 0 0 0 0
Satisfaction 5 8 10 10 6 1 0 0 0 0
Social interactions 6 9 7 7 10 0 0 1 0 0
Accessing community 7 8 10 9 6 0 0 0 0 0
environments

Resource 7.4
information about activity-health
(continued)
II. Activity-health – Tracking change over time
Total number of people completing the Activity Engagement Measure (baseline): N= 40

(follow up 1): N= 38
(follow up 2): N= 34
Difference between
baseline and last
follow-up: (check all
Activity Engagement Baseline Follow-up Follow- up that apply)
Measure evaluation evaluation evaluation -ve = 2 or more point
(Mean) at 6 at one year decrease
months months Neutral = no change
(Mean) (Mean) +ve = 2 or more point
increase
( ) – ve
Balance 3.9 4.1 6.2 ( ) Neutral
( √ ) + ve
( ) – ve
Physical activity 2.85 3.4 5.8
( ) Neutral
( √ ) + ve
( ) – ve
Structure/routine 4.07 5.8 5.8 (√ ) Neutral
( ) + ve
( ) – ve
Meaning 3.15 3.9 5.20 ( ) Neutral
( √ ) + ve
( ) – ve
Satisfaction 3.17 3.05 4.10 ( √ ) Neutral
( ) + ve
( ) – ve
Social interactions 3.23 3.30 3.42 ( √ ) Neutral
( ) + ve
( ) – ve
Accessing community 2.98 3.52 5.3 ( ) Neutral
environments ( √ ) + ve

Action Over Inertia: Worksheets and Resources

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Action Over Inertia

Addressing the activity-health needs of individuals with serious mental illness

Worksheets and Resources

Chapter One: Preparing to use this workbook

Chapter Two: Understanding personal activity patterns

Chapter Three: A first step — making quick changes in activity

Chapter Five: Making longer-term changes

Chapter Six: Supporting and evaluating activity change

Chapter Seven: Focusing on activity-health to inform service development

Service provider’s name: _____________________________________________________

The person’s daily activities demon-

The person spends a large amount

Much of the individual’s day is spent

There is a lack of organized routine/

The person’s daily activities limit their

The person’s daily activities limit

The person cannot define activities

The person experiences distress, or is

The person’s involvement in activity

Action Over Inertia © CAOT PUBLICATIONS ACE 2010

Service provider’s name: _____________________________________________________

This person engages in activities

Skill and/or knowledge development

Making a contribution to society

Gaining physical health benefits

The enjoyment of beautiful things

Self-expression and creativity

A range of social interactions

Meeting personal goals, experiencing

Expressing personal values

Earning a personal income

Giving to others, such as family or

Action Over Inertia © CAOT PUBLICATIONS ACE 2010

Consider each statement and check all that apply

My days are not balanced with time for fun,

I have lots of time, but nothing to do.

I spend most of my day resting, listening to

I do not have a regular routine.

I don’t see many other people during my day or

I do not go to many different places to do

I can’t think of many things I do that are really

I get easily upset or overwhelmed when I do

I wish that I could find some things to do that

There are things I would like to do, but there

Action Over Inertia © CAOT PUBLICATIONS ACE 2010

Check all of the items that apply to you.

My daily activities give me the

Develop new skills and knowledge

Feel as though I am making a valuable

Remain physically active and healthy

Enjoy beautiful parts of life, such as nature,

Express my thoughts and feelings

Interact with other people socially

Achieve goals and feel as though I have

Express values that are personally important

Earn a personal income

Interact with important people in my life

Action Over Inertia © CAOT PUBLICATIONS ACE 2010

Circle the most appropriate response to each statement below:

Name: ___________________________________________ Date: //_

Name: ___________________________________________ Date: //_