Activity management Activity management is a component of CBT, but does not, as a standalone approach, have an evidence base. Anecdotally, it appears to work well, particularly as an early intervention and in straightforward cases where a child is able to engage in making behavioural changes and does not have significant psychiatric comorbidity. It tackles the same patterns of activity as GET, but focusses on a broader range of activity (rather than only physical exercise). Activity management may well be working in the same way to GET. Activity management is aimed at overcoming the unhelpful patterns of activity that arise as a response to being chronically fatigued; that is, a relatively active boom and bust pattern of doing lots of activity, followed by doing very little, or a low active pattern of a significant reduction in overall activity levels. After a period (typically 1e2 weeks) of recording activity levels, distinguishing high energy activities (those activities that are physically, cognitively or emotionally demanding for the individual) from low energy activities (those activities that are not demanding and do not exacerbate fatigue), a ‘baseline’ can be established. This is the median amount of high energy activity during the monitoring period. Once the child has sustained this level of activity for 1e2 weeks without significant payback, the activity level is increased by 10e20% every week. Recording activity levels can help children to notice whether they are doing the same each day or varying their activity.
